MOVEMENT DISORDERS

Question 1

What are the 6ways of treating Parkinsonism?

Answer 1

1.Medication
2.Physical Therapy
3.Cellular Therapy
4.Protective therapy
5.Surgery
6.Deep Brain Stimulation

Question 2

What are the two types of surgery that can be done?And what do they help with?

Answer 2

1.Thalamotomy-Tremor
2.Pallidotomy-Bradykinesia

Question 3

Where in the ganglia does deep brain stimulation occur?

Answer 3

In the GP and Subthalamic nucleus

Question 4

What are the types of medication that can be administered in a patient with Parkinsonism?

Answer 4

1.Anticholinergics
2.Amantadine
3.Dopamine agonists
4.Carbidopa/Levidopa
5.Catechol-O-methyltransferase inhibitors
6.Stalevo
7.Monoamine oxidase type B inbitors

Question 5

What are anticholinergics usually used for?

Answer 5

Treating tremors and rigidity

Question 6

Examples of Anticholinergics

Answer 6

1.Trihexphenidyl (Artane)
2.Benztropine(Cognetin)

Question 7

What is Amantadine used for ?

Answer 7

In mild diseases
And to reduce dyskinesia in advanced diseases

Question 8

Another name for Carbidopa and Levodopa?

Answer 8

Sinemet

Question 9

How does Carbidopa and Levodopa work?

Answer 9

-Levodopa can be converted to dopamine by dopa decarboxylase
-So Carbidopa inhibits dopa decarboxylase and prevents conversion of levodopa to dopamine in the periphery
-Dopamine can’t cross the BBB but Levodopa can

Question 10

What are the side effects of Levodopa

Answer 10

1.Nausea and Vomiting /GI upset
2.Dyskinesia
3.Confusion/Halluncinations
4.Orthostatic Hypotension

Question 11

Complications of Carbidopa and Levodopa?

Answer 11

1.It wears off
2it has an on-off phenomenon

Question 12

Examples of Dopamine Agonists?

Answer 12

1.Bromocriptine
2.Pramipexole
3.Ropinirole

Question 13

Side effects of Dopamine Agonists?

Answer 13

Hallucinations and sleepiness

Question 14

Side effects of Dopamine Agonists?

Answer 14

1.Hallucinations
2.Sleepiness

Question 15

Examples of Catechol-o-methlytransferase inhibitors(COMT)

Answer 15

1.Talcapone and Entacapone

Question 16

Function of COMT inhibitors?

Answer 16

1.Reduce dose requirements and decrease fluctuations
I.e more sustained plasma levels of levodopa

Question 17

What is Stalevo?

Answer 17

Combination of
Carbidopa,Levodopa and entacapone

Question 18

Examples of Monoamine oxidase type B inhibitors?

Answer 18

1.Selegiline and Rasagiline

Question 19

What is the function of Monoamine oxidase type B inhibitors

Answer 19

Inhibit breakdown of Dopamine

Question 20

What are the 4 types of Parkinson-plus Syndromes?

Answer 20

1.Corticobasal Degeneration
2.Multiple System Atrophy
3.Dementia with Lewy bodies
4.Progressive Supranuckear Palsy

Question 21

What are the characteristics of Progressive Supranuclear Palsy.

Answer 21

1.Gait instability (early falls)
2.Supranuclear opthalmoplegia

Question 22

Characteristics of Multiple System Atrophy

Answer 22

1.Autonomic Dysfunction
2.Cerebellar Dysfunction

Question 23

Corticobasal Degeneration characteristics?

Answer 23

Apraxia/clumsiness
Neglect
Alien Hand syndrome
Myoclonus

Question 24

Characteristics of Dementia with Lewy Bodies?

Answer 24

1.Fluctuating dementia and psychosis
2.The Dementia appears before or within one year of Dementia

Question 25

What is a Tremor?

Answer 25

Involuntary,relatively rhythmic ,purposeless oscillatory movements with alternating contraction of opposing groups of muscle.

Question 26

Define an essential tremor

Answer 26

This is typically a postural tremor and it worsens with a goal-directed activity

Question 27

Treatment for essential tremors?

Answer 27

1.Propanolol 2Deep Brain stimulation

Question 28

Causes of Chorea?

Answer 28

1.Hereditary-Wilson Disease 2.infective-Chorea Gravidarum 3.Drug Toxicity-Oral contraceptives,Lithium,Levodopa 4.Cerebrovascular Disease 5.Medical disorders-AIDS,Encephalitis

Question 29

Clinical presentation of Huntington’s Disease?

Answer 29

1.Dementia 2.OCD and Depression 3.Chorea -difficulty initiating saccadic eye movements

Question 30

Prognosis of Huntington’s Disease?

Answer 30

10-20yrs

Question 31

What lesion occurs in Hemibalism?

Answer 31

Lesion of the contra lateral subthalamic nucleus.

Question 32

What is Dystonia?

Answer 32

Is is the slow,bizzare,writhing twisting and turning character. Characterized by repetitive muscle contraction that are sustained at peak-muscles are in constant state of hypertonicity. This postures become fixed by contracture and deformaties form

Question 33

How is dystonia classified?

Answer 33

According to the site of involvement

Question 34

What are the different ways of grouping dystonia according to sites of involvement ?

Answer 34

1.Focal-one body part affected 2.Segmental-two or more contiguous parts involved 3.Multifocal-two or more noncontiguous parts involved 4.Hemidystonia-one side of the body affected 5.Generalized

Question 35

Causes of Dystonia?

Answer 35

1.Could be hereditary OR 2.Parkinson’s/Parkinson-plus syndrome 3.Huntington’s Disease 4.Stroke 5.Drugs-Dopamine receptor antagonists

Question 36

Treatment offered?

Answer 36

Medications which are frequently not helpful. 1.Anticholinergics 2.Benzodiazepines Botox

Question 37

In Dystonia what is Botox used for ?

Answer 37

Focal Dystonia/Writer’s cramp

Question 38

Describe myoclonus?

Answer 38

Abrupt,brief,rapid,jerky arrthymic involuntary contractions involving portions of muscles,entire muscles or group of muscles.

Question 39

Where is myoclonus normally seen?

Answer 39

In muscles of extremities and trunk but involvement may be diffuse or widespread

Question 40

What decreases and increases myoclonus?

Answer 40

1.Voluntary movement 2Stimulation

Question 41

What is Asterixis?

Answer 41

Negative myoclonus

Question 42

Etiology of Myoclonus?

Answer 42

1.Physiologic 2.Epileptic-Progressive myoclonus epilepsy syndromes 3.Essential Myoclonus 4.Drug induced-Levodopa and Lithium 5.Symptomatic-neoplasm

Question 43

Treatment for Myoclonus?

Answer 43

1.Valporic acid 2.Benzodiazepines

Question 44

What worsens tics?

Answer 44

Anxiety Stress Fatigue

Question 45

What relieves tics

Answer 45

By concentrating on a task or doing absorbing activities such as reading

Question 46

What part of the body does Tics involve?

Answer 46

1.face 2.Neck 3.Shoulders