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Flashcards in movement disorders Deck (42)
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1

Direct and indirect pathways

D1(direct)= facilitates movement. D2 (indirect)= inhibits movements

2

Dopamines normal effect on direct/indirect pathways

Dopamine turns up direct pathway and turns down indirect pathway

3

What are hyperkinesias

moving too much: tremor, chorea, tics, dystonia

4

hypokinesias

not moving enough: Parkinsonism

5

Tremor- definition

rhythmic oscillatory movement produced by alternating or synchronous contraction of antagonist muscles

6

tremor- position when happens most

resting, action (intentional), postural (sustained)

7

tremor- frequency, characteristics

can be slow or fast, regular or jerky

8

Drugs that induce tremor

theophylline, bronchodilators, amphetamines, antidepressants, caffeine, cyclosporin, steroids, lithium, alcohol, amiodarone, valproate, neuroleptics, metaclopromide, reserpine, anti-nauseants

9

what is an essential tremor

benign/senile tremor. Postural tremor more common than kinetic. Most common in hands, followed by head

10

Other symptoms occuring with essential tremor

gait disorder, parkinsonism, dystonia, impaired smelling or hearing

11

How do essential tremors change with age

get slower and larger

12

Therapy of essential tremor

beta blockers (propranolol), primidone, topiramate, gabapentin, clonazepam, botulinum toxin, assisted devices

13

surgical options for essential tremor

thalamotomy, deep brain stimulation delivering stimulation to thalamus

14

Parkinsons symptoms

resting tremor, bradykinesia or akinesia, rigidity, gait freezing,

15

compare essential tremor with parkinsons

ET: kinetic, bilateral, disabling. Parkinsons: during rest, unilateral, not disabling, plus parkinsons signs

16

Parkinsons pharmacological treatment

Carbidopa/levidopa, dopamine agonists, anticholinergics, COMT-inhibitors, amantadine, and MAO-b inhibitors

17

What areas of the brain are targeted for deep brain stimulation in parkinsons

subthalamic nucleus, internal globus pallidus, Vim

18

Define tics

brief, intermittent movements or sounds. Sudden, abrupt, transient. Repetitive and coordinated. Vary in intensity, repeated at irregular intervals. May resemble gestures or normal behavior

19

Diagnostic criteria for tourette syndrome

Age of onset 1 yr

20

Tourette syndrome is associated with what other conditions

ADHD, OCD and poor impulse control

21

Is tourettes more common in females or males

males

22

Compare simple and complex tics in tourette syndrome

simple: grimacing, blinking, nose twitching lip pouting. Complex: hopping, clapping, touching, throwing, head banging

23

Tourette syndrome treatment

habit reversal therapy, treat OCD and ADHD

24

Chorea- definition

irregular, brief, dancing like, jerky. Randomly flit from one body part to another.

25

chorea-athetosis

repetitive involuntary, slow, sinuous, writhing movements

26

Diseases associated with chorea

Huntingtons, Sydenham chorea, chorea gravidarum, lupus, antiphospholipid Ab

27

Define dystonia

co-conntraction of muscle agonists and antagonists. Sustained muscle contractions causing twisting, abnormal postures. Can be associated with tremor

28

Causes of dystonia

primary: DYT 1- protein torsin. Secondary: cerebral palsy, neurodegenerative dz (wilsons dz), hypoxic ischemic brain injury, post stroke, post traumatic, meds

29

classifications of dystonia

focal: blepharospasm, oromandibular dystonia, laryngeal, cervical, writers cramp. Segmental. Multifocal. Generalized

30

Task specific dystonias

writers cramp, musicians cramp, golfers dystonia

31

List the different dystonia durations

Can occur while mobile, static, task specific, exercise induced or diurnal

32

Dystonia treatment

Anticholinergics, muscle relaxants, benzos, botulinum toxin type A or type B, deep brain stimulation of internal globus pallidus or subthalamic nuclei

33

akathisia

unpleasant sensation of inner restlessness- inability to sit still or remain motionless

34

ballism

large amplitude, proximal extremity flinging movements

35

hyperekplexia

exaggerated startle

36

myokymia

localized quivering of a few muscle bundles within a muscle, but which are insufficient to move a joint (ie eyelid)

37

myoclonus

sudden, briief, shock like movement

38

stereotypy

repetitive or ritualistic movment, posture or utterance (autism, schizophrenia)

39

Atypical features that suggest a dz is not parkinsons but rather a different parkinsonian type dz

rapid progression, early onset dementia, early onset postural instability, confusion or hallucinations, ataxia, eye movement abnormalities (downgaze), poor response to dopaminergic treatment

40

Atypical parkinsonian syndrome prognosis and treatment

Prognosis is worse than Parkinsons (only 7-10 yr survival). Only 10-15% respond to dopaminergic therapy

41

Progressive supranuclear palsy- characteristics

Progressive, onset >50. Impaired eye movements (downgaze), reptilian or scared look, early onset postural instability (falls within first year), retrocolis.

42

Multiple systems atrophy- responsiveness to dopamine, subtypes

Poor response to dopamine replacement. Subtypes: Parkinsonism (MSA-P), cerebellar symptoms and ataxia (MSA-C) or autonomic symptoms (MSA-A)