Motor Impairments

Question 1

Basal Ganglia functions [3]

Basal Ganglia is subset of Limbic System

Answer 1

Emotion, emotion expression; Reward
Motor Quantity; Acceleration, Deceleration
Learning and Cognition

Question 2

Gimme all symptoms of Parkinsonism

• Motor AND non-motor!!! give ALL

Answer 2

Resting Tremor (Basal Ganglia) - pill rolling
BRADYkinesia
- Decremental Bradykinesia
- Micrographia
- hypophonia, hypomimia (facial expression)

Increased RIGITIDY
Lead Pipe/ Cogwheel
- LP: muscles tone all increased
- Cogwheel: tremors superimposed

Festinant Gait

• short, shuffling steps
• small strides;
• reduced arm swings

Non-motor

• Depression
• Dementia
• Insomnia
• postural hypotension, constipation, incontinence impotence

– Note Mardopa also causes postural hypotension

Question 3

What is Parkinson’s Disease

Answer 3

Apoptosis of dopaminergic substantia nigra neurons
@ Brainstem (midbrain)

Nigro-striatal neurons

• accumulation of alpha-synuclein - form amyloids

Question 4

Give dopamine biochemistry and First line for Parkinson’s Disease

Answer 4

L-Tyrosine to L-Dopa; Then L-Dopa to Dopamine, broken down by MAO and COMT

• Tyrosine Hydroxylase
• then DOPA Decarboxylase

First line: Mardopa

• L-Dopa - to past BBB before Dopamine
• Carbidopa - DOPA Decarboxylase inhibitor, for peripheral conversion into Dopamine, cannot past BBB

Question 5

AE of Mardopa

Answer 5

Postural Hypotension (yes for levodopa, DR agonist)
- Low BP

• Dyskinesia, Nausea
• • Dyskinesia given DopR agonist amantadine
• On Off phenomenon;

— witch between mobility and immobility in levodopa-treated patients

Question 6

2 Parkinsonism Causes other than Parkinson’s Disease

• One iatrogenic
• One congenial

KIV ANTIPSYCHOTICS

Answer 6

Neuroleptic Medications
- depresses nervous functions

Anti-nausea
- dopamine inhibitors - Metoclopramide
Anti-psychotic - Haloperidol 
- mixed dopamine, serotonin, M1 blocking effects;
- Haloperidol for Skitzo 
(Olanzapine atypical antipsychotic)

Wilson Disease - AR

• Biliary copper excretion problem
• accumulate in Liver AND Basal Ganglia;

Question 7

Side effects of anti-dopaminergics

- Metoclopramide and antipsychotics

Answer 7

Dystonia
Parkinsonism
Akathisia - restlessness
Tardive Dyskinesia, involuntary repetitive movements;

Question 8

Recall Dystonia and Dyskinesia

• myoclonus too

Answer 8

Dystonia - repetitive muscle spasms,
Dyskinesia - writhing movements
- everything is involuntary
myoclonus - uncontrolled spasm

Question 9

3 Types of tremors

thinking DDx

Answer 9

Resting tremor - Basal Ganglia
Intention tremor - Cerebellum
Essential, Benign, Postural tremor;

Question 10

Tourettes present as?

Answer 10

Tics

Question 11

Epilepsy present as?

Answer 11

Myoclonus,

• caused by stroke, infections;

Question 12

Choreoathetosis?

3 Causes

Answer 12

Choreoathetosis combines the symptoms of chorea and athetosis.

• Chorea: involuntary muscle movements, rapid, jerky
• Athetosis: slow, twisting, writhing
• Huntington’s Chorea: AD, CAG trinucleotide repeats in Huntingtin protein;
• • damage to basal ganglia and cortex;

Sydenham chorea
- sequelae of Rheumatic Fever, sequelae of S. Pyogenes;

L-DOPA

Question 13

Other Meds? Think Dopamine pathway

Answer 13

DopR agonist - amantadine - used to treat L-DOPA dyskinesia
MAO inhibitor
COMT inhibitor

Question 14

UMN Rigidity vs Parkinsonism

- where will UMN rigidity present;

Answer 14

UMN - tone is increased, resistance increased

• Varies at diff points of the joint
• hence stronger antagonising muscle will control
• – Stroke patients w Elbows flexed and Legs extended

Lead Pipe: resistance is same

Question 15

Describe Festinant Gait

Answer 15

Festinant Gait

• short, shuffling steps
• small strides;
• reduced arm swings