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Nervous System: Unit III > Movement Disorders > Flashcards

Flashcards in Movement Disorders Deck (21):
1

Movement descriptive categories

  • Rhythmicity
  • Speed
  • Duration
  • Onset
  • Pattern
  • Induction
  • Complexity
  • Suppressibility
  • Provoking factors

2

Types of rhythmicity/speed of movements

  • fast vs. slow
  • measured in hz

3

Types of movement duration

  • constant
  • intermittent
  • periodic 
  • episodic

4

Types of onset of movement-related sx

  • insidious (most disorders)
  • sudden = very unusual ==> indicates possible brain insult of psychogenic disorder

5

Types of movement patterns

  • repetitive
  • flowing
  • continual
  • paroxysmal
    •  = a sudden recurrence or attack of a disease; a sudden worsening of symptoms
  • diurnal
    • = of or during the day

6

Types of inductiosn of movement-related sx

  • stimuli-induced
  • action-induced
  • exercise-induced

7

Evaluation of suppressibility of movement-related sx

  • voluntary suppression
  • sensory tricks used for suppression
  • what makes sx better or worse

8

Types of provoking factors of movement-related disorders

  • sensory
  • physical
  • psychological

9

Examples of hyperkinesia

  • hyperkinesia = excess movement
  • Tremor
  • chorea
    • common in HD
  • tics
  • dystonia
    • sustained muscle contractions ==> repetitive movements or abnormal postures 
  • myoclonus
    • quick, involuntary muscle jer

10

Examples of hypokinesia

  • hypokinesia = depressed movements
  • Parkinsonian

11

Characteristics/evaluation of tremor

  • Are rhythmic.
  • Find out when/position that it happens in the most (rest, action, postural)?
  • is the frequency slow or fast? 
  • regular vs. jerky?

12

Tremor characteristics related to syndromes

  • Resting tremor = Parkinson’s
  • Action-induced = Essential/Benign Familial Tremors
  • Fine + Fast = medication induced (iatrogenic) 
  • Jerky = myoclonus or dystonia
  • flapping tremor/coarse tremor = Wilson’s disease

13

Characteristics of Essential Tremor

  • Tremor with posture and action
  • upper extremities > lower, head
  • Insidious onset
  • Worsens with age
  • 75% respond to alcohol

14

Treatment of Essential Tremor

  • Possible pharmacologic treatments:
  • primidone and topiramate (anti-epileptics)
  • propranolol
  • gabapentin (anticonvulsant)
  • clonazepam (benzodiazepines)
    • used to control some seizures and panic attacks
  • occupational therapy
  • deep brain stimulation therapy

15

Characteristics of Tics

  • Brief, intermittent movements or sounds
  • sudden, abrupt, transient
  • repetitive and coordinated
  • vary in intensity, repeated at irregular intervals
  • may resemble gestures, normal behavior

16

Characteristics of Tourette's Syndrome

  • Age of onset <16 yo
  • Onset in youth, more common in males
  • Associated with
    • ADHD
    • OCD
    • Poor impulse control
  • Multiple types of tics (motor, vocal: coprolalia is rare and socially disabling)
  • Suppressible
    • last > 1 year
  • Tics persist into adulthood 25% of time
  • Genetic or idiopathic

17

Treatment of Tourette's Syndrome

  • Treatment: educate patient, family, school, support groups,
  • treat tics only if interfering with their life, treat OCD and ADHD with CBT + Biofeedback
  • Clonidine, SSRI, neuro-epileptics, tetrabenazine, clonazepam
  • Tetrabenazine is a drug for the symptomatic treatment of hyperkinetic movement disorder

18

Characteristics of Chorea

  • Irregular, brief, dancing like jerky
  • Move from one body part to another
  • Diseases
    • HD, variants include westphal which happens in youth and looks more parkinsonian, less dancing movements, gait + balance issues.
    • Sydenham chorea
    • Chorea gravidarum
    • Lupus - behavioral and cognitive deficits (1), seizures (2), chorea (3) ← neuro deficits

19

Characteristics of dystonia

  • Co-contractions of muscle agonists and antagonists
  • Sustained muscle contractions causing twisting, abnormal postures
  • Can be associated with tremor
  • Primary etiology: DYT 1-12 protein
  • Secondary: Cerebral palsy, neurodegenerative disorders, hypoxic/ischemic brain injury, poststroke, posttraumatic, medications, toxins
  • Types of localization: Focal, Segmental, multifocal, generalized
  • Types of duration: static, fixed, mobile, task specific, exercise induced

20

Motor symptoms of Parkinson's disease

  • resting tremor
  • bradykinesia/akinesia
  • rigidity
  • postural instability/stooped posture
  • festinating gait
  • propulsion and retropulsion
  • masked face
  • disarthria, hypophonia
  • dysphagia
  • micrographia

21

Nonmotor symptoms of Parkinson's disease

  • Anosmia = inability to perceive odor
  • Constipation
  • Depression, Anxiety
  • Cognitive impairment
  • Drooling
  • Visual disturbances
  • Sensory changes: parasthesias, muscle cramps, pain
  • Autonomic instability: orthostatic hypotension, diaphoresis, thermal dysregulation, erectile dysfunction
  • Sleep disturbances