L10: Movement Disorders Flashcards
Def of Extrapyramidal Disorders
disorders which impairs the regulation of voluntary motor activity without directly affecting strength, sensation or cerebellar function.
Types of Extrapyramidal Disorders
Def of Extrpyramidal System
Functional system including all nuclei & descending neural pathways outside pyramidal system acting on lower motor neurons.
Functions of Extrpyramidal System
Def of Parkinson’s Disease
Etiology of Parkinson’s Disease
Degeneration of nigrostriatal dopamine system in brain.
Epidemeology of Parkinson’s Disease
- The most common Extra-pyramidal disease is ……
PD
Epidemeology of Parkinson’s Disease
- Age
- 40 - 70 years of age,
- peak age of onset in the 6th decade
- infrequent before 30 years of age.
Epidemeology of Parkinson’s Disease
- Sex
Men are more affected (3:2)
Epidemeology of Parkinson’s Disease
- Incidence
a) All ethnic groups, all socioeconomic classes are affected more in some countries.
b) Egypt: 2nd in prevalence more in rural and boxers
c) Less prevalent in China and other Asian countries, and in African Americans.
Functional Neuroanatomy of Parkinson’s Disease
Neurochemistry in Parkinson’s Disease
Neuropathology of Parkinson’s Disease
Pathogenesis of Parkinson’s Disease
RF for Parkinson’s Disease
CP of Parkinson’s Disease
CP of Parkinson’s Disease
- Face
Mask expressionless face.
CP of Parkinson’s Disease
- Limbs & trunck
Flexed rigid attitude
CP of Parkinson’s Disease
- cardinal Symptoms
- Resting Iremors (main symptom)
- Bradykinesia
- Muscle Rigidity
- Postural instability
what is the most common symptom of Parkinson’s Disease?
Resting tremors
CP of Parkinson’s Disease
- Tremors
CP of Parkinson’s Disease
- Bradykinesia
CP of Parkinson’s Disease
- Voluntary movements
CP of Parkinson’s Disease
- Associative Symptoms
Diminution or loss (e.g. loss of swinging of arms in walking).
CP of Parkinson’s Disease
- Speech
slow, quite & monotonous.
CP of Parkinson’s Disease
- Writing
becomes progressively smaller (Micrographia).
CP of Parkinson’s Disease
- Muscle Rigidity
CP of Parkinson’s Disease
- Postural Instability
D2 loss of postural reflexes.
CP of Parkinson’s Disease
- Gait
CP of Parkinson’s Disease
- Propulsion, Retropulsion & Lateropulsion
patient is unable to stop quickly when pushed forwards, backwards, or laterally.
CP of Parkinson’s Disease
- Fesinating Gait
spontaneous propulsion during walking
CP of Parkinson’s Disease
- kinesia Paradox
patient can do rapid movements better than slow ones e.g. He can walk only very slowly, but may be able to run quite fast.
CP of Parkinson’s Disease
- Reflexes
CP of Parkinson’s Disease
- sensation
Intact: in most cases..
CP of Parkinson’s Disease
- Autonomic System
Impaired GIT motility, bladder dysfunction, sialorrhea, excessive head and neck sweating, and orthostatic hypotension.
CP of Parkinson’s Disease
- Depression
Mild to moderate depression in 50% of patients.
CP of Parkinson’s Disease
- Cognitive Impairment
Dx of Parkinson’s Disease
TTT of Parkinson’s Disease
medical & surgical
Medical Options for Parkinson’s Disease
Dopamenrigic Thrapy:
- DOPA subs.
- Dopamine receptor Agonist
- Metabolism Inhibitors
Others:
- Amantadine
- Anticholinergic Drugs
Dopamenergic Therapy for Parkinson’s Disease
…
TTT of Parkinson’s Disease
- DOPA subs
Cornerstone for TTT of Parkinson’s Disease
DOPA Substitution L-dopa + decarboxylase inhibitor (Sinemet)
TTT of Parkinson’s Disease
- DOPA subs
Mechanism of L-dopa & decarboxylase inhibitor
TTT of Parkinson’s Disease
- Limitations of DOPA Subs
Examples of Dopamine Receptor Agonists
TTT of Parkinson’s Disease
- Metabolism Inhibitors
TTT of Parkinson’s Disease
- Other therapies
TTT of Parkinson’s Disease
- MOA of Amantadine
TTT of Parkinson’s Disease
- SE of Amantadine
as L-dopa but milder
TTT of Parkinson’s Disease
- MOA of Anticholinergic Drugs
Effective on tremor
TTT of Parkinson’s Disease
- SE of Anti-cholinergics
Dry mouth, blurring of vision, constipation, urinary retention, confusion state, hallucinations & impairment of memory.
