Ch 12 - Movement Disorders Flashcards
What is an essential tremor?
Posture-maintaining tremor associated with sustained muscle contraction or stress
What is an intention tremor?
Tremor at end of purposeful movement
What is Parkinson’s Disease?
- 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
What are signs of Parkinson’s Disease?
- Resting tremor (“pill-rolling”) 3-5 Hz
- Bradykinesia
- Cogwheel rigidity
- Masked facies
- Lead pipe rigidity
- Postural instability
- Freezing
What is the general goal of treatment in Parkinson’s Disease?
- ↑ dopamine action
2. ↓ cholinergic effect
What are ergot derivatives?
Dopamine agonist agents produce symptomatic benefit by direct stim of dopamine receptors:
– Bromocriptine
– Pergolide (Permax®)
What are non-ergot derivatives?
– Ropinirole (Requip®)
– Pramipexole (Mirapex®)
What is the MOA of amantadine?
Antiviral agent
Potentiates the release of endogenous dopamine
What are anticholinergic agents used for in Parkinson’s?
Relieve tremor
What does a unilateral Thalamotomy do?
Relieve contralateral tremor
What does a unilateral pallidotomy do?
Permanent ablation of a portion of the globus pallidus
Improve dyskinesias, stiffness, and freezing
What does subthalamic nucleus DBS do?
Improves bradykinesia, rigidity and tremor
Reduces parkinson’s medications by 1/2
MC surgical procedure for PD
What does thalamic DBS do?
Reduces tremor on contralateral side
Worsens bradykinesia, rigidity and gait
Limited use
What does pallidal DBS do?
Controls all cardinal symptoms of PD
What should swallow evaluation be done for in PD?
Evaluate for oropharyngeal dysphagia
What can cause drug-induced parkinsonism?
Neuroleptic agents (haloperidol) Metoclopramide (Reglan®) Reserpine Amiodarone Lithium
What is Dementia pugilistica?
Parkinsonism associated with repeated trauma to the head
What are Parkinson-plus syndromes?
– Progressive supranuclear palsy: Vertical gaze palsy
– Multisystem Atrophy-Parkinsonian Type (MSA-P)
What is Progressive supranuclear palsy?
Vertical gaze palsy: patient cannot look down
Parkinsonian features with bradykinesia and rigidity (axial)»_space; tremor
What is the Most common among parkinsonism-plus syndromes?
Progressive supranuclear palsy
What are types of Multisystem Atrophy-Parkinsonian Type (MSA-P)?
■Shy-Drager syndrome
■ Olivopontocerebellar atrophy
■ Striatonigral degeneration
What is Shy-Drager syndrome?
Parkinsonian features with dysautonomia (autonomic dysfunction)
What is Olivopontocerebellar atrophy?
Parkinsonian features with ataxia and dysarthria
What is Striatonigral degeneration?
Parkinsonian features with dystonia (anterocollis); tremor uncommon
What is Huntington’s disease?
ABN movements (chorea) d/t heightened sensitivity of striatal dopamine receptors
What is the cause of Huntington’s disease?
AD
Trinucleotide CAG repeat on Chr 4p16.3
Huntington ABN gene accumulates in the brain
What is the triad of Huntington’s disease?
- Chorea/choreathetosis
- Dementia and personality d/o
- Family hx
What is the cause of death Huntington’s disease?
Aspiration PNA 15-20 years after diagnosis
What is the goal of treatment of Huntington’s disease?
Dec Dopamine action
What are characteristics of Ataxia-Telangiectasia?
Progressive ataxia in early childhood
Oculocutaneous telangiectasia
High incidence of neoplasia
What differentiates early-onset cerebellar ataxia with Friedreich’s ataxia?
Presence of DTR
No DTR’s in Friedreich’s
What is the MC form of inherited MR?
Fragile-X syndrome
