Movement Disorders - Balaguera Flashcards by Elisabeth Silver

what is the basal ganglia?

collection of nuclear masses (clustered of neurons) w/in the cerebral hemisphere

How well did you know this?

Not at all

Perfectly

what are the 3 functions of the basal ganglia?

(1) help to control movement
(2) help to regulate emotion
(3) help to regulate cognitive skills

How well did you know this?

Not at all

Perfectly

movement d/o’s come the malfunction of the….

basal ganglia

How well did you know this?

Not at all

Perfectly

what are the 2 pathways that the basal ganglia controls movement by?

direct and indirect pathways

How well did you know this?

Not at all

Perfectly

how does the basal ganglia control movement by the direct pathway?

increases muscle movement by decreased inhibition of the thalamus

How well did you know this?

Not at all

Perfectly

how does the basal ganglia control movement by the indirect pathway?

decreases muscle movement via signaling from the thalamus

How well did you know this?

Not at all

Perfectly

3 main parts of the basal ganglia?

caudate, nucleus accumbent, striatum

How well did you know this?

Not at all

Perfectly

if pathology of the caudate part of the basal ganglia, what occurs?

OCD

How well did you know this?

Not at all

Perfectly

if pathology of the nucleus accumbens part of the basal ganglia, what occurs?

depression

How well did you know this?

Not at all

Perfectly

what part of the basal ganglia regulate memory of skills and habits like driving a car?

the striatum

How well did you know this?

Not at all

Perfectly

if damage to the striatum of the basal ganglia, what occurs? what does this lead to?

people lose the ability for the skills they had in the past

leads to dementia, depression, agitation (40% of pts with PD have dementia)

How well did you know this?

Not at all

Perfectly

what is Parkinsonism?

generic terms use to define syndrome that manifests as:

(1) rigidity
(2) resting tremor
(3) bradykinesia
(4) postural inhibition

How well did you know this?

Not at all

Perfectly

what is primary Parkinsonism?

parkinson’s disease

How well did you know this?

Not at all

Perfectly

what is secondary Parkinsonism?

vascular or drug-induced

How well did you know this?

Not at all

Perfectly

Parkinsonism is hypokinetic or hyperkinetic movement?

hypokinetic (very slow)

How well did you know this?

Not at all

Perfectly

Huntington’s disease is hypokinetic or hyperkinetic movement?

hyperkinetic (very fast)

How well did you know this?

Not at all

Perfectly

what are hyperkinetic movements?

tremor, dystonia, chorea, cerebellar ataxia, myoclonus

How well did you know this?

Not at all

Perfectly

what is a tremor?

rhythmic oscillation of a body part

How well did you know this?

Not at all

Perfectly

what is dystonia?

sustained contraction of agonist and antagonist muscles

opposition tremor, have jerk movement, not oscillatory or rhythmic

How well did you know this?

Not at all

Perfectly

what is chorea? what disease is it seen in?

brief, irregular, EXPLOSIVE non-rhythmical movements

seen in Huntington’s

How well did you know this?

Not at all

Perfectly

what is cerebellar ataxia?

impaired initiation and coordination of movements

mainly walking (extremities and gait), also speech

How well did you know this?

Not at all

Perfectly

what is myoclonus?

lightning-like jerking movements, fast but not as elaborated or explosive as HD

How well did you know this?

Not at all

Perfectly

what are the motor sx’s of PD? what parts of body are most frequently affected?

resting tremors

hands, fingers, forearms and feet most frequently affected

How well did you know this?

Not at all

Perfectly

what are the nonmotor sx’s of PD?

hyposmia, speech and voice d/o’s

***dysautonomia, dementia, depression/psychosis

How well did you know this?

Not at all

Perfectly

what is dysautonomia?

when HR doesn't change when the BP changes seen in PD HTN laying down and dropping BP so much when standing up that pt passes out (orthostatic hypotension)

what do you NOT treat dysautonomia with?

anti-HTN meds

what is the cardinal motor feature of PD?

bradykinesia

pts with PD must have at least one of the following...