TTT of Parkinson’s Disease
- Surgical TTT
Def of Myoclonus
Sudden, brief, shock-like involuntary movements.
Types of Myoclonus
Types of Generalized Myoclonus
Types of Generalized Myoclonus
- Physiologic
Types of Generalized Myoclonus
- essential
Types of Generalized Myoclonus
- Epileptic
Types of Generalized Myoclonus
- Symptomatic
Causes of Segmental Myoclonus
Examples of Segmental Myoclonus
TTT of Myoclonus
- Valproic acid is drug of choice.
- May respond to benzodiazepines e.g. clonazepam.
Notes
Def of Hemiballismus
Etiology of Hemiballismus
Usually due to a CVA in contralateral subthalamic nucleus
CP of Hemiballismus
Characters of Chorea
Causes of Chorea, Dystonia & Athetosis
Causes of Chorea, Dystonia & Athetosis
- Hereditary
Causes of Chorea, Dystonia & Athetosis
- Drugs
Causes of Chorea, Dystonia & Athetosis
- CVD
(schemia, hemorrhage) Most common acquired cause of chorea
Causes of Chorea, Dystonia & Athetosis
- Structural Lesions
subthalamic nucleus)
Causes of Chorea, Dystonia & Athetosis
- 2ry to medical Disorders
Causes of Chorea, Dystonia & Athetosis
- Miscellaneous
RF for Rheumatic (Sydenham’s) Chorea
Infections predisposing for Rheumatic (Sydenham’s) Chorea
CP of Rheumatic (Sydenham’s) Chorea
Clinical Varities of Rheumatic (Sydenham’s) Chorea
Chorea Gravidarum
TTT of Rheumatic (Sydenham’s) Chorea
TTT of Rheumatic (Sydenham’s) Chorea
- Bed Rest
(physical & mental) for 4 weeks, longer stay is necessary in carditis.
TTT of Rheumatic (Sydenham’s) Chorea
- Sedatives
phenobarbitone,
TTT of Rheumatic (Sydenham’s) Chorea
- corticosteroids
for active carditis, rheumatic fever& failure of other lines of treatment.
TTT of Rheumatic (Sydenham’s) Chorea
- Tonsilectomy
if there is a history of recurrent tonsillitis & sore throat, performed after convalescence from chorea.
TTT of Rheumatic (Sydenham’s) Chorea
- Long-acting penicillin
(prophylactic against streptococcal infection).
Wilson’s disease
Idiopathic torsion dystonia
Dopa-responsive dystonia
Site of Athetosis
- distal parts of limbs (hands, fingers).
- Can also affect face and tongue
Characters of movements of Athetosis
Involuntary movements characterized by :
- Slow, flowing, often twisting
- Continuous
- Snake-like movements
choreoathetosis
Often use term “ choreoathetosis” due to overlap () syndromes ( chorea referring to less smooth, more jerky movements)
Characters of Dystonia
Condition in which the patient assumes a sustained, abnormal posture or limb position
Pathology in Dystonia
Due to co-contraction of agonist and antagonist muscles in part of body
Types of Dystonia
- Generalized (Torsion) dystonia.
- Focal dystonia.
Def of Generalized (torsion) Dystonia
Involuntary torsion movements of trunk & proximal segment of limbs.
CP of Generalized (torsion) Dystonia
CP of Generalized (torsion) Dystonia
- Age
childhood or adolescence (Familial type).
CP of Generalized (torsion) Dystonia
- No ….
pyramidal signs or wasting.
CP of Generalized (torsion) Dystonia
- Normal …..
Reflexes, sensations, mentality & speech.
CP of Generalized (torsion) Dystonia
- tone
Hypertonia during spasms & hypotonia in-between them.
Examples of Focal Dystonia
Managment of Focal Dystonia
Def of TICS
Recurrent, stereotyped abnormal movements
Etiology of TICS
- Primary; Tourette’s syndrome.
- Secondary: Huntington’s disease.
Characters of TICS
A. May be suppressed voluntarily or with distraction
B. Voluntary suppression leads to anxiety and a build-up of internal unrest.
C. Worsen under
Def of tremors
Classification of tremors
Clinical class. of tremors
TTT of tremors
