Movement Disorder

Question 1

What are the two main categories of movement disorders?

Answer 1

Excess of movement (hyperkinetic) and paucity of movement (hypokinetic).

Question 2

What are the primary structures involved in movement disorders?

Answer 2

Basal ganglia, including the caudate, putamen, globus pallidus, substantia nigra, and subthalamic nucleus.

Question 3

What is the hallmark of hypokinetic movement disorders?

Answer 3

Reduced voluntary and automatic movements, as seen in Parkinson’s disease.

Question 4

What are the cardinal features of Parkinson’s disease (PD)?

Answer 4

TRAP: Tremor (resting), Rigidity, Akinesia/Bradykinesia, and Postural instability.

Question 5

What is the mean age of onset for Parkinson’s disease?

Answer 5

Approximately 60 years.

Question 6

What is the lifetime risk of Parkinson’s disease for men and women?

Answer 6

2% for men and 1.3% for women.

Question 7

What are the non-motor features of Parkinson’s disease?

Answer 7

Sleep dysfunction, anosmia, mood disorders, autonomic disturbances, and cognitive impairment.

Question 8

What is the pathological hallmark of Parkinson’s disease?

Answer 8

Loss of dopaminergic neurons in the substantia nigra pars compacta and presence of Lewy bodies.

Question 9

What protein is primarily found in Lewy bodies?

Answer 9

Alpha-synuclein.

Question 10

What is Braak staging in Parkinson’s disease?

Answer 10

A sequential spread of Lewy body pathology from the brainstem to the cerebral hemispheres.

Question 11

What are the environmental risk factors for Parkinson’s disease?

Answer 11

Exposure to pesticides (e.g., paraquat, rotenone), rural living, and well water consumption.

Question 12

What is the most common genetic mutation associated with Parkinson’s disease?

Answer 12

LRRK2 and PARK2 mutations.

Question 13

What is the diagnostic accuracy of Parkinson’s disease using the U.K. Brain Bank Criteria?

Answer 13

Up to 99% when confirmed pathologically.

Question 14

What is the primary treatment for Parkinson’s disease?

Answer 14

Levodopa, which is considered the gold standard.

Question 15

What are the side effects of long-term levodopa use?

Answer 15

Motor fluctuations and dyskinesias.

Question 16

What are dopamine agonists used for in Parkinson’s disease?

Answer 16

To mimic dopamine effects and reduce motor symptoms.

Question 17

What is the role of MAO-B inhibitors in Parkinson’s disease?

Answer 17

They slow the breakdown of dopamine in the brain.

Question 18

What is the role of COMT inhibitors in Parkinson’s disease?

Answer 18

They prolong the effect of levodopa by inhibiting its breakdown.

Question 19

What is deep brain stimulation (DBS) used for in Parkinson’s disease?

Answer 19

To reduce motor symptoms in advanced cases when medications are insufficient.

Question 20

What is the most common form of atypical parkinsonism?

Answer 20

Multiple system atrophy (MSA).

Question 21

What are the two subtypes of multiple system atrophy (MSA)?

Answer 21

MSA-P (parkinsonian) and MSA-C (cerebellar).

Question 22

What is the hallmark feature of progressive supranuclear palsy (PSP)?

Answer 22

Vertical gaze palsy, especially downward gaze, and postural instability.

Question 23

What is the typical facial expression seen in progressive supranuclear palsy (PSP)?

Answer 23

A worried or surprised appearance with a furrowed brow.

Question 24

What is corticobasal syndrome (CBS)?

Answer 24

A rare atypical parkinsonism characterized by asymmetric dystonia, apraxia, and alien limb phenomenon.

Question 25

What is the alien limb phenomenon?

Answer 25

A limb moves involuntarily, and the patient does not recognize it as their own.

Question 26

What is the primary diagnostic tool for differentiating Parkinson’s disease from atypical parkinsonism?

Answer 26

Clinical features, response to levodopa, and neuroimaging (MRI).

Question 27

What is essential tremor (ET)?

Answer 27

A common movement disorder characterized by bilateral upper limb postural or kinetic tremor.

Question 28

What is the typical frequency of essential tremor?

Answer 28

4–12 Hz.

Question 29

What is the most common treatment for essential tremor?

Answer 29

Propranolol (a beta-blocker) or primidone.

Question 30

What is the role of alcohol in essential tremor?

Answer 30

It can temporarily reduce tremor severity in some patients.

Question 31

What is the diagnostic criteria for essential tremor?

Answer 31

Bilateral upper limb action tremor for at least 3 years, with or without head or voice tremor.

Question 32

What is the most common genetic association with essential tremor?

Answer 32

Family history, with about 50% of cases being familial.

Question 33

What is the primary difference between Parkinson’s disease tremor and essential tremor?

Answer 33

Parkinson’s tremor is a resting tremor, while essential tremor is a postural or kinetic tremor.

Question 34

What is the treatment for essential tremor when medications fail?

Answer 34

Botulinum toxin (Botox) injections or deep brain stimulation (DBS).

Question 35

What is the most common cause of drug-induced parkinsonism?

Answer 35

Antipsychotic medications (e.g., haloperidol) and antiemetics (e.g., metoclopramide).

Question 36

What is the primary feature of Wilson’s disease?

Answer 36

Copper accumulation leading to neurological and hepatic symptoms, including parkinsonism.

Question 37

What is the most common cause of secondary parkinsonism?

Answer 37

Drug-induced parkinsonism, often due to dopamine-blocking agents.

Question 38

What is the role of ubiquitin in neurodegenerative diseases?

Answer 38

It tags misfolded proteins for degradation via the proteasome system.

Question 39

What is the primary mechanism of neurodegeneration in Parkinson’s disease?

Answer 39

Misfolded alpha-synuclein leading to neuronal apoptosis and oxidative stress.

Question 40

What is the most common sleep disorder in Parkinson’s disease?

Answer 40

REM sleep behavior disorder (RBD).

Question 41

What is the most common autonomic symptom in Parkinson’s disease?

Answer 41

Orthostatic hypotension.

Question 42

What is the most common cognitive impairment in advanced Parkinson’s disease?

Answer 42

Parkinson’s disease dementia (PDD).

Question 43

What is the primary difference between Parkinson’s disease and dementia with Lewy bodies (DLB)?

Answer 43

In DLB, dementia occurs before or within one year of motor symptoms.

Question 44

What is the most common cause of death in Parkinson’s disease?

Answer 44

Complications related to immobility, such as pneumonia.

Question 45

What is the primary role of amantadine in Parkinson’s disease?

Answer 45

It reduces dyskinesias and provides mild symptomatic relief.

Question 46

What is the primary role of anticholinergic drugs in Parkinson’s disease?

Answer 46

They reduce tremor and rigidity but are less commonly used due to side effects.

Question 47

What is the most common surgical treatment for Parkinson’s disease?

Answer 47

Deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus interna.

Question 48

What is the primary feature of olivopontocerebellar atrophy (OPCA)?

Answer 48

Cerebellar ataxia, parkinsonism, and autonomic dysfunction.

Question 49

What is the primary feature of fragile X-associated tremor/ataxia syndrome (FXTAS)?

Answer 49

Tremor, ataxia, and parkinsonism in carriers of the FMR1 premutation.

Question 50

What is the primary treatment for myoclonus in movement disorders?

Answer 50

Anticonvulsants such as clonazepam or levetiracetam.