Lecture 20: Movement Disorders, Clinical Phenomenology Flashcards
What are movement disorders?
Conditions characterized by abnormal voluntary movements or excessive involuntary movments
- you can have hypokinetic or hyperkinetic features - reflect dysfunction among basal ganglia structures and between the basal ganglia, cerebellum and other CNS areas
Dystonia
SUSTAINED muscle contraction usually producing TWISTING movements or abnormal postures that are PATTERNED and usually directional
Example: Writer’s dystonia…if someone with this guy holds a pen, arm will be in a contracted state…writers cramp
Tremor
rhythmic, oscillatory movements caused by alternate contraction of opposing muscle groups….PERIODIC MOTION
Differentiation from myoclonus because tremors are rhythmical and myoclonus has a fast and slow phase
Example: PD vs. Essential tremor
Former = assymetrical and latter is symmetrical
PD will have SMALL handwriting, while essential tremor has shaky handwriting
How do you classify the tremor?
i. At rest: PD/parkinsonism
ii. postural: ET, PD, physiologic
iii. Kinetic (when you are moving): ET, cerebellar
iv. Task specific: dystonia
v. All actions: Rubral/cerebellar, ET
When you see tremor, how do you differentiate between PD vs. ET?
PD = rest tremor, asymmetric, micrographia ET = postural/action tremor, symmetric, shaky-graphia (tremor while you are writing)
Tics
intermittent, repeated, and stereotyped movements or sounds (ex. Throat clearing, excessive blinking) under SOME UNDER VOLUNTARY CONTROL
(urge to make the “tic”…need an urge)
Example: Tourette’s Syndrome (motor AND vocal tic)
Great imitator…defining feature is the fact that the patient has “urge”
Motor tic = blinking
Vocal ticks = blowing hair
Myoclonus
SHOCK-LIKE or lightning-like contraction or JERK
-defined by sleep
Example: CJD
How do you classify myoclonus?
i. Physiologic: hypnic jerks (jerks right when you’re about to sleep)…what you do when you jerk awake during lecture…LOL
ii. Hereditary: ET, epileptic, degenerative
iii. Secondary: metabolic, drugs
Chorea
“Dance”; irregular, rapid, random movements that seem to flow from one body part to another
Example: huntington’s disease
Ballism
Form of chorea in which LARGE AMPLITUDE jerking or flinging movement, usually of proximal extremity predominates
Example: on a spectrum with chorea
Athetosis
WRITHING movement of flexion, extension, pronation, supination of fingers and hands, and sometimes of toes and feet
Hypokinetic:
Too few, too small, too slow
Example: PD = hypokinetic
Hyperkinetic
too much, too big, too fast
Example: Essential Tremor
Huntington’s
Phenomenology
the study of the development of human consciousness and self-awareness as a preface to or a part of philosophy
- in relation to movement disorders, you just say what you see
- terminology of movement disorders
What are the clinical symptoms of PD?
Major symptom: rest tremor, bradykinesia (hypokinesia), cogwheel rigidity (stiffness of muscles around a joint)
Minor symptom: micrographia, takes many steps to turn
