Movement Disorders

Question 1

What are the types of movement disorders?

Answer 1

Akinetic rigid syndrome
-parkinson disease
-secondary parkinsonism
-parkinsonism plus syndrome

Dyskinesia
-trmor
-chorea
-dystonia
-tics
-myoclonus

Question 2

Statistics and pathology of PD?

Answer 2

Stat 3
-insidious onset
-usually 6th decade but can occur in younger also
-M>F

Path 2
-progressive degeneration of dopaminergic neurons in sustantia nigra
-Lewy bodies (intra neuronal eosinophilic inclusion bodies)

Question 3

Clinical features of PD?

Answer 3

8
UL onset
Persistent asymmetry
Excellent response to levodopa
4 cardinal features
Tremor 6
Rigidity 6
Akinesia 4
Postural instability 2
Gait features and other features 8

Question 4

Red flags of PD?

Answer 4

6
Symmetric
Early instability
Early severe dementia
Wide based gait
Pyramidal or cerebellar signs
Poor response to levodopa

Question 5

Mx of PD?

Answer 5

No cure just sig symptomatic benefits
Pathophysiology- decrease dopamine and relative increase in Ach
Drugs-
1.levodopa and preparations (cocareldopa,cobeneldopa) 6
2.dopamine agonists (ropinirole,pramipexole)
3.MAO-B inhibitors (seleglinine,rasagiline) 3 dopamine breakdown enzyme inhibitor
4.COMT inhibitors (entacapone) 3
5.amantidine (an antivirus) 2
6.anticholinergic (benzhexol)3
7.sx- deep brain stimulation

Question 6

Secondary parkinsonism?

Answer 6

1.drug induced-neuroleptics,antiemetics,CCB
2.vascular (multi infarcts)
3.metabolic/toxic -wilson’s disease
4.post encephalitis lethargica
5.pugilist encephalopathy

Question 7

Parkinsonism plus syndrome?

Answer 7

Parkinsonism plus
-autonomic dysfunction
-crerebellar signs
-early postural instability
-early dementia
Poor or non sustained response to levodopa

Question 8

Types of dyskinesia?

Answer 8

5
Tremor
Chorea
Dystonia
Tics
Myoclonus

Question 9

What is Tremors? And its classification?

Answer 9

Rhythmic oscillation of the body parts due to alternate contraction of agonist and antagonist muscle
Classification- osmosis

Question 10

Chorea?

Answer 10

Irregular,unpredictable ,brief ,non repetitive ,jerky, dance like movements that fleet from one part of the body to another part.

Causes-
Hereditary 2
Acquired 8

Question 11

Dystonia? Types? Tx?

Answer 11

Sustained contractions of muscles groups that result in disordered postures or twisting movements of limbs or trunks

Primary dystonia
-primary tortion dystonia
-focal/segmental (blepharospasms,spasmodic, torticollis,writer’s cramp)

Secondary dystonia
-Wilson’s
-drugs
-CNS infections

Tx -
Muscle relaxants (baclofen,levodopa,anticholinergic)
Botulinum

Question 12

Tics ?

Answer 12

Abrupt transient purposeless brief stereotypical movements repeated at orrrgular intervals
5

Question 13

Myoclonus?

Answer 13

Brief sudden shock like jerks
4 types

Question 14

Essential Tremor features?

Answer 14

11
Commonest movement days sorder
Familial (AD) in about 50%
Age-15-25 yrs
M=F
Symmetrical
Postural and action tremors
Usually in hand arms head including vocal cords
Head tremors; ues yes no no
Response to alcohol in 50%
Tx- propranolol
Worse with caffeine,emotional stress and hunger