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CMT > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

purpose of the basal ganglia

A
  • make movements & prevents unwanted movements
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2
Q

which is excitatory? which is inhibitory?
* GABA
* Glutamate

A
  • GABA: inhibitory
  • Glutamate: excitatory
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3
Q

describe the direct pathway

A

promotes voluntary movement in trageted muscules (from through to the actual movement)

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4
Q

describe the indirect pathway

A

inhibition of movements in other muscles that do not contribute to the overall wanted movement

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5
Q

in normal movement, what acts on the pathways?

A

dopamine

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6
Q

in normal pathways what does dopamine act on? what after that?

A

thalamus which then excites the motor cortex

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7
Q

vocab

dyskinesia

A

any involuntary movement

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8
Q

vocab

athetosis

A

abnormal muscle contractions cause involuntary writhing movement

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9
Q

vocab

bradykinesia

A

slowness of movements

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10
Q

vocab

chorea

A

jerky involuntary movements affecting especially the shoulders, hips, and face (dance like movements)

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11
Q

vocab

dysmetria

A

misjuding distance to a target

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12
Q

vocab

hyposmia

A

reduced ability to smell

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13
Q

vocab

hemiballismus

A
  • type of chorea
  • usually involving violent, involuntary flinging of one arm/leg
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14
Q

vocab

akathisia

A

restlessness

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15
Q

vocab

titubation

A

shaking of the trunk and head

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16
Q

vocab

rigidity

A

stiffness, noted as increased muscle tone on examination

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17
Q

vocab

tardive dyskinesia

A

involuntary movements due to dopamine antagonists

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18
Q

Tic Disorders

describe tic disorders

A

neuropsychiatric diseases which are common in children

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19
Q

Tic Disorders

characterized by

A
  • sudden twitches
  • movements (motor tic)
  • sounds that people do repeatedly (vocal tic)
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20
Q

Tic Disorders

describe simple motor tics

A
  • appears in one muscle group
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21
Q

Tic Disorders

examples of simple motor tics

8

A
  • nose twitching
  • blinking/rolling eyes
  • neck/head spasms
  • head shaking
  • head leaning back
  • lip biting
  • face grimacing
  • shoulder struggling
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22
Q

Tic Disorders

describe complex motor tics

A
  • simultaneously in more than 2 muscle groups
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23
Q

Tic Disorders

examples of motor tics

4

A
  • kicking, skipping, or jumping while walking
  • imitating others’ movements
  • flaring nostrils and sniffing
  • self hitting/twirling in place
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24
Q

Tic Disorders

examples of simple vocal tics

7

A
  • dry cough
  • chocking sound
  • throat clearing
  • making animal noises
  • sniffling
  • muttering
  • saying syllables
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25
Q

Tic Disorders

examples of complex vocal tics

A
  • palilalia
  • echolalia
  • stuttering
  • coprolalia
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26
Q

Tic Disorders

what is palilalia

A

repletion of one’s own spoken words or sentences

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27
Q

Tic Disorders

what is echolalia

A

repletion of words spoken by others

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28
Q

Tic Disorders

what is coprolalia

A

saying obscene words or searing

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29
Q

Tic Disorders

5 tic disorders

A
  1. transient tic disorder
  2. chronic tic disorder
  3. complex tic disorder
  4. tourette’s syndrome
  5. unclassified tic disorder
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30
Q

Tic Disorders

describe transient tic disorder

A

when the tic sx temporarily and repeatedly appears and disappear before the age of 18

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31
Q

Tic Disorders

describe chronic tic disorders

A

when either one of motor or vocal tic repeatedly appears and disappears continuously for more than a year

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32
Q

Tic Disorders

describe complex tic disorder

A

when vocal and motor tics are combined

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33
Q

Tic Disorders

describe tourette syndrome

A

when the symptoms of a complex tix last more than a year

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34
Q

Tic Disorders

what % of kids experience tics? more common in who?

