Movement disorders

Question 1

Hypokinetic movement disorders

Answer 1

Bradykinesia; PD

Question 2

Hyperkinetic disorder

Answer 2

Dyskinesia; 
tremor
tics
chorea
myoclonus
dystonia

Question 3

What is a tremor?

Answer 3

Rhythmic sinusoidal oscillation of a body part

Question 4

What are the different classifications of a tremor?

Answer 4

Rest; occurs when body at rest (5Hz)
Postural; occurs when the arms are outstretched
Kinetic; occurs during movement of a body part

Question 5

What is an essential tremor?

Answer 5

Seen in hands at 5Hz when hold arms outstretched 
Continues through moto execution 
Familial 
Slow progression 
Ameliorated by alcohol intake
Asymmetric

Question 6

Describe a physiological tremor

Answer 6

Symmetrical
Fast
Small amplitude

Question 7

Describe a wilson’s disease tremor

Answer 7

Early stage postural

Wing beating

Question 8

Describe a hepatic encephalopathy tremor

Answer 8

Asterixis

Repetitive drops of extended hands

Question 9

What is chorea?

Answer 9

Brief irregular purposeless movement that flit and flow from one body part to another
Constantly restless or fidgety
Often generalised but can be focal

Question 10

What can cause chorea?

Answer 10

Drugs/ OCP 
Basal ganglia lesions
Sydenham's chorea
Antiphospholipid syndrome
HD 
Neurocanathocytosis

Question 11

What is myoclonus?

Answer 11

Brief electric shock like jerks
Hiccups o hypnic jerks are common and normal forms of myoclonus
Arises from cortex, subcortical structures, spinal cord or nerve root and plexus

Question 12

What is a tic?

Answer 12

Unvoluntary repetitive, stereotyped movements of vocalizations
They can be suppressed but there will be a growing feeling of anxiety and discomfort during tic suppression and when allowed to relax there will be a flurry of tics

Question 13

What is a motor tic?

Answer 13

Eye blinking
Head jerks
Arm/leg jerks
Complex sequence

Question 14

What is a vocal tic?

Answer 14

Sniffing
Grunting
Snorting

Question 15

What is gilles de la tourette syndrome?

Answer 15

Typically onset of persistent multiple motor and vocal tics, often with assoc psych disturbance (ADHA, OCD, copropraxia, coprolalia)

Question 16

What is dystonia?

Answer 16

Movement disorder characterized by sustained or intermittent muscle contractions causing abnormal often repetitive movements or posture
Tend to be patterned, twisting and may be tremulous
Often initiated o worsened by voluntary action and assoc with overflow muscle activation

Question 17

Motor sy of PD

Answer 17

Tremor
Bradykinesia
Rigidity
Postural and gait impairement

Question 18

Non motor sy of PD

Answer 18

Depression
Dementia
Constipation 
Anosmia
Parasomnias

Question 19

What tremor is assoc with PD?

Answer 19

Pill rolling

3-6 Hz

Question 20

Tx for dementia in PD?

Answer 20

Acetylcholinesterase inhibitor; rivastigmine

Question 21

Tx for depression in PD?

Answer 21

Dopamine agonist
SSRI
Tricyclic

Question 22

Tx for REM sleep behavior disorder in PS?

Answer 22

Benz; clonazepam

Hormone; melatonin

Question 23

Tx for constipation in PD?

Answer 23

Osmotic laxative

Question 24

Tx for GI motility in PD?

Answer 24

Domperidone

Question 25

Tx for orthostatic hypotension in PD?

Answer 25

Domperidone | Fludrocortisone

Question 26

Tx for sialorrhoea in PD?

Answer 26

Atronic drops Glycopyrrolate Botulism

Question 27

Tx for fatigue in PD?

Answer 27

Modanifil

Question 28

What encomapsses bradykinesia?

Answer 28

Slowness of movement with progressive loss of amplitude or speed during rapid alternating movements Hypomimia Hypophonia Micrographia

Question 29

Which rigidity is felt in PD?

Answer 29

Cog wheel Lead pipe Positive froment's maneouvre

Question 30

How is posture and gait affected in PD?

Answer 30

``` Stooped Impaired postural reflexes Gait; slow, shuffling Decreased arm swing Slow turning Freezing Festination Pull test ```

Question 31

Red flags in PD?

Answer 31

``` Absence of asymmetry Severe axial or lower limb Frequent falls Fast disease progression Eye movement; supranuclear palsy, dysmetric or slow saccades Tics, myoclonus or choea Pyramidal or cerebellar dysfunction Bulbar or pseudobulbar features Parietal assoc sensory disturbances Apraxia ```

Question 32

What is vascular parkinsonism?

Answer 32

Affects lower limbs Rest tremor uncommon Other neurological signs; spasticity, hemiparesis, pseudobulbar palsy Poor levodopa response

Question 33

What is drug induces parkinsonism?

Answer 33

Symmetrical Coarse postural tremor Emergence of symptoms after drug exposure, and subsequent improvement after drug withdrawal

Question 34

What is the triad of symptoms in multi system atrophy?

Answer 34

Dysautonomia Cerebellar features Parkinsonism

Question 35

What is progressive supranuclear palsy?

Answer 35

``` Symmetric akinetic rigid syndrome with predominantly axial involvement Gait and balance impairment Vertical gaze supranuclear palsy Pseudobulbar symptoms Retrocollis Continuous frontalis action NO response to levodopa ```

Question 36

How is psychosis in PD managed?

Answer 36

Clozapine; beware of idiosyncratic adverse drug reactions and agranulocytosis