4- Movement Disorders Flashcards
What type of movement is described as a state of restlessness?
Akathisia
What type of movement is defined as an inability to coordinate movements of the trunk/ limbs?
Ataxia
What type of movement is defined as involuntary writhing limb movements?
Athetosis
What type of movement is defined as flailing, ballistic, involuntary movements in a limb?
Ballism
What type of movement is defined as quick, involuntary, dance-like movements?
Chorea
What type of movements are defined as involuntary, chorea-like or tic-like?
Dyskinesias
What is defined as abnormal muscle tone with sustained posture?
Dystonia
What type of movement is defined as involuntary, spasmodic, jerky?
Myoclonus
What type of movement is defined as habitual, semi-voluntary, spasmodic, quick, and brief?
Tic
What type of movement is defined as involuntary, rhythmic, and repetitive?
Tremor
What is the 2nd most common neurodegenerative disease?
Idiopathic PD
What is the disease course of idiopathic PD?
Sx free for ~3 yrs after diagnosis
Major complications after ~5-7 yrs
What are the 4 cardinal features of idiopathic PD?
Rest tremor- unilateral
Rigidity- sustained through passive ROM
Akinesia-bradykinesia
Postural instability- stooping, retropulsion
Masked fascies, loss of manual dexterity, loss of spontaneous animation, and loss of associated movements are a/w with what feature/ disease?
Akinesia-bradykinesia
Idiopathic PD
In addition to the cardinal features of idiopathic PD, what other systems can be affected?
Motor, cognitive, psych, autonomic, sensory, sleep
What are the components of the unified PD rating scale (UPDRS)?
I- mentation, mood, behavior
II- ADL
III- motor exam
IV- therapy complications
What feature of drug-induced parkinsonism will differentiate it from PD?
Symmetric sxs
What feature of vascular disease will differentiate it from PD?
Gait disturbance and UMN findings
What feature of normal pressure hydrocephalus (NPH) will differentiate it from PD and what might be seen on MRI brain?
Apraxia of gait
Ventricular enlargement disproportionate to cerebral atrophy
What feature of corticobasal degeneration (CBS) will differentiate it from PD?
Cognitive disorder
What feature of progressive supranuclear palsy (PSP) will differentiate it from PD and what might be seen on MRI brain?
Early falls, poor L-dopa response
Hummingbird sign
What feature of multi-system atrophy (MSA) will differentiate it from PD and what might be seen on MRI brain?
Early autonomic features
Hot cross bun sign
What feature of dementia with lewy bodies (DLB) will differentiate it from PD?
Hallucinations, cognitive disorder
What is the imaging test of choice if you suspect Parkinsonism?
(gait disorder, falling, cognitive disorders)
MRI brain
What condition should be ruled out in any patient < 50 yo with a movement disorder and suspected Parkinsonism?
Wilson’s disease
What diagnostic study should be ordered for any patient with a tremor?
Thyroid studies
What diagnostic study should be ordered for any patient with cognitive sxs, or functional neuro sxs?
Neuropsychometric testing
What diagnostic study should be ordered for any patient with mixed tremor disorders?
SPECT (DaTSCAN)
What PD tx is used as a trial for all parkinsonism pts, is 1st line for pts > 70 yo and used as refractory tx in pts < 70 yo?
Sinemet (carbidopa, levodopa)
What are the SEs and long-term effects of tx with Sinemet (carbidopa/ levodopa)?
SE: nausea
Long-term: motor fluctuations
What dopamine agonists are used in the tx of PD and when are they indicated?
Pramipexole, Ropinirole, Rotigotine
< 70 yo, mild sxs, dyskinesias
What are the SEs of dopamine agonists used in the tx of PD?
Pramipexole, Ropinirole, Rotigotine
Sleepiness, nausea, orthostatic hypotension, hallucinations
How are PD pts started on tx with dopamine agonists?
Pramipexole, Ropinirole, Rotigotine
6-8 week titration
What are possible tx options for dialorrhea in PD pts?
(dialorrhea: excessive drooling/ salivation)
Robinul (caution in elderly- confusion)
Botox
What are possible tx options for MCI or dementia in PD pts?
(MCI: mild cognitive impairment)
Anticholinesterases
What are surgical tx options for PD?
