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Movement and control > Introduction to movement disorders > Flashcards

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
Q

Tx dyskinesia

A

Reassurance, propranolol, primadone

26
Q

What is an orthostatic tremor ?

A

Tremor in legs occurs when stand-in and walking, frequency of 15 H

27
Q

Treatment for tremor

A

CLonazepam, pronanolol, gabapentin

28
Q

Treatment for dystonia

A

Botox and EMG guided botox

29
Q

Areas to inject with botox for dystonia

A

splenius, SCM, levator scapulae, trapeziuS

30
Q

sx tics

A

Coprolalia (abusive language) and copropraxia (rude gestures)

31
Q

Main cause of tics

A

tourette’s

32
Q

Characteristics of tics and Tourette’s syndrome

A

OCD, autism, anxiety, ADHD, sensory integration disorder

33
Q

Tx tics

A

Dopamine agonists
SSRIs to manage low mood but they actually make tics worse
DBS: centromedian thalamus

34
Q

What is Huntington’s disease?

A

Autosomal dominant condition - CAG twi-nucleotide repeat
Striatal loss of neurones in caudate nucleus of basal ganglia
Huntington protein interacts with gene expression

35
Q

Sx Huntington;s

A

Difficulty concentrating, memory lapses, depression, mood swings

36
Q

Tx Huntington’s

A

Deplete dopamine - tetrabenazine

Movement and control (20 decks)

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