Ch 12 - Movement Disorders Flashcards

1
Q

What is an essential tremor?

A

Posture-maintaining tremor associated with sustained muscle contraction or stress

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2
Q

What is an intention tremor?

A

Tremor at end of purposeful movement

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3
Q

What is Parkinson’s Disease?

A
  • d/o of basal ganglia d/t loss of cells in substantia nigra and locus coeruleus where dopamine produced
  • Degeneration of nigrostriatal pathway results in ↓ dopamine in corpus striatum
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4
Q

What are signs of Parkinson’s Disease?

A
  • Resting tremor (“pill-rolling”) 3-5 Hz
  • Bradykinesia
  • Cogwheel rigidity
  • Masked facies
  • Lead pipe rigidity
  • Postural instability
  • Freezing
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5
Q

What is the general goal of treatment in Parkinson’s Disease?

A
  1. ↑ dopamine action

2. ↓ cholinergic effect

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6
Q

What are ergot derivatives?

A

Dopamine agonist agents produce symptomatic benefit by direct stim of dopamine receptors:
– Bromocriptine
– Pergolide (Permax®)

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7
Q

What are non-ergot derivatives?

A

– Ropinirole (Requip®)

– Pramipexole (Mirapex®)

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8
Q

What is the MOA of amantadine?

A

Antiviral agent

Potentiates the release of endogenous dopamine

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9
Q

What are anticholinergic agents used for in Parkinson’s?

A

Relieve tremor

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10
Q

What does a unilateral Thalamotomy do?

A

Relieve contralateral tremor

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11
Q

What does a unilateral pallidotomy do?

A

Permanent ablation of a portion of the globus pallidus

Improve dyskinesias, stiffness, and freezing

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12
Q

What does subthalamic nucleus DBS do?

A

Improves bradykinesia, rigidity and tremor
Reduces parkinson’s medications by 1/2
MC surgical procedure for PD

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13
Q

What does thalamic DBS do?

A

Reduces tremor on contralateral side
Worsens bradykinesia, rigidity and gait
Limited use

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14
Q

What does pallidal DBS do?

A

Controls all cardinal symptoms of PD

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15
Q

What should swallow evaluation be done for in PD?

A

Evaluate for oropharyngeal dysphagia

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16
Q

What can cause drug-induced parkinsonism?

A
Neuroleptic agents (haloperidol)
Metoclopramide (Reglan®)
Reserpine
Amiodarone
Lithium
17
Q

What is Dementia pugilistica?

A

Parkinsonism associated with repeated trauma to the head

18
Q

What are Parkinson-plus syndromes?

A

– Progressive supranuclear palsy: Vertical gaze palsy

– Multisystem Atrophy-Parkinsonian Type (MSA-P)

19
Q

What is Progressive supranuclear palsy?

A

Vertical gaze palsy: patient cannot look down

Parkinsonian features with bradykinesia and rigidity (axial)&raquo_space; tremor

20
Q

What is the Most common among parkinsonism-plus syndromes?

A

Progressive supranuclear palsy

21
Q

What are types of Multisystem Atrophy-Parkinsonian Type (MSA-P)?

A

■Shy-Drager syndrome
■ Olivopontocerebellar atrophy
■ Striatonigral degeneration

22
Q

What is Shy-Drager syndrome?

A

Parkinsonian features with dysautonomia (autonomic dysfunction)

23
Q

What is Olivopontocerebellar atrophy?

A

Parkinsonian features with ataxia and dysarthria

24
Q

What is Striatonigral degeneration?

A

Parkinsonian features with dystonia (anterocollis); tremor uncommon

25
What is Huntington's disease?
ABN movements (chorea) d/t heightened sensitivity of striatal dopamine receptors
26
What is the cause of Huntington's disease?
AD Trinucleotide CAG repeat on Chr 4p16.3 Huntington ABN gene accumulates in the brain
27
What is the triad of Huntington's disease?
1. Chorea/choreathetosis 2. Dementia and personality d/o 3. Family hx
28
What is the cause of death Huntington's disease?
Aspiration PNA 15-20 years after diagnosis
29
What is the goal of treatment of Huntington's disease?
Dec Dopamine action
30
What are characteristics of Ataxia-Telangiectasia?
Progressive ataxia in early childhood Oculocutaneous telangiectasia High incidence of neoplasia
31
What differentiates early-onset cerebellar ataxia with Friedreich's ataxia?
Presence of DTR | No DTR's in Friedreich's
32
What is the MC form of inherited MR?
Fragile-X syndrome