A

1 in 5 kids
3x more common in boys than girls

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35
Q

Tic Disorders

4 potential causes

A
  • dopamine system dysregulation
  • genetic factor
  • environmental factors
  • psycholgoical factors
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36
Q

Tic Disorders

what meds can be given?

class + 3 drugs

A

anti-psychotic drugs
* haloperidol
* pimozide
* risperidone

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37
Q

Tic Disorders

what does behavioral therapy consist of?

3

A
  • relaxation training
  • habit reversal
  • family education
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38
Q

Tic Disorders

what operations to consider

2

A
  • deep brain stimulation
  • nerve surgery
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39
Q

Tic Disorders

what alternative treatments are available?

2

A
  • cranio-scaral balance therapy
  • TMJ balancing
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40
Q

Tremors

describe them

A

non-intentional rhythmic and oscillatory movements of a body part, which result from alternating or irregular synchronous contractions of muscles that have an opposite effect on a joint

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41
Q

Tremors

how are tremors classified

4

A
  • distribution: which body part is affected
  • state-dependent: action (essential tremor), rest (Parkinson’s disease)
  • tremor frequency (number of oscillations/sec)
  • amplitude (distance of movement)
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42
Q

Tremors

what 3 disorders are action tremors

A
  • postural
  • kinetic
  • isometric
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43
Q

Tremors

what disorder is a rest tremor?

A

parkinson’s

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44
Q

Postural Tremor

describe

A

postural tremor happens when you try to hold a body part still, against the force of gravity

45
Q

Postural Tremor

which is most common?

A

physiologic

46
Q

Postural Physiologic Tremor

typically affects what parts of the body?

A
  • upper limbs
  • hands
47
Q

Postural Physiologic Tremor

potential causes

A
  • exaggerated physiologic responses (anxiety, fatigue, fright)
  • drugs (amphetamines, alc withdrawal, caffeine, amiodarone)
  • metabolic disorders (hypoglycemia, pheochromocytoma, thyrotoxicosis)
  • toxins (mercury)
48
Q

Postural Essential Tremor

most commonly impacts what areas of the body?

A
  • hands and arms
  • individually usually is worse on one side
  • head, voice also possible
49
Q

Postural Essential Tremor

risk factors

A
  • male
  • family hx
50
Q

Postural Essential Tremor

age of onset

A

bi-modal
* 10-20
* 40-60

51
Q

Postural Essential Tremor

what can help alleviate these?

A

alcohol

52
Q

Postural Essential Tremor

how do these change with age?

A
  • amplitude increases
  • frequency decreases
53
Q

Postural Essential Tremor

dx

A

clinical dx

54
Q

Postural Essential Tremor

testing to r/o other differentials

5

A
  • review med list
  • review potential for alcohol/drug withdrawal
  • consider TFTs in pts with hx of hyperthyroidism
  • consider imaging w/ neurologic deficits
  • EMG for tremor analysis
55
Q

Postural Essential Tremor

Describe alcohol as a tx

A
  • can use prophylactically (60 mL 10-15min prior to triggering event)
  • alc potentiates GABA
  • regular alc consumption not recommended
56
Q

Postural Essential Tremor

what other meds are posisble for tx

A
  • propanolol (most effective)
  • primodine
  • benzodiazapines
57
Q

Kinetic Tremor

describe

A

occurs when doing something goal oriented and the tremor becomes worse when closer to the goal (ex: drinking from a cup)

58
Q

Cerebellar Kinetic Tremor

associated with lesions/diseases where?

A
  • cerebellum
  • cereberal outflow pathways
59
Q

Cerebellar Kinetic Tremor

where are tremors located?

A

ipsilaterally

60
Q

Cerebellar Kinetic Tremor

what is it called if someone has these AND postural tremors?

A

head titubation tremor

61
Q

Cerebellar Kinetic Tremor

what PE can you do to r/o?

A
  • finger to nose test
  • finger to finger test
  • heel to shin test
62
Q

Cerebellar Kinetic Tremor

which meds?

