Hypokinetic Movement Disorders

Question 1

Akinesia

Answer 1

Absence, slowness, or decreased amplitude or movements

Question 2

Rigidity

Answer 2

Increased muscle tone to passive motions

Velocity independent

Question 3

Spasticity vs rigidity

Answer 3

Rigidity is increased muscle tone to passive movements

Spasticity is the abnormal muscle contravtion

Question 4

PD classic signs

Answer 4

Tremor at rest
Rigidity
Akinesia/bradykinesia
Postural instability (stoop)

TRAP

Question 5

Tremor in PD

Answer 5

Slow 
Pill rolling 
Asymmetric initially 
May emerge with distraction
Reemerge with sustained posture or walking 

Tremor predominant types are slower progressing

Question 6

Bradykinesia of PD

Answer 6

Slowness of movement

Look for decrement in amplitude

Question 7

Rigidity of PD

Answer 7

Lead Pipe (can be especially felt at the rist)
Must be distingusihed by spasticity (velocity-dependent component in spasticity…UMN)
Cogwheeling
Check axial rigidity at neck

Question 8

PD gait

Answer 8

Decreased armswing and turn en bloc

Pull test positive if more than 2 steps

Also will have freezing of the gait and festination

Question 9

REM behavior disorder

Answer 9

Loss of REM sleep
Vivid dreams
EMG atonia

Question 10

Parkinson prodrome

Answer 10

Olfaction
REM
Constipation
Mood changes

Also could have small handwriting

Question 11

Parthyology of PD

Answer 11

Degen of SN and striatum
Increased microglial activity
alpha synuclein accumulation

Question 12

Prior like hypothesis

Answer 12

Misfolded protein in cell
Transcellular porpogation
Seeding of further misfolded protein in recipient cell

Question 13

Enteric synucleinopathies hypothessi

Answer 13

Neurotropic pathogen enters Meissner’s plexus at gut and then reaches preganglionic parasynpathetic of vagus nerve to travel to medulla

Question 14

Non pharm tx of PD

Answer 14

Exercise early and often and PT

Question 15

PD pharm tx

Answer 15

Mostly carbidopa-levodopa

If younger, may give dopamine agonists

Question 16

Motor fluctuations of PD tx

Answer 16

Wearing off
Dyskinesias 
Dystonia 
Early morning akinesia 
Freezing of gait

Question 17

For tremor nonresponsive to dopaminergics
For wearing off/motor fluctuations
For dyskinesias

Answer 17

Anticholinergics in young
Rytary/duopa
DBS?

Question 18

DBS

Answer 18

GPI or STN - rigitidy, bradykinesia, gait, dystonia

VIM - tremor