Movement Disorders Flashcards
Movement disorders due to damage/disease of _______.
basal ganglia
Possible causes of movement disorders
AGE, environmental toxins, genetic d/o, metabolic d/o, anti-psychotics, Parkinson’s, stroke
ataxia
lack of coordination often producing jerky movements; due to cerebellum or basal ganglia
dystonia
long lasting spasmodic muscle contraction - slow, sustained, unusual postures
Intention tremor caused by _______ damage and resting tremor caused by ________.
cerebellum
basal ganglia
myoclonus
sudden, brief, shock-like contraction
chorea
irregularly timed, non-repetitive, dance-like movements in random distribution, (fidgeting, exaggerated gestures)
athetosis
slower type of chorea; writhing nature and usually distal extremities
Functional movements disorders
abnormal movements NOT due to neuro disease, inconsistent PE
Sydenham’s chorea
chorea in children due to rheumatic fever; “St. Vitus’ dance”
essential tremor
never stops; kinetic or resting
bilateral
resolves with relaxation
improves with mild alcohol
How to treat essential tremor?
Symptomatic tx: BB, antieptileptic, antidepressant
Pathophysiology of Parkinson’s
death/damage to cells of basal ganglia in substantia nigra that release dopamine
Inadequate dopamine inhibits motor regions of cerebral cortex
Tremor of Parkinson’s
resting tremor
“pill rolling”
unilateral early in disease
resolves with voluntary movement
Main symptoms of Parkinson’s
Resting tremor Bradykinesis Rigidity (cogwheeling, lead pipe) Shuffling gait w/ forward bending torso Mask like face
How does essential tremor differ from Parkinson’s?
Normal gait/balance No bradykinesis No rigidity No masked face Bilateral tremor (Parkinson's unilat early in dz)
What is the earliest sign of Parkinson’s?
fine motor skills (then decreased mental status, then tremor)
Mainstay tx of Parkinsons
Levodopa
Dopamine agonists
What is the problem of Parkinsons therapy?
too much dopamine leads to hallucinations and schizophrenia; must assess risks vs benefits
What symptoms of Parkinson’s are not improved with Levodopa?
sleep disturbances, supranuclear palsy, depression, fatigue, constipation
Highest RF of Parkinson’s
age
When is CT/MRI ordered for suspected Parkinson’s?
if ONE inconsistent finding. may be tumor, hydrocephalus, etc.
Typical patient with Tourette’s syndrome
Male < 15 yo
Psych features of Tourette’s syndrome
obsessions, compulsive behaviors, impulsivity, rage attacks, involuntary cursing