A

none have been proven to help!

63
Q

Isometric Tremor

describe

A

occurs when contracting a muscle against an unmoving object
(ex: when doing push ups at gym & hands are on floor and start shaking)

64
Q

Rest Tremors

what are resting tremors due to?

like in the brain

A
  • abnormal synchronicity of basal ganglia and thalamic neuronal activity
65
Q

Rest Tremors

signs/sx

6 components

A
  • pill rolling w/ hands
  • symmetric tremor
  • tremor stops w/ movement but can resume once settled in new position
  • leg, tongue, lip, jaw may be involved
  • tremors worsen w/ emotional stress
  • tremors get better with anti-parkinson meds
66
Q

Parkinson’s Disease

describe

A

progressive neurodegenerative condition resulting in disorder of movement, autonomic functioning, and potentially cognition

67
Q

Parkinson’s Disease

cardinal signs

4

A

TRAP
* Tremor (resting)
* Rigidity of trunk/limbs
* Akinesia or bradykinesia
* Postural instability

68
Q

Parkinson’s Disease

hx findings

A
  • onset is usually asymmetric and gradually spreads
  • restlessness during sleep or sleepwalking is common
  • reduction in smell
69
Q

Parkinson’s Disease

sx (besides cardinal TRAP)

5

A
  • decreased blinking
  • sleep disturbances
  • autonomic dysfunction (constipation, sweating, sex)
  • bradyphrenia
  • dementia
70
Q

Parkinson’s Disease

dx

A

Clinical Diagnosis, testing to r/o other diseases

71
Q

Parkinson’s Disease

what dx tools to consider

A
  • CT/MRI if pt younger than 55 or presents abnormally for parkinson’s
  • SPECT scan: distinguishes essential tremor from parkinson’s
72
Q

Parkinson’s Disease

criteria for diagnosis

A

two plus of the following:
* resting tremor
* rigidity
* bradykinesia

73
Q

Parkinson’s Disease

tx

A

gold standard: carbadopa, levodopa
(can do benztropine, amantadine, COMT inhibitors, MAO-B inhibitors)

74
Q

Parkinson’s Disease

when is an anticholinergic the first choice?

A
  • higher functioning
  • no significant postural instability
  • pt is under 60 y/o
75
Q

Parkinson’s Disease

when is amantadine the first choice tx?

A
  • higher functioning
  • no significant postural instability
  • pt over 60 y/o
76
Q

Parkinson’s Disease

out patient management

A
  • regular follow ups w/ PCP & neurologist
  • screen for depression, mood disorders
  • exercise & speech therapy
  • assistive devices for home
77
Q

Parkinson’s Disease

describe parkinson’s plus conditions

A

characterized by the primary features of Parkinson disease, but also include additional features such as dementia, cognitive deficits, and cranial nerve impairment

78
Q

parkinson’s plus conditions

describe normal pressure hydrocephalus

A
  • sx: wet, wobbly, wacky
  • dx: CT
  • tx: lumbar puncture drainage
79
Q

parkinson’s plus conditions

describe Wilson’s disease

A
  • genetic condition (autosomal recessive)
  • psychiatric disturbances, liver failure, KF rings
80
Q

parkinson’s plus conditions

describe postencephalitic parkinsonism

A

occurs following encephalitis

81
Q

parkinson’s plus conditions

describe progressive supranuclear palsy

A
  • parkinsonian sx PLUS vertical gaze palsy
  • tremor may not be as prominent
82
Q

parkinson’s plus conditions

describe shy-drager syndrome

A
  • parkinsonian sx PLUS severe autonomic instability, gain issues, nystagmus
  • dx: imaging to look for atrophy of brainstem/cerebellum
83
Q

parkinson’s plus conditions

examples of autonomic dysfunction

A
  • orthostatic hypotension
  • UMN lesion sx (hyperreflexia, primitive reflexes)
  • cerebellar sx (nystagmus)
84
Q

parkinson’s plus conditions

describe lewy body dementia

A
  • parkinsonian sx PLUS prominent dementia coinciding w/ onset of parkinsonian sx
85
Q

Huntington’s Disease

describe overall

A
  • CAG repeats create a mutant, damaging protein
  • autosomal dominant genetic disorder
  • gross atrophy of the caudate and putamen
86
Q

Huntington’s Disease

what correlates with severity of sx?

