Movement Disorder

Question 1

The basal ganglia consists of:

Answer 1

Deep gray matter (not myelinated) nuclei in the: cerebral hemisphere, diencephalon, mesencephalon

Question 2

Three NT in the basal ganglia:

Answer 2

Gaba (-), glutamate (+), dopamine (-/+)

Question 3

What part of the brain is affected with bradykinesia and resting tremor (Parkinson’s):

Answer 3

Substantia nigra

Question 4

What is affected with ballismus?

Answer 4

Subthalamic nucleus

Question 5

What is affected with the caudate nucleus?

Answer 5

Chorea

Question 6

What two muscle movements persist in sleep?

Answer 6

Ballismus and myoclonus

Question 7

Sterotypies will not (ex. hand flapping):

Answer 7

DO NOT wax and wane - do not interrupt function

Question 8

Definition of chorea:

Answer 8

Brief, unpredictable, non-rhythmic, non-repetitive that flow form one muscle to the next

Question 9

Definition of atheosis:

Answer 9

Adding twisting and writing movements (snake arm)

Question 10

Definition of ballismus:

Answer 10

More violent flinging movements (more proximal than distal)

Question 11

All three definitions of chorea, athetosis and ballismus:

Answer 11

Interrupt function

Question 12

Definition of dystonia:

Answer 12

HYPOmovement - twisting/repetitive sustained movements

Question 13

Torticollis is an example of:

Answer 13

dystonia

Question 14

Definition of dyskinesia:

Answer 14

Combination of chorea, ballismus, dystonia and athetosis

Question 15

What is spasticity?

Answer 15

Increase in muscle tone due to hyperexcitabiltiy of the stretch reflex

Question 16

A hiccup is an example of:

Answer 16

Myoclonus - twitch followed by rest

Question 17

A tremor occurs in a:

Answer 17

Single plane

Question 18

Functional psychogenic ataxia results from:

Answer 18

Not the basal ganglia but trauma - have more coordination than someone with a movement disorder

Question 19

Syndham’s is a form of ___ that resulted from Rheumatic fever

Answer 19

Chorea; tx wit PCN

Question 20

Tics are:

Answer 20

Suppressible; they wax and wane

Question 21

Tourette syndrome genetics:

Answer 21

Autosomal dominant pattern

Question 22

Progression of Tourette syndrome throughout he ages (3 - think thirds):

Answer 22

1/3 will get 100% better
1/3 will get a it better
1/3 will stay the same or get worse

Question 23

What is corprolalia

Answer 23

Swearing (tic) - rare

Question 24

50% of kids with Tourette syndrome also have

Answer 24

ADHD

Question 25

Two medications for Tourette:

Answer 25

1. Low dose Clonidine (alpha agonist)

2. Atypical antipsychotic

Question 26

What is more important than treating tics?

Answer 26

Identifying co-morbidities that the child may have and treating those

Question 27

Criteria for diagnosing an essential tremor:

Answer 27

1. 2+ in R arm, 1+ in left arm
   OR
2. Cranial-cervical head bobbing tumor 2+ and 1+ in at least one arm - NO ASYMMETRY of cervical muscles are present
3. Exclude other reasons for tremor

Question 28

Essential tremor treatment:

Answer 28

Propranolol (alcohol can also have similar calming effects)

Question 29

Essential tremor genetics:

Answer 29

Autosomal dominant - FH of alcohol abuse to calm the tremors

Question 30

Restless leg syndrome genetics:

Answer 30

Autosomal dominant

Question 31

Secondary cause of Restless leg syndrome (3):

Answer 31

Pregnancy, anemia, medications

Question 32

Treatment for RLS is often not needed, but what are three drugs you could use?

Answer 32

Levodopa, opiate, gabapentin

Question 33

Huntington genetics

Answer 33

Autosomal dominant - CAG trinucleotide repeat

Question 34

Huntington CAG repeat levels:

Answer 34

15-32 repeats - Normal
33-38 repeats - Penetrant
38+ - Diagnostic of Huntingtons

Question 35

The hunting protein is located:

Answer 35

Throughout the body but only affects the CNS

Question 36

Most common finding for Huntington’s on imaging:

Answer 36

Atrophy of the caudate and the putamen

Question 37

The five clinical findings of Huntington’s:

Answer 37

1. Chorea (arms and legs at dx)
2. Dystonia (hands when walking)
3. Psych probs
4. Dementia (cognitive decline)
5. Abnormal eye movements

Question 38

Early in disease course, what is defining for Huntington disease?

Answer 38

Hypotonia with hyperreflexia

Question 39

In juvenile HTD, what is absent?

Answer 39

Chorea

Question 40

Treatment for HTD:

Answer 40

Supportive - treat the tremor, the depression and us PT/OT

Question 41

Sudden onset ANYTHING (chorea, myoclonus, ataxia), what do you do?

Answer 41

Urgent referral