Introduction to movement disorders Flashcards

1
Q

What is the internal capsule?

A

Myelinated fibres running from Cortex to brainstem

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2
Q

3 components of basal ganglia

A

Head of caudate, lentiform and thalamus

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3
Q

Cardinal signs of Parkinson’s

A

Rigidity, tremor, bradykinesia, postural instability

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4
Q

Brain changes in Parkinson’s

A

Loss of dopamine in substantia nigra

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5
Q

Cardinal signs of Parkinsons on DAT scan

A

Asymmetry and loss of comma shaped substantia nigra

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6
Q

Dx Parkinson’s

A

Levodopa trial, DAT scan

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7
Q

How does L-dopa work?

A

L-dopa can cross BBB (dopamine cant) where decarboxylase converts to dopamine. Dopamine is packaged into vesicles and enters synapse

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8
Q

How does carbidopa work?

A

Normally, a reduced amount of l-dopa can cross BBB because it is broken down by DDC in periphery
Carbidopa inhibits DDC to stop breaking down l-dopa
Carbidopa can’t pass BBB so in brain, L-dopa is broken down into dopamine in brain to increase levels

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9
Q

Drug treatment for Parkinson’s

A

Levodopa, carbodopa, dopamine agonists, COMT inhibitors, MOAB inhibitors

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10
Q

How do dopamine agonists work?

A

They mimic dopamine so bind to receptors and reduce side effects of low dopamine levels
Only <65

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11
Q

How do COMT inhibitors work?

A

COMT is an enzyme that normally breaks down dopamine

COMT inhibitors stop this so more dopamine can get to brain

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12
Q

How do MOAB inhibitors work?

A

Mono amino oxidase B breaks down dopamine so MOAB inhibitors stop this

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13
Q

Surgical treatment for Parkinson’s

A

Make lesions using ultrasound and MRI, DBS, reconstruct lost circulation

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14
Q

DBS

A

Electrodes inserted into sub thalamic nucleus, must be careful because optic nerve runs below

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15
Q

How do we reconstruct lost circulation in Parkinson’s patients?

A

Relevant brain area is dissected from developing foetus which is made into suspension and injected into brain, acts as stem cells

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16
Q

Side effects of dopamine agonists

A

Hyper sexuality, personality changes like gambling

17
Q

What is Parkinsonism?

A

A set of characteristic symptoms that can be caused by Parkinson’s disease but also drugs/alcohol etc

18
Q

What is Parkinson’s-plus syndrome

A

Parkinson’s but additional sx too - PSP, MSA, Wilson’s disease, CBD

19
Q

Symptoms os PSP

A

Parkinsonism, can’t look up or down without moving head, Pseudobulbar palsy (mood swings), rigid neck and trunk, dysarthria, dementia

20
Q

MSA

A

Multiple system atrophy -

21
Q

MSA sx

A

parkinsonism, autonomic failure, cerebellar degeneration (poor balance), pyramidal signs (spastic paraparesis and weakness), deep sighs and sleep apnoea

22
Q

Dx MSA

A

Characteristic hot cross bun sign in midbrain on MRI

23
Q

Tx MSA

A

L-dopa, anticholinergics, fludrocortisone

24
Q

Dx dyskinesia

A

PD (rest) or intention tremor (primary), drugs responsible or hyperthyroidism (secondary), get pt to draw spiral to see hand tremor, MRI won’t be of use because tremor won’t be visible

25
Tx dyskinesia
Reassurance, propranolol, primadone
26
What is an orthostatic tremor ?
Tremor in legs occurs when stand-in and walking, frequency of 15 H
27
Treatment for tremor
CLonazepam, pronanolol, gabapentin
28
Treatment for dystonia
Botox and EMG guided botox
29
Areas to inject with botox for dystonia
splenius, SCM, levator scapulae, trapeziuS
30
sx tics
Coprolalia (abusive language) and copropraxia (rude gestures)
31
Main cause of tics
tourette's
32
Characteristics of tics and Tourette's syndrome
OCD, autism, anxiety, ADHD, sensory integration disorder
33
Tx tics
Dopamine agonists SSRIs to manage low mood but they actually make tics worse DBS: centromedian thalamus
34
What is Huntington's disease?
Autosomal dominant condition - CAG twi-nucleotide repeat Striatal loss of neurones in caudate nucleus of basal ganglia Huntington protein interacts with gene expression
35
Sx Huntington;s
Difficulty concentrating, memory lapses, depression, mood swings
36
Tx Huntington's
Deplete dopamine - tetrabenazine