Lecture 3: Parkinsons/Movement Disorders Flashcards
Physiological Tremor
- 6-12Hz
- Normal finding
Intention tremor
- During activity
- Cerebellar injury → superior cerebellar peduncle involvement
- Tremor increases when trying to focus a laser to a target
Resting tremor
- 4-6Hz
- associated with parkinsons disease
- Think → basal ganglia
Chorea
- Dance like movements
- Involuntary rapid, irregular muscle jerks
Chorea is associated with a lesion to
caudate or putamen
Can voluntary movements be distorted with chorea?
Yes; especially if strong facial and tongue movements can be observed
chorea when unilateral is called
- what muscles are most invovled
hemibalismus
Proximal muscles of a single limb are the most involved
Dystonia & Athetosis
- Slow, purposeless, writhing movements (athetosis)
- Dystonia refers to those movements which are more like or turn into postures
Are dystonia and Athetosis present during sleep?
What are they effected by?
No
Stress and intention
Athetosis and dystonia are associated with:
perinatal anoxia, CP, Huntington’s & drug side effect
can be categorized as inhereited or required
Myoclonus
Sudden, violent muscle jerks
physiologic myoclonus examples
nocturnal myoclonus and hiccups
Essential myoclonus
- isolated abnormality
- myoclonic muscle jerks are the most prominent or only clinical finding
Epiletic myoclonus
manifestation of epilepsy
Tics
- sudden, recurrent, coordinated abnormal movements or verbilizations
- occur repeatedly
- can be voluntarily supressed for short periods of time
- worsen with stress
- diminished during voluntary movements or mental concentration and dissapear during sleep
transient simple tics
common in children; usually go away within a year
chornic simple tics
begin in childhood; benign but don’t go away
persistent single or multiple tics of childhood or adolesence
verbal and/or motor with complete remission by the end of adolesence
Tourette’s Syndrome
chronic multiple motor and vocal
Involuntary verbal tics typical to include
grunts, barks, hisses, or coughing
Tourettes
Coprolalia
vulgar or obscene utterances
Tourettes
Echolalia
parroting of another’s speech
Tourettes
parilalia
repeating the same word over and over
involuntary motor tics common to include
blinking, grimacing, sniffing
Tourettes
echopraxia
imitation of another’s movement
Tourettes
Self-mutilation
- 40-50%
- Biting nails, picking nose, pulling hair
Other related phenomena related to tourretes:
- Attention defecits
- Learing difficulties
- Impulse control and OCD
Lesions of the basal ganglia decompose ___ into _____
decompose behavior into isolated motor acts
Lesions of basal ganglia decompose intended motor acts into ____
- movements of innapropriate amplitude
- too little or too much
Idopathic Parkinsons
- Progressive neurodegenerative disease
- Deficits due to loss of dopamine degeneration of dopaminergic neurons in substatina nigra parts compacta
Idopathic parkinsons have ___ symptoms and respond to ____
Hypokinetic symptoms
levodopa - works my converting to dopamine in the brain
Idopathic Parkinsons
Temor dominant
- Resting Tremor is the first sign
- Akineitic
- More common in younger people
Idopathic Parkinsons
PIGD
More postural instability, gait difficulty - associated with worse prognosis
more common in older people
Genetic factors of parkinsons
- 5-10% familial inheritance
- role of alpha-synuclein protein
- Lewy bodies
Environemtal risk factros for PD
environmental toxins
High Risk of Parkinsons
- Rural living
- well water
- Agriculture occupation
- High dairy consumption
- Head injury
- Methamphet. use
- Melanona
Low risk of Parkinsons
- Cigs
- Alcohol
- Caffiene
- Physical activity
- Regualar ibuprofen use
- Calcium channel blocker
Pathology of Parkinsons
Distribution of Lewy bodies is more widespread than originally appreciated
Early non-motor signs of PD
- High level of evidence for olfaction involvement (hyposomia)
- constipation
- REM sleep behavior disorder
Severity of PD correlates with the extent of degeneration of ___ neurons in SNpc.
