CM: Movement Disorders Flashcards
What is parkinsonism?
clinical syndrome w several components: bradykinesia, tremors at rest, rigidity, stooped posture, shuffling gait, postural instability
What is bradykinesia/akinesia?
slowness of movement, absence or paucity of spontaneous movement and/or decreased amplitude
What is a tremor?
rhythmic oscillation of any body part, amplitude varies but frequency predictable
What are the different kinds of tremors?
essential, rest, dystonic, task-specific
What is Parkinson Disease?
neurodegenerative disorder characterized by paucity or slowness of movements and rest tremor
also has flexed posture, freezing, asymmetrical onset
How can Parkinson dz be diagnosed?
bradykinesia and 1 of the following: rigidity, rest tremor, postural instability (appears later)
exclude other etiologies
What are non-motor symptoms of Parkinson’s dz?
REM behavior disorder, cognitive disorders, autonomic dysfunction, GI and GU symptoms, sexual dysfunction, sensory symptoms (restless leg), fatigue
What is the pathogenesis of Parkinson’s dz?
less inhibition of SN –> more inhibition of thalamus –> less activation of cortex
When is levodopa used as treatment for Parkinson’s?
initiated when symptoms are “disabling”
complications = side effects, motor fluctuations, dyskinesia
When are DOPA agonists used as treatment for Parkinson’s?
early onset therapy, less effective long term, more side effects in older patients (sudden somnolence, hallucinations, edema, compulsive behaviors)
What are the features of surgical management of PD?
motor symptoms not optimally controlled: on-off fluctuations, significant dyskinesias
no evidence of cognitive decline
includes deep brain stimulation of STN or GPi
What are the features of DBS in PD?
doesn’t cure
bilateral needed for gait
smooths out on-off fluctuations, improves tremor, rigidity, dyskinesia
akinesia and postural instability responds least
programming requires frequent diligent follow up
decreases meds, doesn’t eliminate them
How can essential tremor be recognized?
progressive action tremor: postural + kinetic
bilateral: may involve head, voice, limbs
absence of other progressive neurological signs
may be mitigated by alcohol
torpedoes = swelling of proximal purkinje cells in cerebellum
What is dystonia?
abnormal muscle contraction causing sustained posture, co-contraction of agonist-antagonists
interrupts and is induced by limb movement
may cause repetitive tremor-like contractions
What are the different types of dystonia?
focal or generalized
idiopathic = primary cervical dystonia
drug induced = acute dystonia, tardive dystonia
genetic = primary torsion, dopa-responsive, Wilson’s dz
blepharospasm = eye closure
What is chorea?
non-rhythmyic, abrupt, unsustained
writhing, flowing, dance-like
random, unpredictable timing
focal or generalized
What is ballism/hemiballism?
proximal, large amplitude, hemibody movements from lesion of contralateral STN/basal ganglia
What is dyskinesia?
abnormal, involuntary, hyperkinetic movements
nonspecific
What is stereotypy?
repetitive, usually continuous movements
fragments of normal movements
autism, rett disorder, mental retardation
How can tardive dyskinesia be recognized?
persistent abnormal involuntary movements
face, mouth, lip sterotypies (chewing movements, tongue protrusion)
choreiform movements of limbs
pelvic thrusting, dystonia
How can Wilson’s dz be recognized?
high serum and urine copper, low ceruloplasmin
neurological: tremor, drooling, dystonia, parkinsonian syndrome, cognitive impairment, dementia, psychosis
giant panda sign in midbrain
How can Sydenham dz be diagnosed?
usually after group A beta hemolytic strep
chorea (hemi, of distal extremities), hypotonia, tics, behavioral abnormalities
elevated anti-streptolysin O, DNA-ase B titers
What is the clinical triad of Huntington’s?
chorea and other movement abnormalities, cognitive (dementia, executive dysfunction), psychiatric (personality changes, depression, disinhibition, OC, addiction)
What is myoclonus?
non-rhythmyic, abrupt, unsustained, rapid jerk-like
random unpredictable timing
What is a tic?
recognizable pattern, unpredictable timing
urge –> tic –> transient relief –> urge –> tic…
How can Tourette’s syndrome be diagnosed?
multiple motor and phonic tics
occur many times a day for at least 1 yr
onset before 21, no other explanation
What is the pathophysiology of Huntingtons?
AD
CAG repeats >40
>60 = juvenile form
