(Huntington) - Dystonia - Chorea - Tic disorders

Movement Disorders Flashcards by Briana Echols

Pyramidal is

direct and monosynaptic

How well did you know this?

Not at all

Perfectly

Extrapyramidal is

indirect and polysnaptic

How well did you know this?

Not at all

Perfectly

What are four targets of the extrapyramidal system?

Control of motor tone
Control of movement amount and velocity
Suppression of undesirable motor activity
Reflexes

How well did you know this?

Not at all

Perfectly

Where does things usually go wrong in the Extrapyramidal system?

Basal nuclei (collection of nuclei)
Striatum

How well did you know this?

Not at all

Perfectly

Large collections of nuclei that modify movement constantly?

Basal nuclei and cerebellum

How well did you know this?

Not at all

Perfectly

Cerebellum output?

excitatory

How well did you know this?

Not at all

Perfectly

Basal nuclei output

Inhibitory

How well did you know this?

Not at all

Perfectly

What is disturbance?

movement disorders

How well did you know this?

Not at all

Perfectly

Hypokinetic

it will be slow

Parkinson disease

How well did you know this?

Not at all

Perfectly

Hyperkinetic

(Huntington)

Dystonia
Chorea
Tic disorders

How well did you know this?

Not at all

Perfectly

What 3 drugs causes drug induced movement disorders?

SSRIs, Stimulants, Anti-psychotics

How well did you know this?

Not at all

Perfectly

What is the most common cause of postural or action tremor?

Essential tremor

How well did you know this?

Not at all

Perfectly

What causes essential tremor?

Familial tremor (autosomal dominant w/ reduced penetrance)
environmental influence

How well did you know this?

Not at all

Perfectly

What causes essential tremor?

UNEXPLAINED.. need more studies

How well did you know this?

Not at all

Perfectly

What is usually not involved in essential tremor?

legs

How well did you know this?

Not at all

Perfectly

What body parts are usually involved in essential tremor?

one or both hands (usually bilateral)

- Head (laryngeal muscles)

How well did you know this?

Not at all

Perfectly

What disease usually improves with alcohol consumption?

essential tremors

How well did you know this?

Not at all

Perfectly

What is seen on a physical exam for pts with a essential tremor?

difficulty handwriting, manual skills, speaking

Worsened w/ anxiety, excitement

How well did you know this?

Not at all

Perfectly

When is treatment not necessary in a essential tremor?

symptoms are mild

How well did you know this?

Not at all

Perfectly

What is the treatment for mild, situational exacerbations?

Propranolol (Inderal), Alprazolam (Xanax), small amount of
alcohol,
Primidone (Mysoline)

How well did you know this?

Not at all

Perfectly

What is the treatment for persistent disability due to essential tremor?

Propranolol (Inderal), Primidone (Mysoline), OR combination

How well did you know this?

Not at all

Perfectly

Treatment for continuous symptoms of essential tremor despite treatment?

Topiramate (Topamax), Gabapentin (Neurontin)
Botulinum toxin A- associated w/ muscle dependent
weakness at the injection site

How well did you know this?

Not at all

Perfectly

Treatment for disabling tremor not responsive to meds?

High frequency thalamic stimulation

Subdural motor cortex stimulation

How well did you know this?

Not at all

Perfectly

Where should all essential tremor patients be referred to?

Neurologist

How well did you know this?

Not at all

Perfectly

Bradykinesia + what 3 things meets for Parkinsonism?

- Resting tremor - Rigidity - Postural instability

What is the most common cause of Parkinson Disease?

Idiopathic

What 2 structures make up the Substantia Nigra?

- Pars Reticulata | - Pars Compacta

What two things are found in Parkinson Disease?

- Presence of Lewy Bodies | - Neuronal degeneration

What are lewy bodies?

Abnormal aggregates of protein within neuron cytoplasm in the substantia nigra or cortex

What is the patho of Parkinson Dx?

degeneration of dopaminergic nigrostriatal system

What causes the tremor in Parkinson?

lack of dopamine and cerebellar influence

What two pathways are affected in Parkinson?

direct and indirect

What are the 5 risk factors for Parkinson Disease?

- Age (45-65yrs) - Family Hx - Male - Herbicide/Pesticide exposure - PMH of head trauma

What is the biggest cardinal symptom seen in 70% of pts w/ Parkinson?

