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Flashcards in Movement Disorders Deck (26)
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1
Q

Basal ganglia

A

Responsible for unconscious motor control, smoothness of movements, coordination between different muscle groups; muscle tone

2
Q

Direct and Indirect Pathways

A

D1: Direct pathway–> facilitates movement
D2: indirect pathway–>inhibits movement
–Normally dopamine: turns up direct, turns down indirect
**So: dopamine facilitates movement (DA is the key NT in extrapyramidal system, responsible for motor control)

3
Q

Hyperkinesias

A
moving too much:
tremor
chorea
tics
dystonia
myoclonus
restless legs
4
Q

Hypokinesias

A

not moving enough

Parkinsonism

5
Q

Tremor

A
Rhythmic oscillatory movement produced by alternating or synchronous contraction of antagonist muscles
Happens most:
resting
action (intentional)--> w/ ET
postural 

*Chin tremor seen with Parkinson’s

6
Q

Essential Tremor

A
*tremor with posture and action
(not chin)
-upper ext>lower,head
-insidious onset
-worsens with age (peaks 20-30, then 60-70)
-75% respond to alcohol
7
Q

Tics

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

Can cause emergency if neck involvement and spinal cord damage over time.

8
Q

Tourette Syndrome

A

Age of onset1 yr

  • More common in males
  • Assoc w/: ADHD, OCD, poor impulse control
  • 25% of tics persist into adulthood

Pathogenesis:
SLITRK1 gene, chrom 13 (one pt only)
others: AD inheritance
Otherwise idiopathic

Treat tics if interfering with life
Treat OCD/ADHD
CBT
Biofeedback

Meds:
Clonidine (antiHTN)
SSRIs (OCD)
Neuroleptics (fluphenazine, aripiprazole: SE weight gain, sedation)
Tetrabenazine
Clonazepam
9
Q

Chorea

A

irregular, brief, dancing like, jerky movement
Diseases:
-Huntington (CAG repeat, chrom 4, anticipation; near 100% penetrant)
-Sydenham chorea (usally bilateral and transient)
-chorea gravidarum
-lupus (three neuro complications: abnormal movement, behavioral and mood problems, epilepsy)

10
Q

Dystonia

A

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”: can be completely abolished in position of the affected part of the body
  • Alleviating maneuver: actions that can improve or abolish dystonic posturing or tremor
  • Note timing/duration
11
Q

Etiology of Dystonia

A

Primary: DYT 1-12 (DYT1–protein torsin)

Secondary:
cerebral palsy
Neurodegen disorders (wilson's, PKND,ferritinopathies (NBIA), neruoacantocytosis)
Hypoxic-ischemic brain injury
post-stroke
post-traumatic
-meds/toxins
12
Q

Classification of dystonia

A
Focal:
blepharospasm
hemifacial spasm
oromandibular dystonia
laryngeal dystonia
spasmodic torticolis (cervical dystonia-->botox can help with this and Meige syndrome: belpharospasm and facial dystonia)

Segmental
Multifocal
Generalized

DBI for dystonia can also help

13
Q

Athetosis

A

slow distal twisting movements

14
Q

Myoclonus

A

sudden, brief, shock-like movements

15
Q

Ataxia

A

poorly coordinated, clumsy movement

16
Q

Parkinson disease (motor, non-motor sx)

A

resting tremor
bradykinesia or akinesia
rigidity
(others)

nonmotor: anosmia, dep, anxiety, constipation, cognitive impairment, drooling, visual disturbances, sensory changes, autonomic instability, sleep disturbance

ASYMMETRIC

17
Q

DDx Parkinsonism

A
vascular, drug-induced, post-traumatic, post-infectious
Lewy Body dementia
FTDP
PSP
corticobasal degen
Multiple Systems atrophy
FRAXTAS
18
Q

Atypical features for DDx Parkinsonism

A
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
Prominent retrocollis or anterocollis
Eye movements abnormalities (downgaze!)
Poor response to dopaminergic treatment

[Atypical parkinsonian syndromes: prognosis 7-10 y; only 10-15% respond to DA therapy; RARE]

19
Q

PSP

A
Progressive, onset >50
impaired eye movements (downgaze!)
Reptilian or scared look
early onset of postural instability (falls w/in first yr)
retrocollis
20
Q

Multiple Systems Atrophy (MSA)

A

Avg life expectance 7-9 yr
Poor response to DA (25% are responsive)
Subtypes:
Parkinsonism (MSA-P)–striatonigral degeneration
Cerebellar sx, ataxia (MSA-C)–olivopontocerebellar degen
Autonomic sx (MSA-A)–Primary autonomic insufficiency; Shy-Dragger syndrome

21
Q

Most common movement disorders in adults/kids

A

Adults

  1. restless leg syndrome
  2. essential tremor
  3. parkinson disease

(Children: tics)

22
Q

Description of most movement disorder progression

A

usually start insidiously and progress slowly
–sudden onset and waxing and waning course are suspicious for Psychogenic movement disorder
Exceptions:
-waxing and waning course typical for tics
-Sudden onset:
poststroke, postischmic
toxin induced
postinfections
metabolic (mitochondrial)

23
Q

Sensorimotor disorders

A

RLS
Tics
Akasthesia
Painful limbs/toes

24
Q

Movement disorders of sleep

A

usually movement disorders disappear while asleep
Persisting in sleep include: REM sleep behavioral disorder; PLMS; Whipple’s disease

RLS is a disorder of restless wakefulness
Hypnogogic myoclonus happens while drowsy

25
Q

**Most common movement disorder in children

A

TICS

26
Q

**Indication of Wilson’s disease

A

Tremor in young person (especially big floppy tremor)–Wilson’s until proven otherwise

Don’t miss because chelation therapy available and can stop progression