Adult Movement (Shivkumar) Flashcards
Diagnosis?
- First described in 1817, then late 1800s
- India, China, Ancient Greece
- Bible
- Most common movement disorder affecting 1-2% of the general
population over the age of 65 years - Prevalence is higher in men; unknown reason
- Second most common neurodegenerative disorder after AD
- May be less prevalent in China & other Asian countries + African Americans
Parkinson’s Disease
What are some risk factors in development of Parkinson’s Disease?
- ?
- ?
- ?
- ?
- ? e.g. herbicide, pesticide, metals (mang, iron), well water, farming, rural, residence, wood pulp mills, steel alloy industry
- ?
- ? protective
- Age
- Male gender
- Race (non-Asian)
- Family hx. (LRRK2, PARK2, PARK7, PINK1, SNCA)
- Environmental
- Trauma
- Cigarette smoking
Parkinson’s disease:
- Loss of _______ within the ______
- Occurs most prominently in the ______ portion
- About 60-80% of dopaminergic neurons are lost before the motor signs of the disease emerge
- Accumulation of ______ and ______
- pigmented dopaminergic cells, substantia nigra
- Ventral lateral
- Lewy bodies, Lewy neurites
What are the eosinophilic, round cytoplasmic inclusions involved in Parkinson’s disease pathology?
- first described by German neuropathologist in 1919
Lewy bodies, lewy neurites
What is the major organ of the dopaminergic innervation of the striatum and is part of the extrapyramidal system which processes information coming from the cortex to the striatum, and returns it back to the cortex through the thalamus?
(Striatum - under the control of this organ, regulates posture, muscle tone)
Substantia nigra
Name the motor features of Parkinson’s disease.
(Asymmetric, pill-rolling/wrist supination or pronation – eventually affects all limbs)
(Slowness of movement, and increased tone causing movement resistance)
- Can you name any others not in the mnemonic?
Tremor, Rigidity, Akinesia, Postural instability
- Stooped posture, shuffling gait, enbloc turning, poor arm swing
What are some of the non-motor features of Parkinson’s disease?
- dementia
- depression, anxiety, hallucinations
- REM sleep behavior disorder
- constipation, sialhorrhea, urinary frequency, sweating, orthostatic hypotension
*
- constipation, sialhorrhea, urinary frequency, sweating, orthostatic hypotension
- Cognitive
- Psychiatric
- Sleep
- Autonomic dysfunction
- Pain
Oral medications used for treatment of Parkinson’s disease?
- -
- -
- -
- -
- -
- -
- Sinemet - levodopa/carbidopa
- Dopamine agonists - ropinarole
- MAO B inhibitors - rasageline, selegiline
- Amantidine
- COMT inhibitors - entacapone, talcapone
- Stalevo - levadopa/carbidopa/entacapone
Surgical treatment of Parkinson’s/tremor/dystonia -
- Placement of an electrode into:
- ____: dyskinesia & tremor
- ____: dystonia
- ____: tremor
- Deep Brain Stimulation
- STN
- GPe
- VIM
What are the following treatments for the non-motor symptoms of Parkinson’s disease?
- Postural instability?
- Constipation?
- Orthostatic hypotension?
- Depression?
- REM sleep?
- Dystonia/pain?
- Dementia?
- PT/OT
- Miralax, herbal remedies
- Fluids, TED hose, liberalize salt intake
- SSRI
- Sleep study, clonazepam
- BOtulinum TOXin
- Donepezil, Memantine, Rivastigmine
Diagnosis?
- Present with a gradually progressive disorder. Classic triad
- Abnormal gait - earliest feature and most responsive to treatment, bradykinetic, broad-based, magnetic, shuffling
- Urinary Incontinence - frequency, urgency, or frank incontinence
- Dementia - prominent memory loss and bradyphrenia, forgetfullness, decreased attention, inertia
Normal pressure hydrocephalus
How is normal pressure hydrocephalus diagnosed?
- Imaging?
- procedure?
- CT, MRI
- LP with goal of removing large volume of CSF
- Test walking speed/ number of steps over 10 meters/MoCA before and 30 mins after
Diagnosis?
Using only the T2 weighted MRI
*** can also treat with Ventriculoperitoneal or lumboperitoneal shunting
Dilation of ventricles out of proportion to sulcal atrophy in a patient with nph
Diagnosis?
- Fluctuations in cognitive function with varying levels of alertness and attention (daytime drowsiness despite adequate nightime sleep/daytime sleep >2 hrs, staring, episodes of disorganized sleep)
- Visual hallucinations - well formed, people/animals; initially know that these are not actually present
- Parkinsonian motor features - before cognitive and psych features (~1 year before)
- Anterograde memory loss - may be less prominent
- More prominent executive function deficits and visuospatial impairment
Lewy Body Dementia
Diagnosis?
- Atypical parkinsonism with peak incidence in 6th decade of life
- Cardinal manifestations - Supranuclear ophthalmoplegia (downward before upward), pseudobulbar palsy, prominent neck dystonia, Parkinsonism (more bradykinesia and less tremor, or rigidity symptoms), Behavioral cognitive gait disturbances that cause imbalance; frequent falls/impaired postural reflexes
Progressive Supranuclear palsy
***Hummingbird sign; Mickey mouse sign
What is the pathophysiology behind Huntingon’s disease?
- The entire brain is atrophied, however there is striking atrophy of the __________
- Microscopically?
Caudate nucleus
- loss of the spiny striatal neurons with gliosis
FYI: core criteria for ET
- bilateral action tremor of hands/forearms
- absence of other neurologic signs, with exception of cogwheel phenomenon
- May have isolated head tremor with no signs of dystonia
Secondary criteria: long duration, + fhx. , responds to EtOH
Essential Tremor:
- Two main forms - ____ and _____, each of which comprise half of cases
- ____ of patients with ET have an increased risk of developing the disorder –> esp. when proband develops disorder at an early age
Treatment:
- Primarily treated with _____
- Some data suggest _____ use as first line
- _____ is also used after the first has failed - but causes sedation, cognitive slowing at larger doses
- WHen medical therapy fails - ____ with electrodes to the VIM of the thalamus can be curative
- Familial, sporadic
- First-degree relatives
Tx.
- beat-blockers, propranolol
- Topiramate
- Primidone
- Deep Brain Stimulation
