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Neurology > Movement Disorder > Flashcards

Movement Disorder Flashcards

1
Q

Involuntary, rhythmic oscillations

A

Tremor

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2
Q

Limb is moving through space

A

Kinetic tremor

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3
Q

Kinetic tremor
vs.
intention tremor

A

More shaking as approaching intended target

Cerebellar pathology

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4
Q

Tremor evaluation

A
  • location + laterality
  • frequency (fast/slow)/ amplitude (big / small)
  • situations/maneuvers that cause tremor\
  • Rest
  • Action
    • postural
    • kinetic
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5
Q

Postural+kinetic

  • medium frequency
  • bilat (arms)
  • also head/lower limbs/face

*MC
Middle age
*may have had slight one as kid
*often w/ dystonia, myoclonus, ataxia, cognitive impairment

A

Essential tremor

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6
Q

Essential tremor

Alcohol

A

Helps (most)
Many become alchys
Small dose

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7
Q

Essential tremor

Prognosis

A
  • slow progression
  • no life-span reduction
  • can become Parkison’s
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8
Q

Essential Tremor

Tx. - behavioral mods

A
  • caffeine/stimulants

- assistive devices

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9
Q

Essential tremor

Rx

A 
Propranolol = S.E. HypoTN, bradycardia
Primadone = S.E. sedation

Can combine = synergistic

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10
Q

Essential tremor

3rd line Tx

A

Deep brain stimulation

Thalamotomy

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11
Q
  • abnormal contraction of muscle
  • sustained/intermittent
  • focal/segmental/multi-focal/hemi/generalized
  • worsened = voluntary (TASK-SPECIFIC)
A

Dystonia

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12
Q

Dystonia

Tx

A
  • chemodenervation (focal) = botox
  • oral Rx (lower limb, segmental, generalized) = dopaminergic, antichol, dop depleting, muscle relaxants
  • Deep brain stim (severe generalized/segmental)
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13
Q
  • brief, sterotyped movement / vocalization

* motor/vocal, simple/complex

A

Tics

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14
Q

Tics

Dx

A
  • urge
  • relief
  • supressible
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15
Q

Tics

Who

A

Childhood, reappear in adult hood

*adult tics abnormal

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16
Q

Multiple motor tics + 1 vocal tic starting b/f age 21
*daily/ multiple times per day for AT LEAST 1 year

  • Men
  • ADHD, OCD, anxiety, depression, phobias

Dx for?

A

Tics

tourette’s syndrome

17
Q

Tics

Tourette’s

Tx

A
  • Rx - daily
  • non-pharm = cognitive behavioral therapy, habit reversal therapy
  • Tx comorbidities (psyc specialist) = OCD, ADHD
18
Q
  • U = urge to voluntary move limbs (dysesthesia)
  • R = Rest induces symptoms
  • G = Getting active reduces s/s
  • E = Evening + night worsens s/s

Dx

A

Restless Leg syndrome

19
Q

Restless Leg syndrome

Primary

A
  • middle age

* heredity

20
Q

Restless Leg Syndrome

Secondary

A
  • iron def anemia
  • pregnancy

Rxs = caffeine, ADDs, lithium, narc withdrawals, anticonvulsants

21
Q

Restless leg syndrome

Labs

A

Ferritin 40>

22
Q

Restless Leg Syndrome

Rxs

A
  • 1st line = Dopa ags
  • 2nd line = levodopa, gabapentin,
  • 3rd = opiates, benzo
  • Off-label = topiramate

Alternative = quinine

23
Q
  • Involuntary, brief irregular
  • Flows from one body part to next
  • familial = huntington’s dz
  • non-familial = metabolic, others
A

Chorea

24
Q

Huntington’s dz

A
  • auto-dominant
  • 50% chance inherit
  • Chrom 4 CAG repeat (>40)
  • develop 34-50
25
Q

Huntington’s Dz

Dx

A

Clinical pres, family history, GENETIC test

26
Q

Huntington’s dzt

Tx

A

Symptomatic/supportive

  • Chorea = dopa blocker
  • cognitive = AchE inhibitors, keep routines, other behavior tx
  • psyc s/s = anti-depressants, anti-psycs
  • genetic counseling, family support
27
Q

Drug induced involuntary movements

A
  • Tremor
  • chorea
  • Parkisonism
  • mixed-movements

SEE SLIDE LIST

28
Q

Tardive Dyskinesias

Cause

A

*Drug-induced involuntary chorieform: (Oral-buccal-lingual movements) = DOPA blockers (anti-psyc meds, metoclopromide)

29
Q

Movement disorder

General Path

A

Disrupted sensorimotor processing:

  • basal ganglia
  • cerebellum
  • thalamus
  • motor cortex
30
Q

TRIAD:

1) Motor
* chorea, poor motor, gait, ESP, etc,

2) Cognitive
* exec function loss, dementia

3) Psychiatric
* depression, impulsivity, irritability

S/s?

A

Huntington’s Dz

31
Q

Tardive Dyskinesia

Tx

A

*Stop/Reduce Rx
*add antichol (benzotropine, trihexyphenidyl)
*tetrabenzene/Valbenzene
BENZes

32
Q

Abnormal movement approach

A
  • ID movement type
  • Determine onset, trigger, mitigating factor, meds
  • Make differential

Neurology (20 decks)

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