Resting tremor

How do symptoms usually spread in Parkinson?

Starts in one limb and spreads to the other limb on that same side

What are 5 facial symptoms of Parkinson?

- Immobile-masked facies - Widened palpebral fissures - Infrequent blinking - Scalp/face seborrhea - Soft voice

What is Myerson sign?

tapping pts face and they constantly blink

How do you diagnosis Parkinson dx?

Clinical dx: a minimum of bradykinesia + tremor or rigidity

When is the challenge test used?

if dx is in doubt

What are 2 components of the "challenge test"?

- Carbidopa levodopa | - Apomorphine (Apokyn)

What is the gold standard diagnosis for Parkinson?

neuropathologic examination

When is Parkinson dx , txt started?

when dx negatively impacts living

What is the DOC for Parkinson?

Levodopa (L-dopa) (converts to dopamine)

What is the txt for Parkinson?

- Dopamine agonists - Levodopa - Carbidopa - Sinemet - MAOIs - Amantadine (Symmetrel)

What does Carbidopa do?

limits extra-cerebral breakdown of levodopa

Two dopamine agonist for txt Parkinson?

Pramipexole (Mirapex) | Ropinirole (Requip)

What drugs are effective in early or advanced Parkinson?

Dopamine agonist

What drug improves all clinical features, but does not stop progression?

Levodopa (L-dopa)

Carbidopa/Levodopa?

Sinemet`

Used prior to starting levodopa or with Sinemet?

Dopamine agonist

2 MAOIs for txt of Parkinson?

Rasagiline (Azilect) | Selegiline (Eldepryl)

MAO of amantadine?

increase dopamine | release or block dopamine reuptake

Who gets deep brain stimulation in Parkinson dx?

Patients w/o cognitive impairment or psychiatric disorder w/ good response to levadopa, but having response fluctuations

What type of deep brain stimulation is used for Parkinson?

High frequency stimulation of subthalamic | region

Parkinson progress more quickly in ppl who:

- are older when symptoms begin | - Do not have tremor

T/F Parkinson is fatal?

False, but can reduce longevity

What causes Huntington dx?

Trinucleotide repeat on chromosome 4 (autosomal dominant inheritance)

What is the age of onset for Huntington?

30-50 yrs

T/F Huntington is fatal?

True, 15-20yrs

What is the patho for Huntington dx?

Degeneration of the striatal cortex, basal ganglia, GABA neurons (inhibitory) in the striatum

What are the 2 symptoms of Huntington?

Dementia and Chorea

What imaging is used for Huntington's?

CT scan or MRI | PET

DIAGNOSIS of choice for Huntington's?

GENETIC TESTING!!!

Txt for Huntington's chorea?

purely symptomatic: there is no cure, nor ability to slow progression

What 4 dx are used for Huntington's chorea?

- Tetrabenazine (Xenazine) - Haloperidol or phenothiazines - Quetiapine (Seroquel)

What should be done w/ all pts diagnosied w/ huntington?

offer GENETIC testing for . all family members

What is Tourette Syndrome?

complex interaction between social and environmental factors and multiple genetic abnormalities

What and where is Bilineal transmission seen in?

Tourette Syndrome: inheritance from both parents is clearly evident in most cases

What area does Tourette effect?

Disturbance in the striatal-thalamic-cortical | (mesolimbic) spinal system

What causes the motor and vocal tics in Tourette?

disinhibition of the motor and limbic system?

Whats the biggest intital presentation for tourette?

Motor tics (80%)

What age does Tourette present?

prior to age 21 (2-15yrs)

Why is actual diagnosis of Tourette delayed?

due to mis diagnosis

How is Tourette diagnosed?

Clinical diagnosis

How could Tourette be misdiagnosed?

- No abnormalities on physical exam | - Normal neuro exam

What is the DSM-5 Criteria for Tourette?

- Multiple motor + >1 vocal tics present at some time - Tics present >1 yr - ONSET BEFORE 18yrs - Not due to direct physiologic effects of substance or meds

Txt for mild disabling tics?

education and counseling WITHOUT tic suppression therapy meds

Txt for bothersome tics?

Tetrabenazine (Xenazine)

Txt for focal motor or vocal tics?

Botulism toxin injections into the affected muscles

Txt for bothersome tics who want non-med txt or who have failed meds?

Behavioral therapy w/ habit reversal training

Movement Disorders Flashcards

(80 cards)