Movement disorders

Question 1

What can cause movement disorders?

Answer 1

• age-environment toxins
• genetic disorders
• medication
• metabolic
• parkinson’s dz-stroke

Question 2

Ex of genetic disorders?

Answer 2

-Huntington dz-wilson dz

Question 3

Types of movement disorders?

Answer 3

• ataxia
• dystonia
• tics
• tremor
• myoclonus
• chorea
• athetosis

Question 4

What is trunkal ataxia?

Answer 4

-cannot stand on own-normal strength in arms and legs

Question 5

What are tics?

Answer 5

• involuntary muscle contractions

- has a strong urge/sensation –> relieved by contraction

Question 6

Tic categorized?

Answer 6

-simple-complex

Question 7

Ex of tics?

Answer 7

• blinking
• clearing of throat
• facial twitching
• grunting
• shrugging
• sighing

Question 8

Tic compressed?

Answer 8

-can but feels uncomfortable

Question 9

Tremor?

Answer 9

• hyperkinetic disorder
• fast or slow
• symmetric/non-symmetric

Question 10

Categorization of tremor?

Answer 10

-rest-essential/intension

Question 11

Rest tremor?

Answer 11

-basal ganglia

Question 12

Intention tremor?

Answer 12

-cerebellar

Question 13

What is important to ask about tremors?

Answer 13

-start with one hand or both?

Question 14

What is dystonia?

Answer 14

• long lasting muscle contraction

- sometimes painful

Question 15

What is myoclonus?

Answer 15

• sudden, brief muscle contraction

- can be confused w/tic

Question 16

Does rest tremor get go away?

Answer 16

-no, it gets better when doing something

Question 17

What is chorea?

Answer 17

• may look like fidgeting
• involves distal extremities
• “irregular timed, non repetitive, complex motor movements, random, abrupt”

Question 18

What is athetosis?

Answer 18

-involves distal extremities

Question 19

Similarities of chorea and athetosis?

Answer 19

• restlessness
• exaggerated gestures
• may look like fidgeting
• dance like gait

Question 20

What dz is chorea and athetosis related to?

Answer 20

Hunnington dz

Question 21

Essential tremor:
age
time
what is it

Answer 21

age: 40-60yo
time: progressive
what is it: kinetic and postural (occurs w/ voluntary maintenance; shakes when doing something but no tremor at rest)

Question 22

Essential tremor- neurological findings?

Answer 22

• bilateral
• improves w/ walking
• tone and reflexes are normal
• gait and balances are normal

Question 23

Essential tremor - difference from Parkinson?

Answer 23

• no bradykinesis
• no rigidity
• no masked face

Question 24

Essential tremor - worse/better?

Answer 24

worse: stress
better: drinking

Question 25

Essential tremor - tx?

Answer 25

betablockers

Question 26

Parkinson - patho?

Answer 26

lacking dopaminergic cells of the basal ganglia (substantia nigra)

Question 27

Parkinson - RF?

Answer 27

age

Question 28

Parkinson - timeline?

Answer 28

early: movement probs (tremor) later: behavior, mental progressive dz

Question 29

Parkinson - non movement PE?

Answer 29

``` sleep distrubances progressive supranuclear palsy depression fatigue constipation *does not improve w/ tx ```

Question 30

Parkinson - PE?

Answer 30

- bradykinesis - tremor at rest - rigidity - postural instability - mask like face - shuffling gate

Question 31

Parkinson - tremor?

Answer 31

resting tremor "pill rolling" +/- vocal cords

Question 32

Parkinson - rigidity?

Answer 32

stiff, resistance like PASSIVE muscle movements "lead pipe rigidity" - bending a lead pipe "cogwheeling" - ratchet feeling

Question 33

Parkinson - bradykinesis?

Answer 33

not able to get out chair/walking (cannot initiate first step) not able to write (fine motor skills goes downhill)

Question 34

Parkinson - postural instability?

Answer 34

not able to walk/sit | arms not swinging as walking

Question 35

Parkinson - labs?

Answer 35

nothing - clinical dx | r/o: CT/MRI/CSF: NORMAL

Question 36

Parkinson - tx?

Answer 36

dopamine (dopamine agonist) - levodopa surgery

Question 37

Tourette's syndrome - sx?

Answer 37

- vocal/motor tics - usually childhood - linked w/ personality and physical - many times a day - best to see in corner of eye b/c they can suppress it (though it's uncomfortable)

Question 38

Tourette's syndrome - timeline?

Answer 38

age 5: simple motor tics (blinking) age 7: complex (snorts, shrugs) age 14: violent head shake, vocals involved age 17: subtle head shake, abdominal tense

Question 39

Tourette's syndrome - sx mental?

Answer 39

obsessive compulsive behaviors -rage attack

Question 40

Transient tics?

Answer 40

-in childhood and goes away on its own

Question 41

Huntington's dz - timeline?

Answer 41

early behavioral changes (irritability, depression, apathy) usually not until 30-40yo (but can be juvenile - 21yo) subtle motor changes (restlessness, coordination probs, gait abnormalities)

Question 42

Huntington dz - RF?

Answer 42

autosomal dominant | *be careful for suicide in pts and FH

Question 43

Huntington dz - dx?

Answer 43

gene probe

Question 44

Huntington dz - tx?

Answer 44

symptomatic - life expectancy 15-20 yrs after diagnosis

Question 45

Restless leg syndrome - sx?

Answer 45

``` pt is restless when legs are at rest - esp at night "paresthesias" "dysesthesias" leg kicks while sleeping NORMAL neurologic examination ```

Question 46

Restless leg syndrome - labs?

Answer 46

CBC - check iron | if anemic, tx anemia RLS might go away

Question 47

Restless leg syndrome - dx?

Answer 47

1) urge to move legs 2) rge worse at night 3) legs >>> arms 4) sx, walk, sx again

Question 48

Restless leg syndrome - tx?

Answer 48

lifestyle changes: avoid caffeine, exercise, hot baths | no med tx

Question 49

Tardive dyskinesia - RF?

Answer 49

too much dopminergic antagonist properties long term/HD anitpyschotics schizophrenic/bipolar pts elderly pts on potent meds

Question 50

Tardive dyskinesia - sx?

Answer 50

smacking of lips pursing of lips rapid eye blinking athetosis of fingers/toes

Question 51

Tardive dyskinesia - tx?

Answer 51

remove drug

Question 52

Tardive dyskinesia - prevention?

Answer 52

start of low and go slow/short (dopamine antagonist)