6.5 Movement Disorders Flashcards
- move too little
- akinetic/rigid syndromes
- parkinsonism
hypokinetic movement disorders
- move too much
- abnormal, involuntary movements
hyper-kinetic movement disorders
primary clinical signs of Parkinsonism are _________, increased _____, and ________ instability
bradykinesia/akinesia, tone/rigidity, postural
Parkinsons’s is a chronic, progressive, neurodegenerative disease; get slow and selective loss of __________ dopaminergic neurons
substantia nigra
rest tremor, rigidity, bradykinesia, and postural instability, autonomic dysfunction, and neuropsychiatric disturbances are clinical features of what disease?
Parkinson’s
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
- onset
- rest tremor
- abrupt
- rapid
- parkinsonian features
- poor response to levodopa
- early postural instability and speech difficulties
multiple system atrophy, striatonigral degeneration
multiple system atrophy with autonomic failure, parkinsonian features, pyramidal tract signs, cerebellar signs, and peripheral neuropathy
Shy Drager syndrome
postural tremor greater than resting tremor in __________ parkinsonism, reversible and treated with phenothiazines or metoclopramide
drug induced
ischemia to striatum, with history of HTN and strokes, MRI white matter changes
vascular parkinsonism
MPTP induced parkinsonism causes death of ________
substantia nigra neurons
most effective agent for treatment of Parkinson’s, used with carbidopa to block peripheral decarboxylase, crosses blood brain barrier and is converted to dopamine
levodopa
wearing off, dyskinesias caused by ________ of L-dopa and decreasing ability of ________ to store dopamine
short half life, nigral neurons
- reduces motor fluctuations
- reduces metabolism of dopamine
- selegiline
MAO-B inhibitors
- methyltransferase, named entacapone and tolcapone
- inhibit levodopa catabolism
COMT inhibitors
- stimulate post synaptic dopamine receptors directly
- effective for tremor, bradykinesia, rigidity
- pramipexole, ropinirole, bromocriptine
- stimulate mesolimbic system, bad side effects
dopamine agonists
- abnormal involuntary movements
- pathophysiology unknown, etiology unknown
hyperkinetic movement disorders
- rhythmic, predictable
- essential most common
- treat with primidone or propanolol
tremor
arrhythmic and suppressible, urge to move, Tourette’s in childhood and adult onset, treat with neuroleptics that block dopamine
tics
- arrhythmic, insuppressible, sustained movements
- writhing=athetosis
- focal or generalized
- due to lack of reciprocal inhibition
- treat with Botox, anticholinergics, neuroleptics
dystonia
- non sustained, arrhythmic, ballistic movements
- common diseases are hemi ballismus, huntington’s, post strep autoimmune
- treat with dopamine blockers, anticholinergics (tardive)
chorea
- brief shock like movements
- idiopathic, primary generalized epilepsies, post anoxic
- treat w/ antiseizure meds, long acting benzodiazepines
myoclonus
- involuntary movements after use of dopamine blocking agents
- treatment: increase dopamine blocker, anticholinergics to prevent
tardive dyskinesia
