Movement Disorder Flashcards
What are the two main categories of movement disorders?
Excess of movement (hyperkinetic) and paucity of movement (hypokinetic).
What are the primary structures involved in movement disorders?
Basal ganglia, including the caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus.
What is the hallmark of hypokinetic movement disorders?
Reduced voluntary and automatic movements, as seen in Parkinson’s disease.
What are the cardinal features of Parkinson’s disease (PD)?
TRAP: Tremor (resting), Rigidity, Akinesia/Bradykinesia, and Postural instability.
What is the mean age of onset for Parkinson’s disease?
Approximately 60 years.
What is the lifetime risk of Parkinson’s disease for men and women?
2% for men and 1.3% for women.
What are the non-motor features of Parkinson’s disease?
Sleep dysfunction, anosmia, mood disorders, autonomic disturbances, and cognitive impairment.
What is the pathological hallmark of Parkinson’s disease?
Loss of dopaminergic neurons in the substantia nigra pars compacta and presence of Lewy bodies.
What protein is primarily found in Lewy bodies?
Alpha-synuclein.
What is Braak staging in Parkinson’s disease?
A sequential spread of Lewy body pathology from the brainstem to the cerebral hemispheres.
What are the environmental risk factors for Parkinson’s disease?
Exposure to pesticides (e.g., paraquat, rotenone), rural living, and well water consumption.
What is the most common genetic mutation associated with Parkinson’s disease?
LRRK2 and PARK2 mutations.
What is the diagnostic accuracy of Parkinson’s disease using the U.K. Brain Bank Criteria?
Up to 99% when confirmed pathologically.
What is the primary treatment for Parkinson’s disease?
Levodopa, which is considered the gold standard.
What are the side effects of long-term levodopa use?
Motor fluctuations and dyskinesias.
What are dopamine agonists used for in Parkinson’s disease?
To mimic dopamine effects and reduce motor symptoms.
What is the role of MAO-B inhibitors in Parkinson’s disease?
They slow the breakdown of dopamine in the brain.
What is the role of COMT inhibitors in Parkinson’s disease?
They prolong the effect of levodopa by inhibiting its breakdown.
What is deep brain stimulation (DBS) used for in Parkinson’s disease?
To reduce motor symptoms in advanced cases when medications are insufficient.
What is the most common form of atypical parkinsonism?
Multiple system atrophy (MSA).
What are the two subtypes of multiple system atrophy (MSA)?
MSA-P (parkinsonian) and MSA-C (cerebellar).
What is the hallmark feature of progressive supranuclear palsy (PSP)?
Vertical gaze palsy, especially downward gaze, and postural instability.
What is the typical facial expression seen in progressive supranuclear palsy (PSP)?
A worried or surprised appearance with a furrowed brow.
What is corticobasal syndrome (CBS)?
A rare atypical parkinsonism characterized by asymmetric dystonia, apraxia, and alien limb phenomenon.
What is the alien limb phenomenon?
A limb moves involuntarily, and the patient does not recognize it as their own.
What is the primary diagnostic tool for differentiating Parkinson’s disease from atypical parkinsonism?
Clinical features, response to levodopa, and neuroimaging (MRI).
What is essential tremor (ET)?
A common movement disorder characterized by bilateral upper limb postural or kinetic tremor.
What is the typical frequency of essential tremor?
4–12 Hz.
What is the most common treatment for essential tremor?
Propranolol (a beta-blocker) or primidone.
What is the role of alcohol in essential tremor?
It can temporarily reduce tremor severity in some patients.
What is the diagnostic criteria for essential tremor?
Bilateral upper limb action tremor for at least 3 years, with or without head or voice tremor.
What is the most common genetic association with essential tremor?
Family history, with about 50% of cases being familial.
What is the primary difference between Parkinson’s disease tremor and essential tremor?
Parkinson’s tremor is a resting tremor, while essential tremor is a postural or kinetic tremor.
What is the treatment for essential tremor when medications fail?
Botulinum toxin (Botox) injections or deep brain stimulation (DBS).
What is the most common cause of drug-induced parkinsonism?
Antipsychotic medications (e.g., haloperidol) and antiemetics (e.g., metoclopramide).
What is the primary feature of Wilson’s disease?
Copper accumulation leading to neurological and hepatic symptoms, including parkinsonism.
What is the most common cause of secondary parkinsonism?
Drug-induced parkinsonism, often due to dopamine-blocking agents.
What is the role of ubiquitin in neurodegenerative diseases?
It tags misfolded proteins for degradation via the proteasome system.
What is the primary mechanism of neurodegeneration in Parkinson’s disease?
Misfolded alpha-synuclein leading to neuronal apoptosis and oxidative stress.
What is the most common sleep disorder in Parkinson’s disease?
REM sleep behavior disorder (RBD).
What is the most common autonomic symptom in Parkinson’s disease?
Orthostatic hypotension.
What is the most common cognitive impairment in advanced Parkinson’s disease?
Parkinson’s disease dementia (PDD).
What is the primary difference between Parkinson’s disease and dementia with Lewy bodies (DLB)?
In DLB, dementia occurs before or within one year of motor symptoms.
What is the most common cause of death in Parkinson’s disease?
Complications related to immobility, such as pneumonia.
What is the primary role of amantadine in Parkinson’s disease?
It reduces dyskinesias and provides mild symptomatic relief.
What is the primary role of anticholinergic drugs in Parkinson’s disease?
They reduce tremor and rigidity but are less commonly used due to side effects.
What is the most common surgical treatment for Parkinson’s disease?
Deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus interna.
What is the primary feature of olivopontocerebellar atrophy (OPCA)?
Cerebellar ataxia, parkinsonism, and autonomic dysfunction.
What is the primary feature of fragile X-associated tremor/ataxia syndrome (FXTAS)?
Tremor, ataxia, and parkinsonism in carriers of the FMR1 premutation.
What is the primary treatment for myoclonus in movement disorders?
Anticonvulsants such as clonazepam or levetiracetam.
