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Flashcards in Movement Disorders Deck (28)
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1

Hyperkinesias

Moving too much

Tremor
Chorea
Tics
Dystonia
Myoclonus

2

Hypokinesias

Not moving enough

Parkinson's

3

Summary of basil ganglia function

Responsible for unconscious motor control: smoothness of the movements, coordination between different muscle groups muscle tone etc

4

What is the key neurotransmitter in the extrapyramidal system, responsible for motor control?

Dopamine

5

What is the most common movement disorder in the general population?

Restless leg syndrome (12% in general population)

6

What is the most common movement disorder seen in clinic?

Parkinson's disease

7

Tremor

Definition: Rhythmic oscillatory movement produced by alternating or synchronous contraction of antagonist muscles

Happens most when resting, action (intentional), postural (with sustained posture)

Frequency- Slow or fast ( ex. PD tremor 6 HZ)

Regular or jerky

8

Essential tremor

Clinical features:

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

Usually familial

9

Tics

Definition:

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

10

Tourettes

Age of onset 1 year

Clinical features:
Onset in youth, more common males

Associated with:
ADHD,
OCD,
poor impulse control

Tics persist into adulthood 25%

11

Chin tremor

Parkinson's

12

Head and voice tremor

Essential tremor

13

Tremor in young pts is suspicious for what?

Wilson's disease
Especially if floppy tremor

14

Most common movement disorder in children

tics

15

Treatment of Tourettes

Educate family, patient, school
Support groups
Treat tics only if interfering with life
Treat OCD, ADHD
Cognitive-Behavioral Therapy (CBT) (BEST BEHAVIORAL INTERVENTION THAT HAS BEEN STUDIED)
Biofeedback

16

Meds for Tourettes

Clonidine - antihypertensive
SSRIs: OCD

Neuroleptics:
Fluphenazine, aripiprazole (Side effects: weight gain, sedation)
Tetrabenazine –Dopamine depleting drug,
Clonazepam

17

Chorea

Irregular, brief, dancing like, jerky
Move from one body part to another

18

What diseases have Chorea?

Huntington disease
Sydenham chorea
Chorea gravidarum
Lupus

19

Dystonia

Co-contraction of muscles agonists and antagonists
Sustained muscle contractions causing twisting, abnormal postures
Can be associated with tremor

Position dependent
Presence of “Null point”
Alleviating maneuver (sensory tricks, geste antagoniste)

20

What is the etiology of primary distonia

DYT 1 – Protein Torsin

21

Causes of secondary distonia

Cerebral palsy

Neurodegenerative disorders (Wilson’s Disease,
Panthokinase-assocoated neurodegeneration (PKND), Other ferritinopathies (NBIA), Neuroacantocytosis)

Hypoxic- ischemic brain injury

Poststroke

Posttraumatic

Medications, toxins

22

3 cardinal symptoms of Parkinson's

Resting tremor
Bradykinesia or akinesia
Rigidity

23

Red flags that a patient might have an atypical form of Parkinson's

Rapid progression of the disease
Early onset of dementia
Early onset of autonomic instability
Early onset or predominance of postural instability
Confusion or hallucinations, unrelated to medications
Ataxia
Downgaze impairment

24

Atypical parkinsonian syndromes

Prognosis: average 7-10 years
Worse than Parkinson disease

Treatment:
Only 10-15% respond to dopaminergic therapy

Rare

LBD – Lewy Bodies Dementia
FTDP – Frontotemporal dementia-parkinsonism
PSP – Progressive Supranuclear Palsy
CBD – Corticobasal degeneration
MSA – Multiple Systems Atrophy
FRAXTAS – Fragile X associated Ataxia Tremor syndrome

25

Progressive supranuclear palsy (PSP)

Progressive, onset > 50,
Impaired eye movements
Downgaze !
“Reptilian” or scared look
Early onset of postural instability
Falls within the first year !
Retrocollis

26

Multiple systems atrophy (MSA)

Average life expectance 7-9 years
Poor response to dopamine replacement treatments ( 25% can be responsive)

27

What is the typical presentation of a movement disorder?

Usually start insidiously and progress slowly

Sudden onset is suspecious for psychogenic movement disorder

28

Movement disorders and sleep

Usually movement disorders disappear while at sleep

Movement disorders that persist or start during sleep:
REM sleep behavioral disorder
PLMS
Whipple’s disease

RLS is a disorder of restful wakefulness
Hypnogogic myoclonus happen while drowsy