4-6 Hz resting tremor, muscular rigidity, postural instability (late presentation)

in PD there must be absence of a ___

secondary cause

pts with PD must have at least 3 supportive criteria...

- Unilateral onset, progressive, resting tremor w/ persistent asymmetry - Excellent response to levodopa - Severe levodopa induced chorea - Levodopa response for >5 yrs - Clinical course of >10 yrs

what is the most effective tx for PD?

levodopa + dopa decarboxylase inhibitor

what tx for PD is effective in improving motor fxn and tx of depression?

subthalamic deep-brain stimulation

PD is a loss of?

DA neurons

what is vascular secondary Parkinsonism?

Microvascular changes and small infarcts from atherosclerosis may disrupt the basal ganglia → parkinsonian s/s w/o degeneration of DA neurons

vascular secondary Parkinsonism pts present early with what sx's?

gait problems or marked postural tremor

what are the vascular Parkinsonism RF's?

typical vascular RF's -HTN, DM, hyperlipidemia, smoking, older age

what is the tx for vascular Parkinsonism?

what is the MAIN drug that causes drug induced Parkinsonism? others?

Haloperidol others: Thioridazine, Perphenazine, Antiemetics

what sx's does drug induced Parkinsonism typically produce vs PD?

BILATERAL EQUAL BRADYKINESIA (PD starts unilateral)

is drug induced Parkinsonism reversible or irreversible?

irreversible

how can you tell vascular secondary Parkinsonism from primary PD?

because PD responds to Leva-Dopa whereas vascular dz doesn't

what is Huntington's?

Hereditary d/o of the basal ganglia caused by a mutation in one gene in chromosome 4

presentation of HD?

Progressive motor incoordination, abnormal movements, and intellectual decline ***CHOREA - powerful, forceful movements (can get rhabdo)

HD is associated with what disorders? high rates of what with HD?

dementia, depression, OCD HIGH RATES OF SUICIDES

what is the ONLY FDA approved drug for HD and what is it's indication and MOA?

Tetrabenazine Indication: control chorea MOA: monoamine depleting agent

what can you use in HD to control chorea and behavioral comorbidities?

antidepressants

what other drugs may be used to decrease chorea?

amantadine and nabilone

what are some complications of HD?

dementia ARF 2/2 rhabdomyolysis - use IVF and early dx to treat Aspiration PNA

what is the M/C movement d/o?

essential tremor

what is the mean age of onset of essential tremor?

45 y/o

how does the essential tremor usually start?

bilaterally from hands or forearms

essential tremor can be what?

postural (occurring w/outstretched arms) or kinetic (occurring w/initiating movement)

during what actions does essential tremor occur?

- Finger to nose mvmt - Pouring and drinking water from a cup - Writing - Drawing archimedean spirals

what's the KEY DIFFERENCE b/w essential tremor and tremor in PD?

PD tremor is resting essential tremor occurs with action

can essential tremor cause cognitive impairments?

NO!!!

is essential tremor related to alcoholism?

NO!!!

what is NOT seen in essential tremor, but is seen in PD?

NO GAIT abnormalities, NO SPEECH abnl (dysarthria), NOT a/w DEPRESSION

what's the core criteria to dx essential tremor?

- Postural or kinetic tremor of the hands and forearms or at least 1 hand - Head tremor w/ no signs of dystonia - Absence of other etiologic factors and neuro signs → meds, ETOH, parkinsonism, dystonia, hyperthyroidism

what's the additional dx criteria for essential tremor?

- bilateral - duration >1 year - severity (interferes w/ ADLs like writing, vocalization)

what is the recommended initial tx for essential tremor?

Propranolol or primidone (alone or in combo)

if essential tremor is refractory, then what's the tx?

deep brain stimulation of the thalamus and unilateral thalamotomy

Movement Disorders - Balaguera Flashcards

(61 cards)