Movement disorders

Question 1

What are the non-neurological causes of tremor?

Answer 1

• Hyperthyroidism
• Anxiety
• COPD -> CO2 retention
• Chronic liver disease

Question 2

What are the characteristics of an essential tremor?

Answer 2

• Onset at any age
• Familial
• Symmetrical
• Can be present in legs and jaw
• Worse with movement
• Improves with alcohol

Question 3

What is the triad of parkinsonism?

Answer 3

• Tremor
• Bradykinesia
• Rigidity

Question 4

What are the characteristics of idiopathic PD?

Answer 4

Primary motor features

• Unilateral -> bilateral
• Pill-rolling tremor, improves on movement, concentration and sleep
• Bradykinesia
• Cog-wheel rigidity

Secondary motor features

• Hypomimia
• Hypophonia
• Gait abnormalities

Mon-motor features

• REM SDB
• Constipation
• Anosmia
• Swallowing problems/drooling

Question 5

What are the characteristics of vascular parkinsonism?

Answer 5

• Lower body Rigidity

- Lack of facial expression

Question 6

What are the characteristics of dementia with Lewy bodies?

Answer 6

• Dementia
• Parkinsonism
• Visual hallucinations

Question 7

What are the characteristics of drug-induced parkinsonism?

Answer 7

• Symmetrical rigidity

- Lack of facial expression

Question 8

What are the characteristics of progressive supranuclear palsy?

Answer 8

• Early falls
• Truncal rigidity
• Vertical gaze palsy
• Symmetrical parkinsonism

Question 9

What are the characteristics of multi-systems atrophy?

Answer 9

• Symmetrical parkinsonism

- Autonomic complications

Question 10

What are the characteristics of normal pressure hydrocephalus?

Answer 10

• Dementia
• Gait disorder
• Bladder instability

Question 11

What are the characteristics of corticobasal degeneration?

Answer 11

• Asymmetrical parkinsonism

- Dyspraxia

Question 12

What medications can cause drug-induced parkinsonism?

Answer 12

• Haloperidol, chlorpromazine (1st gen antipsychotics)
• Prochorperazine, metoclopramide (anti-emetics)
• SSRIs
• CCB
• Lithium
• Connarizine
• Amiodarone
• ACH inhibitors
• Sodium valproate
• Methyldopa
• Pethidine

Question 13

What are the characteristics of Huntington’s disease?

Answer 13

• AD

- Progressive behavioural disturbance, chorea, cognitive impairment

Question 14

What are the characteristics of Wilson’s disease?

Answer 14

o Copper deposition

o Tremor, dystonia, parkinsonism, ataxia and psychiatric symptoms

Question 15

What are the characteristics of Creutzfeldt-Jakob disease?

Answer 15

• Personality change
• Cognitive decline
• Abnormal jerking
• Loss of coordination
• Slurring of speech

Question 16

What are the Rx for PD?

Answer 16

• Working with pesticides and heavy metals
• Prior head injuries
• 60yrs<
• Male
• Family Hx

Question 17

What is the 1st line management for PD?

Answer 17

o Motor symptoms not affecting QoL: Rasagaline/selegiline

o Motor symptoms affecting QoL: Co-Beneldopa (madopar)/co-careldopa (sinemet)

Question 18

If symptoms are still affecting PD patient, what else can you give?

Answer 18

o Dopamine agonists
o Or MAO-B inhibitor
o Or COMT inhibitor

Question 19

What are the SE of levodopa?

Answer 19

Postural hypotension
N+V
Dyskinesias (dystonia, chorea, athetosis)
Psychosis
Drowsiness

Question 20

What is neuroleptic malignant syndrome and what can cause it?

Answer 20

Fever, altered mental state, muscle rigidity, autonomic dysfunction

Acutely stopping anti-parkinsonism drugs

Question 21

How do you manage neuroleptic malignant syndrome?

Answer 21

Dopamine agonist patch

Question 22

What are the motor fluctuations with levodopa?

Answer 22

End-of-dose fading
o Due to progressive loss of neurones

On-off phenomenon
o On = medications working
o Off = medications wearing off

Dyskinesia - involuntary movements