Lecture 3: Mvmnt Disorders Flashcards

1
Q

Benign Essential Tremor

A
  • postural tremor of hands, head or both
  • fam Hx
  • gets better with alcohol
  • no other abnormal findings
  • tx: propanolol or primidone
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2
Q

Parkinsonism: essentials of dx

A

any combo of tremor, rigidity, BRADYKINESIA, progressive postural instability

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3
Q

Most common variety of Parkinsonism

A

Idiopathic Parkinson Dz: begins btwn 45-65 y/o

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4
Q

Other causes of Parkinsonism

A
  • rarely family basis
  • postencephalic parkinsonism= rare
  • toxin exposure (C disulfide, manganese dust, CO poisoning)
  • MPTP use
  • Reversible parkinsonism: use of neuroleptic drugs
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5
Q

Idiopathic Parkinson Dz etiology

A

dopamine depletion due to degeneration of dopaminergic nigrostriatal system leads to an intolerance of Dopa and Ach

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6
Q

Risk factors for Idiopathic Parkinson

A

Age, fam hx, male sex, ongoing herbicide/pesticide exposure, significant prior head trauma

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7
Q

Parkinson Clinical Findings:

A
  • 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
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8
Q

Park: Clinical Dx

A
  • 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
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9
Q

Other Park findings:

A

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

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10
Q

Park Tx:

A

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

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11
Q

Ldopa side effects

A

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
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12
Q

Huntington Dz main features:

A

***Chorea and dementia and family hx
Other findings: onset 30-50, fatal in 15-20 yrs; very debilitating; CT: atrophy
-NO cure

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13
Q

Idiopathic Torsion Dystonia

A

dystonic mvmnts and postures; NORMAL birth and development: no other neurological signs

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14
Q

Dystonic mvmnts in Idiopathic Torsion Dystonia

A

-mvmnts of head and neck: torticollis, blepharospasm, facial grimacing, forced open/closing of mouth

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15
Q

DDX Idiopathic Torsion

A

-birth trauma, kinecterus, prenatal anoxia all cause dystonia, but all have abnormal early development

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16
Q

Guilles de la Tourette Syndrome : features

A
  • multiple motor tics or phonic tics
  • sx’s begin before 21 y/o
  • tics occur frequently for 1 ye
  • tics vary in #, frequency and nature over time
17
Q

Features of tics

A
  • motor tics: initial manifestation (80%), involve face, head and shoulders
  • phonic tics: 20%, grunts, barks, hisses, throat clearing, coughs; may be verbal utterances; echolalia or palilalia
  • some can be self harming
18
Q

Essential of dx

A

Tic like character of abnormal mvmts and absence of neurological signs

19
Q

Tics Tx

A
  • symptomatic
  • Alpha adrenergic agonists: clonidine
  • typical antipsychs: haloperidol
  • atypical antipsychs: risperidone, apripazole
20
Q

Chorea

A

involuntary, continuous, abrupt, rapid, brief, unsustained, irregular mvmnts that flow from randomly from one body part to another
**dance-like mvmnt of feet and hands

21
Q

Disorders/Drugs that cause Chorea

A

Disorders: Huntington dz, Wilson’s dz

Drugs: Dopaminergics, anti-dopaminergics, anticonvulsants

22
Q

Dystonia:

A

neurologic syndrome characterized by involuntary, sustained, patterned, and often repetitive muscle contractions of opposing muscle movements or abnormal postures
***longer duration than chorea, twisting of body parts, younger age at onset

23
Q

Drugs that cause Dystonia

A

Dopamine blocking agents, neuroleptics, certain nausea meds