6.2.2 Movement Disorders

Question 1

What are the common types of tremors?

Answer 1

Postural, action, rest

Rx with primidone, propanolol

Question 2

What is chorea?

Answer 2

Non-sustained, arrhythmic, ballistic (agonist, antagonist, agonist) movements

Question 3

What is the mainstay in treatment of Parkinson’s dz?

Answer 3

Carbidopa/Levodopa

Question 4

What is the MOA of COMT inhibitors?

Answer 4

Inhibits catechol-O-methyltransferase, which reduces COMT breakdown of dopamine

This increases the bioavailability of levodopa

Question 5

What is the primary abnormality in Parkinson’s disease?

Answer 5

Slow and selective loss of substania nigra dopaminergic neurons

Question 6

Why are MAO-B inhibitors typically given?

Answer 6

To reduce motor flucuations and increases on time as an adjunct to levodopa (5-10 mg/day)

Question 7

What is the MOA of dopamine agonists?

Answer 7

Stimulate postsynaptic dopamine receptors directly

Question 8

What is dystonia?

Answer 8

Sustained abnormal involuntary movements; either focal or generalized

Question 9

Draw out the flowchart of the abnormal involuntary movements

Answer 9

Question 10

What is the MOA of LDOPA?

Answer 10

A precursor to dopamine that can cross the BBB, get converted into dopamine, and be stored in nigral neurons

Question 11

What are the primary clinical signs of akinetic rigid syndrome?

Answer 11

Bradykinesa/akinesia

Increased tone: rigidity

Postural instability

Question 12

What are movement disorders?

Answer 12

A group of disorders affecting the ability to produce and prevent movement

Question 13

What is myoclonus?

Answer 13

Brief shock-like movement

Question 14

What are the clinical features of parkinson’s disease?

Answer 14

Rest tremor, rigidity, bradykinesia and postural instability in later stages of disease

autonomic dysfunction

neuropsychiatric disturbances (sometimes related to rx)

Question 15

What is the difference between Parkinsonism and Parkinson’s disease?

Answer 15

Parkinsonism (akinetic rigid syndrome) is the clinical triad of akinesia, rigidity, and postural instability. Parkinson’s disease is the most common cause of Parkinsonism, but not eveyone with Parkinsonism has Parkinson’s disease.

Question 16

Common diseases with chorea?

Answer 16

Hemi-ballismus, essential chorea, Huntington’s, post streptococcal (autoimmune)

Question 17

What is the MOA of carbidopa? Why is it used?

Answer 17

Prevents peripheral conversion of levodopa to dopamine through inhibiton of dopamine decarboxylase (DDC)

Usage increases the amount of levodopa (1% -> 5-10%) that crosses the BBB

Question 18

What is the MOA of MAO-B inhibitors?

Answer 18

Irreversible inhibitor of monoamine oxidase, type b (MAO-B) resulting in decreased formation of free radicals derived from oxidative metabolism of dopamine

Question 19

What are tics? What are the two common dz’s with tics?

Answer 19

Suppressible and with an urge to move; Tourette’s syndrome and Adult onset Tic disorder

Question 20

What are the two COMT inhibitors?

Answer 20

Entacapone and tolcapone

Question 21

How are Parkinsonism and akinetic rigid syndrome related to one another?

Answer 21

They are synonymous

Question 22

What are the names of the two MAO-B inhibitors

Answer 22

Selegiline and Rasagiline