Movement Disorders

Question 1

Hypokinetic Disorders

Answer 1

Parkinsons Disease

Parkinsonian like disease

Question 2

Hyperkinetic disorders or symptoms

Answer 2

termor
dystonia
chorea

Question 3

Parkinson Disease (PD)- pathology

Answer 3

Lose DA projections from substantia nigra to the caudate and putamen- the nigrostriatal tracts

Question 4

PD and Lewy bodies

Answer 4

Lewy bodies are alpha synuclein deposits ni the cytoplasm of the nigrostriatal pathway neurons

Question 5

SSx and PD

Answer 5

STRAPD
shuffling gait
tremor- resting, pill rolling
Rigidity- cogwheel rigidity
Akinesia/bradykinesia- slow absence of movement 
Autonomic dysfunction- orthostasis, neurognenic bladder, constipation, ED
Postural Instability
Dementia, depression

Question 6

Dx

Answer 6

Clinical

can only see substantia nigra is on autopsy

Question 7

Treatment-

Answer 7

Cinemet- Carbidopa/ Levadopa
anticolonergics- benztropine
dopamine receptor agonists
COMT and MAOD inhibitors

Question 8

Best drug for depression in PD

Answer 8

Amitryptilline

Question 9

Best drugs for psychosis in PD

Answer 9

Clonazapine, Olanzapine, Quitiapine

Question 10

Best drugs for dementia in PD

Answer 10

donepezil and rivastigmine

Question 11

Surgery and PD tx

Answer 11

use DBS of STB, GPI and VIM

Question 12

Essential tremor

Answer 12

Rhythmic oscillating movements of agonits and antagonist resulting in an intention tremor.
most common hyperkinetic disorder

Question 13

What parts of the body does ET affect

Answer 13

posture, heads, neck, and hands

worsens with movement

Question 14

Essential tremor- etiology

Answer 14

AD inheritance

Question 15

ET- age of onset

Answer 15

bimodal distribution in 20s and 60s

Question 16

ET- treatment

Answer 16

Pts often self medicate with alcohol

beta blockers ie propranolol work

Question 17

Dystonia- definition

Answer 17

involuntary sustained muscle contraction leading to twisting or repetitive movements.

Question 18

Focal dystonia- types

Answer 18

Torticollis

Bleophasm

Question 19

Global dystonia- etiology

Answer 19

hereditary

or medication induced- antipsychotics, metaloclopramide

Question 20

Treatment of Dystonia

Answer 20

Anticholinergics
Muscle relaxants
Botox
Sx
DBS

Question 21

How does botox work

Answer 21

Botox blocks presynaptic ACH receptors by inhibiting one of the 3 types of proteins that make up the SNARE complex.
Each type of botox (A,B,C) inhibit a dif protein in the SNARE complex.

Question 22

Torticollis

Answer 22

dystonia of the SCM and Trap so the head points towards the effected SCM and the chin points away from it

Question 23

Huntington disease- etiology

Answer 23

AD mutation on chromosome 4- CAG repeats

Question 24

HD- changes in the brain

Answer 24

atrophy of caudate caused by frank neuronal loss

Question 25

What is anticipation, how does it relate to HD

Answer 25

HD exhibits anticipation diz presents earlier and causes death earlier the larger the repeat gets. the repeat ges larger every generation

Question 26

HD- SSx

Answer 26

``` chorea dementia lack of coordination personality changes depression and anxiety ```

Question 27

HD- Dx

Answer 27

chromosomal analysis

Question 28

HD- tx

Answer 28

none | symptomatic relief with neuroleptics and benzos

Question 29

Wilsons dz

Answer 29

hepatorenticuar degeneration

Question 30

WD- damages what organs

Answer 30

liver and brain

Question 31

WD liver damage

Answer 31

defective hepatic transport of Cu into bile for excretion --> cirrhosis, inc Cu in liver and spleen

Question 32

WD- lenticular damage

Answer 32

Cu builds up in putamen and subhalamic nucleus --> PD like movement disorders or hemiballismus

Question 33

WD- lab findings

Answer 33

Cu deposits in tissues total serum Cu is low but free urine and reum Cu are higher in later stages Serum Ceruloplasmin is low

Question 34

WD- clinical findings

Answer 34

Kayser Fleischer ring movement disorders- hemibalismus, dementia hepatosplenomegaly hemolytic anemia renal dz- fanconi syndrome b.c of damage to proximal tubules --> inc excretion of glucose AA, and Phosphate

Question 35

WD- tx

Answer 35

penicilalmine Zn liver transplant