Lecture 3: Mvmnt Disorders

Question 1

Benign Essential Tremor

Answer 1

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

Question 2

Parkinsonism: essentials of dx

Answer 2

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

Question 3

Most common variety of Parkinsonism

Answer 3

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

Question 4

Other causes of Parkinsonism

Answer 4

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

Question 5

Idiopathic Parkinson Dz etiology

Answer 5

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

Question 6

Risk factors for Idiopathic Parkinson

Answer 6

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

Question 7

Parkinson Clinical Findings:

Answer 7

• 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

Question 8

Park: Clinical Dx

Answer 8

• 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

Question 9

Other Park findings:

Answer 9

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

Question 10

Park Tx:

Answer 10

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

Question 11

Ldopa side effects

Answer 11

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

Question 12

Huntington Dz main features:

Answer 12

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

Question 13

Idiopathic Torsion Dystonia

Answer 13

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

Question 14

Dystonic mvmnts in Idiopathic Torsion Dystonia

Answer 14

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

Question 15

DDX Idiopathic Torsion

Answer 15

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

Question 16

Guilles de la Tourette Syndrome : features

Answer 16

• 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

Question 17

Features of tics

Answer 17

• 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

Question 18

Essential of dx

Answer 18

Tic like character of abnormal mvmts and absence of neurological signs

Question 19

Tics Tx

Answer 19

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

Question 20

Chorea

Answer 20

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

Question 21

Disorders/Drugs that cause Chorea

Answer 21

Disorders: Huntington dz, Wilson’s dz

Drugs: Dopaminergics, anti-dopaminergics, anticonvulsants

Question 22

Dystonia:

Answer 22

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

Question 23

Drugs that cause Dystonia

Answer 23

Dopamine blocking agents, neuroleptics, certain nausea meds