Lecture 3: Mvmnt Disorders Flashcards
Benign Essential Tremor
- postural tremor of hands, head or both
- fam Hx
- gets better with alcohol
- no other abnormal findings
- tx: propanolol or primidone
Parkinsonism: essentials of dx
any combo of tremor, rigidity, BRADYKINESIA, progressive postural instability
Most common variety of Parkinsonism
Idiopathic Parkinson Dz: begins btwn 45-65 y/o
Other causes of Parkinsonism
- rarely family basis
- postencephalic parkinsonism= rare
- toxin exposure (C disulfide, manganese dust, CO poisoning)
- MPTP use
- Reversible parkinsonism: use of neuroleptic drugs
Idiopathic Parkinson Dz etiology
dopamine depletion due to degeneration of dopaminergic nigrostriatal system leads to an intolerance of Dopa and Ach
Risk factors for Idiopathic Parkinson
Age, fam hx, male sex, ongoing herbicide/pesticide exposure, significant prior head trauma
Parkinson Clinical Findings:
- tremor: usually one limb or one side of body for many yrs before becoming more generalized; decreases with voluntary mvmnts
- rigidity
- bradykinesia: most disabling of sx’s: ***decrease arm swinging
Park: Clinical Dx
- immobile face w/ widened palpebral fissures; infrequent blinking; fixity of facial expression
- blepharoclonus and tremor at mouth/lips
- repetitive tapping at bridge of nose prides sustained blinking = Myerson sign
Other Park findings:
gait: shuffling of feet, slow to turn, no swinging of arms
- impairment of fine rapid alternating mvmnts and micrographia
- NO muscle weakness, alteration in reflexes or plantar response
Park Tx:
Amatadine: mild sx’s, help with side effects of l-dopa
Anticholinergic agents: better balance with dopa levels
L-dopa: improves all major features of parkinsonism; long term use increase side effects
Dopamine Agonist: directly act on dopa receptors and help with SE of Ldopa
Selective MOIs: rasagiline: inhibit breakdown of Dopa
COMT inhibs: reduce metab of Ldopa, decrease SE due to increase levels of Ldopa = entacapone
Atypical antipsychs
Brain stimulation
Ldopa side effects
Occurs wit=h prolonged use
- dyskinesia, restlessness, confusion, and other behavioral changes
- “on/off” phenomenon: abrupt transient fluctions in severity throughout day with marked bradykinesia
Huntington Dz main features:
***Chorea and dementia and family hx
Other findings: onset 30-50, fatal in 15-20 yrs; very debilitating; CT: atrophy
-NO cure
Idiopathic Torsion Dystonia
dystonic mvmnts and postures; NORMAL birth and development: no other neurological signs
Dystonic mvmnts in Idiopathic Torsion Dystonia
-mvmnts of head and neck: torticollis, blepharospasm, facial grimacing, forced open/closing of mouth
DDX Idiopathic Torsion
-birth trauma, kinecterus, prenatal anoxia all cause dystonia, but all have abnormal early development