Movement Disorders

Question 1

What is a tremor?

Answer 1

Involuntary rhythmic oscillatory movement of a body part, usually due to reciprocal antagonistic muscle groups

Question 2

Resting tremors are minimal during activity. True/False?

Answer 2

True

Question 3

Action tremors incorporate which tremors and are always below what frequency?

Answer 3

Always below 13Hz

Postural, kinetic or intention tremors

Question 4

Which tremor is associated with Parkinson’s disease?

Answer 4

Resting tremor

Question 5

Intention tremors occur during voluntary movement and can be signs of which brain region dysfunction?

Answer 5

Cerebellar disorder

Question 6

Give examples of causes of physiological tremors

Answer 6

Stress
Anxiety
Stimulants
Postural changes

Question 7

A cerebellar tremor usually occurs unilaterally. True/False?

Answer 7

True

Question 8

Which tremor is more associated with family history - resting or essential/postural?

Answer 8

Essential/postural tremor

Question 9

What is dystonia?

Answer 9

Involuntary sustained muscle contraction in a body part leading to abnormal posture
Can lead to twisting, intermittent spasms and repetitive movement

Question 10

Dystonias can be generalised or focal/segmental. What is the main treatment for each?

Answer 10

Generalised dystonia: anticholinergic, muscle relaxants

Focal/segmental: botox injection

Question 11

List some diseases associated with secondary dystonias

Answer 11

Wilson’s disease
Multiple sclerosis
Parkinson’s disease
Cerebral palsy

Question 12

What is chorea?

Answer 12

Non-rhythmic jerky purposeless movement, akin to fidgetiness, usually generalised but may be confined

Question 13

List inherited causes of choreas

Answer 13

Huntington disease
Wilson’s disease
Spinocerebellar ataxia
Neuroacanthocytosis

Question 14

List autoimmune causes of chorea

Answer 14

SLE
Anti-phospholipid syndrome
Behcet disease
Coeliac disease
Hashimoto thyroiditis
Sydenham's chorea

Question 15

Which drugs can provide symptomatic relief for choreas?

Answer 15

Tetrabenazine

Dopamine blockers

Question 16

What are tics?

Answer 16

Non-rhythmic stereotypical rapid movements that provide relief after doing them

Question 17

Give examples of tics

Answer 17

Eye blinking
Clearing throat
Arm swinging
Shouting/singing out loud

Question 18

What is the main primary tics disorder?

Answer 18

Tourette’s syndrome

Question 19

What is myoclonus?

Answer 19

Brief, shock-like muscle contraction

Question 20

Spasticity is related to an UMN/LMN disorder of which motor tract?

Answer 20

UMN

Pyramidal tract

Question 21

Give examples of hyperkinetic movement disorders

Answer 21

Dystonia
Tics
Myoclonus
Chorea
Tremor

Question 22

Hyperkinetic movement disorders are associated with which motor tract and which are of the brain?

Answer 22

Extra-pyramidal tract

Basal ganglia

Question 23

Give examples of hypokinetic movement disorders

Answer 23

Rigidity
Bradykinesia
(parkinsonism, parkinson’s disease)

Question 24

Hypokinetic movement disorders are associated with which motor tract and which area of the brain?

Answer 24

Extra-pyramidal tract

Basal ganglia

Question 25

What is bradykinesia?

Answer 25

Slowness of movement

Question 26

Ataxia is associated with a lesion in which area of the brain?

Answer 26

Cerebellum

Question 27

What is the function of the basal ganglia?

Answer 27

Collection of gray matter nuclei with important connections to other parts of the brain - involved in movement and coordination

Question 28

How does the basal ganglia control movement?

Answer 28

Circulatory control with excitatory and inhibitory signals

Question 29

List structures of the basal ganglia

Answer 29

``` Caudate nucleus Putamen Globus pallidus Subthalamic nucleus Substantia niagra ```

Question 30

Which tremor would be elicited by eating or carrying plates?

Answer 30

Postural tremor | Holding hands out

Question 31

What cerebellar test would you use to check for intention tremor?

Answer 31

Finger-nose test

Question 32

What class of drug is typically used to treat postural tremors?

Answer 32

B blockers

Question 33

Outline the management of tic disorders

Answer 33

CBT | Clonidine/ tetrabenazine

Question 34

Tic disorders are most common in..

Answer 34

Teenagers | Males

Question 35

A primary movement disorder is assocaited with no underlying cause. True/False?

Answer 35

True | Secondary = underlying cause

Question 36

List the 4 main causes of movement disorders

Answer 36

Primary/ idiopathic Secondary Heredo-degenerative (late onset, progressive) Psychogenic e.g. depression

Question 37

List the clinical features of functional weakness

Answer 37

``` No wasting Normal tone Normal reflexes Erratic power Non-anatomical loss ```

Question 38

What is Sydenham's chorea?

Answer 38

Widespread chorea due to rheumatic fever | Typically occurs in young females