Approach To Movement Disorders Flashcards
Defining characteristics of tics
Stereotyped; mimicked easily
Urge and Relief
Suppressed
*SUS
Where do tics usually predominate
Face, neck and upper arms
How do stereotypies differ from tics?
They are longer lasting, more complex, purposeless and/or ritualistic
Cite diseases which manifest with stereotypies
Autism, MR, Rett, psychosis, congenital blindness and deafness
How do you classify tics?
- Simple vs. Complex
* Motor vs. Phonic tics
What are dystonic tics?
Tics with an abrupt onset but the subsequent movement is prolonged or slow.
Differentiate Rigidity from Spasticity.
- Rigidity-increased resistance to passive motion during the WHOLE trajectory; equal bet. Flexion and Extension
- Spasticity-PREFERENTIAL inc. resistance such as in arm flexion and leg extension; has SUDDEN DECREASE in resistance (clasp-knife phenomenon)
True or Flase. Cogwheeling can also be felt in ET and Dystonic Tremors.
True.
True or False. Orthostatic tremors cannot be seen by the naked eye.
True. You can either:
•palpate-feel the shivering
•auscultate-has the thumping sound of a helicopter
What are dystonic tremors?
Tremors seen in a body part affected by dystonic.
How do you differentiate dystonic tremor from ET?
Presence of dystonic posturing in dystonic tremors
What kind of tremors are seen in Holmes Tremor?
It’s a combined tremor; it has Resting, Postural and Intention Tremors.
What is the frequency of Holmes tremor?
2-3 Hz
This type of tremor has an unusually high and pathognomonic frequency of 14-18 Hz.
Orthostatic Tremor
Differentiate Simple Kinetic from Intention Tremor from Terminal Kinetic Tremor.
- Simple Kinetic- tremor in the entire movement trajectory
- Intention Tremor- progressive inc. in tremor towards the target
- Terminal Kinetic Tremor-seen at the end of a target-directed Movement
What kind of tremor/s is/are seen in ET?
Postural and Simple Kinetic Tremors.
Defining characteristic of tremors.
Rhythmic
Defining characteristic of dystonia
•ABNORMAL POSTURE resulting from co-contraction of antagonist muscles
Characteristics of athetosis.
Slow
Writhing movt.
Distal extremities affected
Abnormal Posture
*Sawadeeka Athe
Age cut off to define whether dystonia is early or late.
26
Classification of dystonia based on cause
- Primary-dystonia only
- Dystonia-Plus-with a second neurologic feature; eg. Parkinsonism, Ataxia, Myoclonus
- Degenerative
- Secondary-has an identifiable cause
Gene defect in DYT 11 Myoclonus-Dystonia
Gene encoding for e-sarcoglycan
Characteristics of dystonia.
- Consistent Direction
- Same muscle group affected
- Fixed when progressed, mobile in early dystonia
- Sensory Tricks
- Action brings it out, e.g. writer’s cramp, musician’s dystonia
What type of dystonia is an early feature of CBS?
Fixed dystonia
Characteristic of psychogenic dystonia.
It has fixed posturing immediately at the onset of the disease.
Describe mobile dystonia.
Seen in the early stage of dystonia; px can still actively or passively move the affected body part
True or False. Patients with ET may have impaired tandem gait.
True
Parkinsonism, Ataxia, autonomic dysfunction, spasticity, myoclonus
MSA
Differentiate the parkinsonism in PSP and in CBS
PSP-symmetric vs. CBS-asymmetric
Chorea, dystonia and bradykinesia
HD
*CDP. Think XDP which also has caudate atrophy
Dystonia plus tremor
Primary dystonia
Tremor (rest and postural), dystonia, akinetic-rigid syndrome
WD
- si kuya wilson kay TiReD na maging pro-PRRD.
- PRRD= Pres. Rodrigo Roa Duterte= postural + rest tremor + rigidity + dystonia
- TRD= Tremor + Rigidity + Dystonia
T/F. DYT is alcohol responsive.
True
Neuroleptics produce movement disorders esp. if they act on ___ receptors.
D2
Spontaneous contractions of muscle fibers supplied by a single motor unit that are too small to cause movement across a joint.
Fasciculations
Involuntary, continuous, rippling of muscles which does not produce movement across a joint.
Myokimia
Chorea, ataxia, oculomotor apraxia and telangiectasia
AR AT
Which type of movement disorder does APAS present with?
Chorea
Most common form of tremor
ET
Differentiate BRADY- from HYPOkinesia.
BRADY-slow + decrement
HYPO-smaller movements
Characteristics of myoclonus
Abrupt
Brief
Shocklike
*ABS
Differentiate positive from negative myoclonus.
- Positive myoclonus-occurs during muscle contraction
* Negative myoclonus-occurs during brief loss or inhibition of muscle tone (eg. Asterixis)
How do you classify myoclonus?
- Distribution: focal, multifocal, segmental and generalized
- Etiology: physiologic, essential (idiopathic/hereditary), epileptic, symptomatic
- Origin: Cortical, subcortical (eg. Brainstem), spinal and peripheral
- Activation: spontaneous, action, reflex (tactile or auditory stimuli)
Match:
A. Focal
B. Generalized
- Cortical myoclonus
- Subcortical myoclonus
- A
2. B
Neuroleptics produce movement disorders esp. if they act on ___ receptors.
D2
Spontaneous contractions of muscle fibers supplied by a single motor unit that are too small to cause movement across a joint.
Fasciculations
Involuntary, continuous, rippling of muscles which does not produce movement across a joint.
Myokimia
Characterisitcs of chorea
Flowing, random
*FLO,RA
Motor impersistence is characteristic of which movt. Do?
Chorea
Which characteristic reflex is seen in HD?
HUKJR= hung-up knee jerk reflex;
The HUKJR is a classical clinical sign specific of HD that can be observed at physical examination along the disease course. HUKJR happens when testing the knee jerk reflex if the extended leg does not relax straightaway and remains elevated. This singularity of HD, known as “Gordon’s reflex phenomenon”, is due to a sustained contraction of the quadriceps femoris muscle and its origin is still unknown.
Motor impersistence is characteristic of which movt. Do?
Chorea
Which characteristic reflex is seen in HD?
HUKJR= hung-up knee jerk reflex;
Characteritic of ballisms
Flinging
Large-amplitude
Unilateral
Proximal
*BALI FLUP
Which tends to present earlier in life- generalised dystonia or focal dystonia?
Generalized
Upon discontinuing DRBAs, what is the usual course seen in DIP?
~80% of DIP will resolve within 8 weeks upon discontinuing the drug
Define dyskinesia
a loosely used term to denote any involuntary movement but is more commonly used to refer to drug-induced chorea and dystonia
