Movement Disorder Flashcards
Involuntary, rhythmic oscillations
Tremor
Limb is moving through space
Kinetic tremor
Kinetic tremor
vs.
intention tremor
More shaking as approaching intended target
Cerebellar pathology
Tremor evaluation
- location + laterality
- frequency (fast/slow)/ amplitude (big / small)
- situations/maneuvers that cause tremor\
- Rest
- Action
- postural
- kinetic
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
Essential tremor
Essential tremor
Alcohol
Helps (most)
Many become alchys
Small dose
Essential tremor
Prognosis
- slow progression
- no life-span reduction
- can become Parkison’s
Essential Tremor
Tx. - behavioral mods
- caffeine/stimulants
- assistive devices
Essential tremor
Rx
Propranolol = S.E. HypoTN, bradycardia Primadone = S.E. sedation
Can combine = synergistic
Essential tremor
3rd line Tx
Deep brain stimulation
Thalamotomy
- abnormal contraction of muscle
- sustained/intermittent
- focal/segmental/multi-focal/hemi/generalized
- worsened = voluntary (TASK-SPECIFIC)
Dystonia
Dystonia
Tx
- chemodenervation (focal) = botox
- oral Rx (lower limb, segmental, generalized) = dopaminergic, antichol, dop depleting, muscle relaxants
- Deep brain stim (severe generalized/segmental)
- brief, sterotyped movement / vocalization
* motor/vocal, simple/complex
Tics
Tics
Dx
- urge
- relief
- supressible
Tics
Who
Childhood, reappear in adult hood
*adult tics abnormal
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?
Tics
tourette’s syndrome
Tics
Tourette’s
Tx
- Rx - daily
- non-pharm = cognitive behavioral therapy, habit reversal therapy
- Tx comorbidities (psyc specialist) = OCD, ADHD
- U = urge to voluntary move limbs (dysesthesia)
- R = Rest induces symptoms
- G = Getting active reduces s/s
- E = Evening + night worsens s/s
Dx
Restless Leg syndrome
Restless Leg syndrome
Primary
- middle age
* heredity
Restless Leg Syndrome
Secondary
- iron def anemia
- pregnancy
Rxs = caffeine, ADDs, lithium, narc withdrawals, anticonvulsants
Restless leg syndrome
Labs
Ferritin 40>
Restless Leg Syndrome
Rxs
- 1st line = Dopa ags
- 2nd line = levodopa, gabapentin,
- 3rd = opiates, benzo
- Off-label = topiramate
Alternative = quinine
- Involuntary, brief irregular
- Flows from one body part to next
- familial = huntington’s dz
- non-familial = metabolic, others
Chorea
Huntington’s dz
- auto-dominant
- 50% chance inherit
- Chrom 4 CAG repeat (>40)
- develop 34-50
Huntington’s Dz
Dx
Clinical pres, family history, GENETIC test
Huntington’s dzt
Tx
Symptomatic/supportive
- Chorea = dopa blocker
- cognitive = AchE inhibitors, keep routines, other behavior tx
- psyc s/s = anti-depressants, anti-psycs
- genetic counseling, family support
Drug induced involuntary movements
- Tremor
- chorea
- Parkisonism
- mixed-movements
SEE SLIDE LIST
Tardive Dyskinesias
Cause
*Drug-induced involuntary chorieform: (Oral-buccal-lingual movements) = DOPA blockers (anti-psyc meds, metoclopromide)
Movement disorder
General Path
Disrupted sensorimotor processing:
- basal ganglia
- cerebellum
- thalamus
- motor cortex
TRIAD:
1) Motor
* chorea, poor motor, gait, ESP, etc,
2) Cognitive
* exec function loss, dementia
3) Psychiatric
* depression, impulsivity, irritability
S/s?
Huntington’s Dz
Tardive Dyskinesia
Tx
*Stop/Reduce Rx
*add antichol (benzotropine, trihexyphenidyl)
*tetrabenzene/Valbenzene
BENZes
Abnormal movement approach
- ID movement type
- Determine onset, trigger, mitigating factor, meds
- Make differential