A

extent of brain damage

87
Q

Huntington’s Disease

avg age of onset? what impacts age of onset?

A
  • 32 to 38 y/o
  • onset becomes earlier w/ more CAG repeats
88
Q

Huntington’s Disease

hx findings

A
  • most pts know there is a family hx of huntington’s
  • others may say they have family hx of “early onset dementia”
89
Q

Huntington’s Disease

movement sx

5

A
  • fidgetiness
  • ballism or hemiballismus
  • chorea
  • parkinsonian features
  • rigidity
90
Q

Huntington’s Disease

cognitive sx

5

A
  • anhedonia
  • apathy
  • untidiness
  • short term memory loss
  • dementia
91
Q

Huntington’s Disease

behavioral symptoms

5

A
  • change in affect
  • mood disorders (depression, OCD)
  • suicide
  • psychosis
92
Q

Huntington’s Disease

PE findings

4 components

A
  • chorea (uncontrollable, jerky movements)
  • hemiballismus (violent flinging of one arm)
  • athetosis (abnormal, involuntary writhing movements)
  • parkinsonian sx
93
Q

Huntington’s Disease

dx

A
  • clinical
  • genetic testing (gold standard)
  • imaging will show increased bicaudate diameter
94
Q

Huntington’s Disease

tx

A
  • no cure for the disease, just manage individual sx
95
Q

Huntington’s Disease

what med options for:
* ballismus/choreathetosis
* parkinsonian sx
* depressive disorder
* psychosis

A
  • benzodiazepines
  • levo/carbo
  • SSRIs
  • atypicals
96
Q

Ataxia

describe

A

loss of control of body movements

97
Q

Ataxia

3 causes

A
  1. inherited/genetic
  2. acquired
  3. idiopathic (unk cause)
98
Q

Ataxia

describe input pathway to cerebellum

A

peripheral nerve –> dorsal root ganglia –> spinal cord –> dorsal column –> spinocerebral pathway –> cerebellum

99
Q

Sensory Ataxia

describe

A

problems w/ the proprioceptive pathway

100
Q

Sensory Ataxia

PE finding

A
  • inability to stand w/ eyes closed (Romberg test pos)
101
Q

Sensory Ataxia

sx

A
  • limb ataxia
  • vibration defects
  • proprioception defects
102
Q

Genetic Ataxia (Friedrich)

age of onset

A

5-25 y/o

103
Q

Genetic Ataxia (Friedrich)

sx

2

A
  • progressive ataxia
  • nystagmus
104
Q

Genetic Ataxia (Friedrich)

PE Findings

4

A
  • axonal neuropathy
  • distal atrophy
  • absent LE tendon reflexes
  • upgoing toes w/ Babinski
105
Q

Genetic Ataxia (Friedrich)

MRI findings

A

no cerebellar atrophy

106
Q

Ataxia

Dx of ataxia

6 components

A
  1. PMH, FH of neurology (including durgs/toxins)
  2. blood test to r/o drugs/toxin/deficiencies
  3. UA for mercury
  4. MRI or CT of brain
  5. neuroimaging of spinal cord
  6. Electrophysiologic testing if sx of peripheral nerve dysfunction
107
Q

Ataxia

Tx of ataxia

4 components

A
  1. medication has minimal impact unless caused by nutrional deficiences
  2. Some meds can reduce leg spasticity and address cerebellar tremors
  3. PT/OT
  4. Assistive devices
108
Q

Ataxia

what are pts w/ ataxia more likely to do?

A
  • mix meds
  • fall
  • become ill w/ aspiration pneumonia

CMT (72 decks)

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