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INTERNAL MEDICINE > MOVEMENT DISORDERS > Flashcards

MOVEMENT DISORDERS Flashcards

1
Q

What are the 6ways of treating Parkinsonism?

A

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

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2
Q

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

A

1.Thalamotomy-Tremor
2.Pallidotomy-Bradykinesia

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3
Q

Where in the ganglia does deep brain stimulation occur?

A

In the GP and Subthalamic nucleus

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4
Q

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

A

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

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5
Q

What are anticholinergics usually used for?

A

Treating tremors and rigidity

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6
Q

Examples of Anticholinergics

A

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

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7
Q

What is Amantadine used for ?

A

In mild diseases
And to reduce dyskinesia in advanced diseases

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8
Q

Another name for Carbidopa and Levodopa?

A

Sinemet

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9
Q

How does Carbidopa and Levodopa work?

A

-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

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10
Q

What are the side effects of Levodopa

A

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

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11
Q

Complications of Carbidopa and Levodopa?

A

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

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12
Q

Examples of Dopamine Agonists?

A

1.Bromocriptine
2.Pramipexole
3.Ropinirole

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13
Q

Side effects of Dopamine Agonists?

A

Hallucinations and sleepiness

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14
Q

Side effects of Dopamine Agonists?

A

1.Hallucinations
2.Sleepiness

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15
Q

Examples of Catechol-o-methlytransferase inhibitors(COMT)

A

1.Talcapone and Entacapone

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16
Q

Function of COMT inhibitors?

A

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

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17
Q

What is Stalevo?

A

Combination of
Carbidopa,Levodopa and entacapone

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18
Q

Examples of Monoamine oxidase type B inhibitors?

A

1.Selegiline and Rasagiline

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19
Q

What is the function of Monoamine oxidase type B inhibitors

A

Inhibit breakdown of Dopamine

20
Q

What are the 4 types of Parkinson-plus Syndromes?

A

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

21
Q

What are the characteristics of Progressive Supranuclear Palsy.

A

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

22
Q

Characteristics of Multiple System Atrophy

A

1.Autonomic Dysfunction
2.Cerebellar Dysfunction

23
Q

Corticobasal Degeneration characteristics?

A

Apraxia/clumsiness
Neglect
Alien Hand syndrome
Myoclonus

24
Q

Characteristics of Dementia with Lewy Bodies?

A

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

25
Q

What is a Tremor?

A

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

26
Q

Define an essential tremor

A

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

27
Q

Treatment for essential tremors?

A

1.Propanolol
2Deep Brain stimulation

28
Q

Causes of Chorea?

A

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

29
Q

Clinical presentation of Huntington’s Disease?

A

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

30
Q

Prognosis of Huntington’s Disease?

A

10-20yrs

31
Q

What lesion occurs in Hemibalism?

A

Lesion of the contra lateral subthalamic nucleus.

32
Q

What is Dystonia?

A

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

33
Q

How is dystonia classified?

A

According to the site of involvement

34
Q

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

A

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

35
Q

Causes of Dystonia?

A

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

36
Q

Treatment offered?

A

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

37
Q

In Dystonia what is Botox used for ?

A

Focal Dystonia/Writer’s cramp

38
Q

Describe myoclonus?

A

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

39
Q

Where is myoclonus normally seen?

A

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

40
Q

What decreases and increases myoclonus?

A

1.Voluntary movement
2Stimulation

41
Q

What is Asterixis?

A

Negative myoclonus

42
Q

Etiology of Myoclonus?

A

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

43
Q

Treatment for Myoclonus?

A

1.Valporic acid
2.Benzodiazepines

44
Q

What worsens tics?

A

Anxiety
Stress
Fatigue

45
Q

What relieves tics

A

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

46
Q

What part of the body does Tics involve?

A

1.face
2.Neck
3.Shoulders

INTERNAL MEDICINE (2 decks)

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