6.5 Movement Disorders

Question 1

• move too little
• akinetic/rigid syndromes
• parkinsonism

Answer 1

hypokinetic movement disorders

Question 2

• move too much

- abnormal, involuntary movements

Answer 2

hyper-kinetic movement disorders

Question 3

primary clinical signs of Parkinsonism are _________, increased _____, and ________ instability

Answer 3

bradykinesia/akinesia, tone/rigidity, postural

Question 4

Parkinsons’s is a chronic, progressive, neurodegenerative disease; get slow and selective loss of __________ dopaminergic neurons

Answer 4

substantia nigra

Question 5

rest tremor, rigidity, bradykinesia, and postural instability, autonomic dysfunction, and neuropsychiatric disturbances are clinical features of what disease?

Answer 5

Parkinson’s

Question 6

symmetry at ______, absence of ______ tremor, early dementia, _______ onset of symptoms, ______ disease progression, severe autonomic dysfunction, UMN or cerebellar signs, and early falling suggest a non-parkinson’s disease cause of parkinsonism

Answer 6

• onset
• rest tremor
• abrupt
• rapid

Question 7

• parkinsonian features
• poor response to levodopa
• early postural instability and speech difficulties

Answer 7

multiple system atrophy, striatonigral degeneration

Question 8

multiple system atrophy with autonomic failure, parkinsonian features, pyramidal tract signs, cerebellar signs, and peripheral neuropathy

Answer 8

Shy Drager syndrome

Question 9

postural tremor greater than resting tremor in __________ parkinsonism, reversible and treated with phenothiazines or metoclopramide

Answer 9

drug induced

Question 10

ischemia to striatum, with history of HTN and strokes, MRI white matter changes

Answer 10

vascular parkinsonism

Question 11

MPTP induced parkinsonism causes death of ________

Answer 11

substantia nigra neurons

Question 12

most effective agent for treatment of Parkinson’s, used with carbidopa to block peripheral decarboxylase, crosses blood brain barrier and is converted to dopamine

Answer 12

levodopa

Question 13

wearing off, dyskinesias caused by ________ of L-dopa and decreasing ability of ________ to store dopamine

Answer 13

short half life, nigral neurons

Question 14

• reduces motor fluctuations
• reduces metabolism of dopamine
• selegiline

Answer 14

MAO-B inhibitors

Question 15

• methyltransferase, named entacapone and tolcapone

- inhibit levodopa catabolism

Answer 15

COMT inhibitors

Question 16

• stimulate post synaptic dopamine receptors directly
• effective for tremor, bradykinesia, rigidity
• pramipexole, ropinirole, bromocriptine
• stimulate mesolimbic system, bad side effects

Answer 16

dopamine agonists

Question 17

• abnormal involuntary movements

- pathophysiology unknown, etiology unknown

Answer 17

hyperkinetic movement disorders

Question 18

• rhythmic, predictable
• essential most common
• treat with primidone or propanolol

Answer 18

tremor

Question 19

arrhythmic and suppressible, urge to move, Tourette’s in childhood and adult onset, treat with neuroleptics that block dopamine

Answer 19

tics

Question 20

• arrhythmic, insuppressible, sustained movements
• writhing=athetosis
• focal or generalized
• due to lack of reciprocal inhibition
• treat with Botox, anticholinergics, neuroleptics

Answer 20

dystonia

Question 21

• non sustained, arrhythmic, ballistic movements
• common diseases are hemi ballismus, huntington’s, post strep autoimmune
• treat with dopamine blockers, anticholinergics (tardive)

Answer 21

chorea

Question 22

• brief shock like movements
• idiopathic, primary generalized epilepsies, post anoxic
• treat w/ antiseizure meds, long acting benzodiazepines

Answer 22

myoclonus

Question 23

• involuntary movements after use of dopamine blocking agents
• treatment: increase dopamine blocker, anticholinergics to prevent

Answer 23

tardive dyskinesia