Ablative
MRgFUS (MRI guided focus US)
Deep brain stimulation (bilateral)
What is the location for deep brain stimulation (DBS) if ET or tremor predominant PD?
Vim
What is the location for deep brain stimulation (DBS) if PD?
(non-specific)
STN
What is the location for deep brain stimulation (DBS) if dystonia or rigidity prominent PD?
GPi
What are the indications for DBS surgery? (4)
Significant disability
Motor fluctuations w/ max meds
L-dopa responsive
No cognitive impairment
How does the frequency of an essential tremor (ET) compare to a PD tremor?
ET: 4-11 Hz (higher frequency)
PD: 4-7 Hz
What are the characteristics of an ET?
Bilateral UE’s
Rest tremor may develop later on
May improve with EtOH/ worsen with caffeine
What is the non-pharmacologic tx for ET?
Wrist weights, weighted utensils
What meds are used for 1st and 2nd line tx of ET?
1st line: Propranolol, Primidone, Gabapentin
2nd line: Topiramate
What meds can be used as adjunct tx of ET?
Diazepam, Clonazepam
Botox (head tremor)
What is the tx for a med refractory ET?
DBS of Vim
Restless leg syndrome (RLS) is defined as abnormal sensations with urge to the move the legs. When are sxs alleviated/ worse?
Alleviated by movement (occurs at rest)
Worse at night
Neuropathy, Fe deficiency, pregnancy, and renal failure can be secondary causes of what condition?
RLS
How are pharmacologic tx options used for RLS?
Only at night in the beginning of disease course
What drug classes can be used in the tx of RLS?
Dopamine agonists
Anti-epileptics
Benzos- sleep
Opioids
What drugs should be avoided in the tx of RLS due to potential for rebound and augmentation (sxs earlier in day, pts awoken early in a.m. or sxs in arm)?
Carbidopa/ L-dopa
What etiologies should be ruled out for chorea?
Hereditary
Metabolic
Drug-induced
Systemic disorders
Infectious/ post-infectious
Age-related
“Butterfly ventricles” noted on brain imaging/ eval is concerning for what condition?
Huntington’s Disease (HD)
What is the classic triad a/w HD?
Motor (chorea)
Cognitive
Psychiatric (most disabling)
What is used for symptomatic tx of HD?
Anti-dopaminergic drugs (chorea)
Benzodiazepines
Anti-depressants
What type of disorder is semi-voluntary, suppressible, can be motor or phonic, and simple vs complex?
Tic disorder
(simple- sniff, grunt, blink, complex- words, chewing, scratching)
What time frame is defined as a provisional vs chronic tic disorder?
Provisional: < 1 yr then goes away
Chronic: > 1 yr
What type of tic disorder occurs after exposure to dopamine blocking agents?
Tardive tic
What conditions might be a/w a tic?
OCD, ADD
What is the tx for tics?
Clonidine
Neuroleptics
Benzos
Tourette’s syndrome is a primary/ genetic cause of a tic. What is the DSM-5 criteria?
2+ motor tics AND 1+ phonic tics for > 1 yr
No secondary causes
Onset before 18 yo
Copralalia (< 10%)
What is the tx for Tourette’s syndrome?
Meds, botox, DBS (if severe, disabling)
How do you distinguish between primary generalized and primary focal dystonia?
Primary generalized- childhood onset
Primary focal- adult onset
What is tx for dystonia?
Botox (no systemic sxs)
DBS (if severe)
(others: dopaminergic, muscle relaxers, benzos, anticholinergics)
Geste antagoniste (sensory trick) is most commonly a/w what type of dystonia?
Cervical focal
What is defined as involuntary, intermittent spasm of half the face and begins initially in the periorbital muscles, and what are the majority of cases caused by?
Hemifacial spasm (HFS)
Caused by CN VII compression
Bright light, wind, fatigue, stress, smiling, or speaking can be triggers for what condition?
Hemifacial spasm (HFS)
How is hemifacial spasm (HFS) diagnosed and what is the tx?
Dx w/ clinical and MRI
Tx with Botox-A
Pt presenting with bizarre movements, exaggerated efforts, and distraction/ inconsistent movements is concerning for what?
Functional/ psychogenic movement disorder
What is the tx for functional/ psychogenic movement disorders?
Multidisciplinary approach
