Movement Disorders

Question 1

Normal movement

Answer 1

• Intact cortex -> NMJ
• Fine tuned by cerebellum and basal ganglia for fluid movement
• Intact CNS: think soemthing-> pass medsage sthorugh pyramidla trac to muscles and have action

Question 2

**Difficulties with movement

Answer 2

• Can arise anywhere from Cortx -> nMJ
• Stroke, multiple scleroisis, tumour, motor neurone disease, myaesthenia, metsbolic issues etc.

Question 3

**Movement disorders

Answer 3

• Uusally refers to problems with fluid movement - cerebellum, basal ganglia, metabolic
• Too little movement - hypokinesia (eg, parkinosim)
• Too much movement - hyperkinesia

Question 4

Basal ganglia

Answer 4

• Pathways that tell you to go and stop need to be in balance
• Structures deep within brain

Question 5

How the basal ganglia works

Answer 5

Pathway tells you to goa nd pathway telling you to stop

Question 6

DIrect pathway (go pathwya) of the basal ganglia

Answer 6

• Cortex stimualtory structure and tells striatum it wants to go
• STriatum is inhibitory structure and wants to fine tune the movement
• globus pallidus interna is also inhibitory - turned down by straitum so thalamus which is go structure goes up and get more go.
• Direct pathway = MORE GO

Question 7

Normal basal ganglia function - INDIRECT pathway

Answer 7

• Cortex is stimulatory
• STraitum inhibitory and inhibits globus pallidus externa
• Globus pallifus externa inhibitory so inhibits subthalamic nucleus which is stimulatory structure and stimulate globus pallidus intern which turns down thslaamus more.
• Indirect pathway = mORE STOP LESS GO

Question 8

Substantia nigra function in normal basal ganglia

Answer 8

• lubricates process - promotes go
• Through D1 receptors it stimulates go pathway and inhibits through D2 receptors the stop pathway so
• iNhibits stop pathway through S2 receptors
• Substantia more go, direct pathway more go and indirect pathwya more stop and its about balance

Question 9

Hypokinesia - Parkinsonism

Answer 9

• Must have bradykinesia ( slow and decrmeental movement)
• and 1 of:
  
  • Rigidity
  • Rest tremor (4-6Hz)
  • Postural instability

Question 10

Parkinsonism neuroanatomy

Answer 10

Damage to substantia nigra, results in too much stop not enough go.

Question 11

Causes parkinsonism

Answer 11

• Idiopathic Parkinsons disease
• Vascular parkinsonism
• Medications that block dopamine
• Rarer causdes - Dementia with lewy bodues, parkinsons plus sundromes (PSP, MSA)

Question 12

Hyperkinesia (too much movement) disorders

Answer 12

• Tremor
• Chorea
• Dystonia
• Myoclonus
• Tics

Question 13

Describe Tremors - define

Answer 13

• Rhythmical, sinusoidal, alternating movement
• Shaking
• Type of tremor often leads you to diagnosi.

Question 14

Chorea

Answer 14

• Chorea = random
• “Dance like”, unpredicatble, flowing movements moving from one area to another
• Ballism- chorea that affects proximal joints so movements are large and flinging
• Hemi-chorea/hemi-ballismus : affecting half the body

Affecting indirect pathway, straitum damage so loss of inhibition of the indirect pathway so too much go

Question 15

Causes of Chorea

Answer 15

• Any structural lesion of striatum: stroke, tumour etc
• Neurodegenerative/ genetic: Huntington’s chorea, Wilson’s disease
• Immune mediated - sydenham’s chorea (in response to Group A strep infection)
• Drug induced - levodopa induced dyskinesia in parkinson’s disease
  *

Question 16

Dystonia

Answer 16

• Sustained or intermittent muscle ocntraction resulting in abnormla postural movement
• Can be repepitive, can be taask specific (writers cramp)
• Can be painful
• Geste antagoniste
• Botox is sometimes option

Question 17

Causes of Dystonia

Answer 17

• Idiopathic? (“overuse?”)
• Genetic
• Part of other conditions (eg, PD)
• Structural lesions (trauma, tumour, stroke) - brain, spinal cord or peripherl nerve
• Immune mediated
• Post infectious
• Drugs (antipsychotics, antiemetics)

Question 18

Myoclonus

Answer 18

• Jerky, shock like movements
• Lots of causes
• Normal -> medications-> epilepsy -> dementia
• Can be picked up by EMG

Question 19

Tivs

Answer 19

• Uusally brief, often sterotyped
• Can be movement or osund
• Can be simple or complex
• Can be suppressed for short periods of time
• Tourettes syndrome most common cause

(tics can usually be surpressed but myoclonus usually isnt)

Question 20

Wilsons disease

Answer 20

• Can present with parkinsonism, choream dystonia, psychiatric issues, liver disease
• Important not to miss as further brain/ liver damage can be prevented
• Wilson’s disease is a rare inherited disorder that causes copper to accumulate in your liver, brain and other vital organs.
• They have mix movement disorders.

Question 21

Functional movement Disorders

Answer 21

• Abnormal movement due to the Nervous system not working properly without an underlying neurological disease
• Can cause - Gait abnormalities, tremor, jerking movements, mimic dystonia etc..

Question 22

Hypo VS Hyperkinetic movement sdisorders

Answer 22

• Classification of movement disorders:
• Hypokinetic = too much stopm, lesion may be substantia nigra, systemic (Parkinsonism/ Akinetic-Rigid syndrome
• Hyperkinetic = too much go, lesion may be cerebellar, striatal, systemic (Tremor, chorea (ballism, hemi-ballism), dystonia, myoclonus, tics