B2W2 Trans Phys Movement Disorders Flashcards
Basal Ganglia
Group of subcortical nuclei involved in motor coordination and modulation
Striatum
Input nuclei
Globus Pallidus (GPi) and Substantia Nigra (SNr)
Output Nuclei
Types of Basal Ganglia Disorders
Hypokinetic Disorders - Too little movement
Hyperkinetic Disorders - Too much movement
Parkinson’s Disease
A hypokinetic BG disorder caused by the loss of dopaminergic neurons in the substantia nigra
Parkinson’s Disease Symptoms
After losing 70% of dopaminergic receptors
Motor
- Tremor at rest
- rigidity
- bradykinesia or slow movements
- Posture and gait changes
Non-Motor
- Anosmia
- REM Sleep Disorder
- - Unable to not move muscles during REM sleep
Atypical Parkinsonian Disorders
Alpha-Synuclein Pathology
- Significant REM Behavior Disorder
- Dementia w/ Lewy Bodies
Tau Pathology
- Progressive Supranuclear Palsy
- Corticobasal ganglionic degeneration
Dementia w/ Lewy Bodies
Alpha-Synuclein Pathology
Similar to PD but has early cognitive impairment
Cognitive impairment appears within 1 year of motor symptoms
Progressive Supranuclear Palsy
Tau Pathology
- Early falls
- Gait Disturbance
- Supranuclear Vertical Gaze Palsy
Corticobasal Ganglionic Degeneration
Tau Pathology
- relatively rare
- Cortical Involvement
- - Apraxia, cortical sensory loss
- Alien Limb Sign
Levodopa (L-DOPA) in PD
L-Dopa precursor to dopamine that can pass through the BBB
Response is maintained throughout the disease but duration of benefits decreases over time.
Other Treatments for PD
MAO Inhibitors
COMT Inhibitors
DA agonists
Deep Brain Stimulation
MAO Inhibitors
Inhibits MAO increasing [DA] in cleft
COMT Inhibitors
Reduce peripheral conversion of L-Dopa
Works Presynaptically
More L-Dopa can cross the BBB and increase DA in the brain
DA Agonists
Mimic effects of Dopamine post synaptically by binding to dopamine receptors
