Movement Disorder Flashcards
The basal ganglia consists of:
Deep gray matter (not myelinated) nuclei in the: cerebral hemisphere, diencephalon, mesencephalon
Three NT in the basal ganglia:
Gaba (-), glutamate (+), dopamine (-/+)
What part of the brain is affected with bradykinesia and resting tremor (Parkinson’s):
Substantia nigra
What is affected with ballismus?
Subthalamic nucleus
What is affected with the caudate nucleus?
Chorea
What two muscle movements persist in sleep?
Ballismus and myoclonus
Sterotypies will not (ex. hand flapping):
DO NOT wax and wane - do not interrupt function
Definition of chorea:
Brief, unpredictable, non-rhythmic, non-repetitive that flow form one muscle to the next
Definition of atheosis:
Adding twisting and writing movements (snake arm)
Definition of ballismus:
More violent flinging movements (more proximal than distal)
All three definitions of chorea, athetosis and ballismus:
Interrupt function
Definition of dystonia:
HYPOmovement - twisting/repetitive sustained movements
Torticollis is an example of:
dystonia
Definition of dyskinesia:
Combination of chorea, ballismus, dystonia and athetosis
What is spasticity?
Increase in muscle tone due to hyperexcitabiltiy of the stretch reflex
A hiccup is an example of:
Myoclonus - twitch followed by rest
A tremor occurs in a:
Single plane
Functional psychogenic ataxia results from:
Not the basal ganglia but trauma - have more coordination than someone with a movement disorder
Syndham’s is a form of ___ that resulted from Rheumatic fever
Chorea; tx wit PCN
Tics are:
Suppressible; they wax and wane
Tourette syndrome genetics:
Autosomal dominant pattern
Progression of Tourette syndrome throughout he ages (3 - think thirds):
1/3 will get 100% better
1/3 will get a it better
1/3 will stay the same or get worse
What is corprolalia
Swearing (tic) - rare
50% of kids with Tourette syndrome also have
ADHD
Two medications for Tourette:
- Low dose Clonidine (alpha agonist)
2. Atypical antipsychotic
What is more important than treating tics?
Identifying co-morbidities that the child may have and treating those
Criteria for diagnosing an essential tremor:
- 2+ in R arm, 1+ in left arm
OR - Cranial-cervical head bobbing tumor 2+ and 1+ in at least one arm - NO ASYMMETRY of cervical muscles are present
- Exclude other reasons for tremor
Essential tremor treatment:
Propranolol (alcohol can also have similar calming effects)
Essential tremor genetics:
Autosomal dominant - FH of alcohol abuse to calm the tremors
Restless leg syndrome genetics:
Autosomal dominant
Secondary cause of Restless leg syndrome (3):
Pregnancy, anemia, medications
Treatment for RLS is often not needed, but what are three drugs you could use?
Levodopa, opiate, gabapentin
Huntington genetics
Autosomal dominant - CAG trinucleotide repeat
Huntington CAG repeat levels:
15-32 repeats - Normal
33-38 repeats - Penetrant
38+ - Diagnostic of Huntingtons
The hunting protein is located:
Throughout the body but only affects the CNS
Most common finding for Huntington’s on imaging:
Atrophy of the caudate and the putamen
The five clinical findings of Huntington’s:
- Chorea (arms and legs at dx)
- Dystonia (hands when walking)
- Psych probs
- Dementia (cognitive decline)
- Abnormal eye movements
Early in disease course, what is defining for Huntington disease?
Hypotonia with hyperreflexia
In juvenile HTD, what is absent?
Chorea
Treatment for HTD:
Supportive - treat the tremor, the depression and us PT/OT
Sudden onset ANYTHING (chorea, myoclonus, ataxia), what do you do?
Urgent referral