dopamineric
Cardinal features of sporadic PD
- Resting tremor
- Rigidity -cogwheel or lead pipe
- Bradykinesia- slow movement
- Postural instability
PD has a ___ onset
- unilateral onset with persistent assymetry
- always starts unilaterally and becomes a bilateral disease
- Progressive
- responses to dopamine therapy
- Olfactory dysfunction
exclusion criteria of PD
- Lack of benefit from dopamine
- Current or recurrent use of dopaminergic blockers
- documentation of alternative cause
- hydrocephalus, encephalitis, trauma, toxins, vascular disorder
exclusion criteria of PD - phyisical exam
- Cerebellar signs
- Early dimentia
- Supranuclear gaze
- PD limited to LEs for more than 3 years
- Cortical signs (aphaasia, apraxia, astero-agnosia)
Diseases that may look like PD
- Progressive supranuclear palsy
- multiple system atrophy
- lewy body disease
PD voluntary movement
- Akinesia
- no movement
- delay in initiation
- bradykinesia
- slow movement
- Hypokinesia
- low amplitude movement
PD involuntary movement
- Tremor
- pill rolling
- resting (4-6times/s)
- Rigidity
- different than spasticity
PD and walking
- Flexed posture
- anterior COM
- Short, shuffling steps
- loss of associated movements
- festinating gait (a hard time stepping)
PD and static balance
- postural Predisposition to lose balance
PD and dynamic balance
- impairments in prep post. adjustments
- loss of righting and protective responses
Cognitive function and PD
- Can occur early
- 20% have cogntitive impairment early
- significant declines happen later
- dimentia in 40-70%
- Visual disturbances (hallucinations)
- Depression
Treatment for PD
- Precursor to dopamine (L-dopa)
- 2-5 yr max benefit
PD treatment aimed to restore balance
- Dopamine
- Dopamine agonsits
- Anticholinergfics
- Monoamine oxidase
Brain stimulation and PD
- Symptoms not responsive to drugs will not be helped by this
- Subthalamic nucleus
Huntintons Disease
- Proressive degenerative disorder of striatum
- Heridataary disorder - manifests itself in early adult to mid life
- each child of affected parent has 50% change of inhereting the gene
- ½ of offspring get it (autosomal dominant) - if you have the gene youll have HD
- Earlier onsent more likely when disease is inherited from the father
average lifespan after HD diagnosis
15 years
what makes definitive diagnosis for HD
degenerative testing
genetic counseling is indicated
Clinical findings of HD
- Chorea: restlessness, cant supress blinks, proresses to choreifrom movements
- Motor impersistence
- cant hold tongue out
- drop objects
- minor car accidents
- Dystonia
- abnormal posture - super imposed on chorea
- example: landing on lateral aspect of foot
- abnormal posture - super imposed on chorea
- Westphal variant
- Juveinelle form
With OCD & chorea ___ is a huge problem in HD patients
weight loss
Hemiballismus
- Unilateral
- Acute onset of flinging - choreic movements (proximal muscle involvement)
- lesion of subthal. nucleus in BG
- usually result of CVA
Tardive dyskinesia
- Choreo- movements of face, mouth, and jaw
- pursing mouth
- fish gaping
- Associated with prolonged use of psycoactive drugs
Damage to the cerebellum signs
- Incoordination
- Delays in movement initiation and termination
- Hypotonia
- Intention temor
- Dysequilirbium & vertigo
Fridreich’s Ataxia
- one of the most common heridiatry disorders of the NS
- Autosomal recessive
- Age of onset = 13
- wheelchair bound by 20
- Ataxia in lower limbs
- Nystagmus & dysarthia
- Impairment of sensaation
- Scoliosis
Olivopontocerebellar atrophy
- Degneration of cerebellum, pons, inferior olives
- Progressive ataxia
- later onset than friedreichs ataxia
- slow proression over 20 years uually leading to death
- gait aaffected first with resultant decreased movement speed and balance defecits
- later onset than friedreichs ataxia
