Movement Disorders Flashcards
Essential Tremor: Cause, syx, mx
Pts change job due to social embarrassment tremor/severe psychosocial disability it causes.
Cause is unknown h/e there is genetic and environmental involvement
Syx
- Postural/action tremor
- On movement + improves with alcohol (15%)
- Difficulty writing, eating, fine motor tasks etc
- No other neuro signs or deficits
Mx
(1. ) Reassure, not associated with serious underlying condition
(2. ) Propranolol or Primidone [1st line] Bb CI: Asthma
(3. ) Surgery: Deep brain stimulation if medical rx fails, impairment of ADL
Parkinson’s Disease: cause, rf, syx
- Age related disorder.
- Depletion of DA-neurons in substantia nigra
- Cause: idiopathic, genetic
- RF: 60y, FH, male, pesticide exposure
Clinical features:
(1. ) Bradykinesia
(2. ) Hypokinesia
(3. ) Lead pipe + cog wheel rigidity
(4. ) Tremor at rest
(5. ) Shuffling gait
(6. ) Nonmotor syx:
- hyposmia
- ANS: constipation, impotence, postural hypotension
- psychiatric syx: depression, anxiety, hallucination
Parkinson’s Disease: dx
UK Parkinson’s Disease Society (PDS) Brain Bank Criteria for diagnosis:
(1. ) step 1: dx of parkinsonism syndrome: bradykinesia, rigidity, resting tremor, postural instability
(2. ) step 2: exclusion criteria for parkinson’s disease
(3. ) step 3: supportive criteria for parkinson’s disease
DaTSCAN shows reduced DA activity i.e. death of sub nigra neurons
Mx of Parkinsons + complications of medical rx
Refer to neuro or geriatric.
Rx is initiated if impacting QOL.
(1. ) L-dopa/Levodopa (1st line)
(2. ) Dopamine agonists (1st line <60y)
(3. ) COMT/MAO-Bi
(4. ) Deep brain stimulation - if optimal medial rx fails
Non-pharmacological
- Occupational, Speech therapy, Physio
Complications of meds
- On-dyskinesias - involuntary, erratic, movements when starting drug
- Off- dyskinesias - medication is wearing off, painful dystonic movement
- Freezing - unpredictable loss of mobility
- DA-agonist SE: tiredness, gambling, hypersexuality
