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Neuro > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

Classification of movement disorders

A

-Hypokinetic
=Parkinsonism

-Hyperkinetic
=Tremor
=Chorea
=Myoclonus
=Dystonia
=Tics

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2
Q

What is chorea?

A

-Irregular, purposeless movements that flow from one part of the body to another

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3
Q

Clinical features of chorea

A

-Can be generalised, confined to one body region (orofacial) or one side of the body (hemichorea) (look restless or fidgety)
-Ballism is a severe proximal form of chorea in which there is flinging movements of the affected limbs
=hemiballism due to injury to contralateral subthalamic nucleus (vascular cause)

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4
Q

Causes of chorea

A

-Genetic (Huntington’s, C9orf72 mutations, Wilson’s, neurocanthocytosis, ataxia telangiectasia)
-Drug-induced (neuroleptics, contraceptive, levodopa)
-Structural lesions (basal ganglia)
-Autoimmune (SLE, antiphospholipid syndrome, encephalitis)
-Infections (HIV)
-Metabolic (thyroid, glucose, sodium, calcium, polycythaemia rubra vera)
-Pregnancy
-Paroxysmal dyskinesia

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5
Q

Chorea treatment

A

-Tetrabenazine (VMAT 2 inhibitor)
-Dopamine blocking drugs

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6
Q

What is myoclonus?

A

-Brief, electric shock-like muscle jerks

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7
Q

Clinical features of myoclonus

A

-Can affect one muscle or groups of muscles
-Sometimes myoclonus causes temporary cessation of muscle activation (negative myoclonus- asterixis in liver failure, lower limbs bouncy legs with sudden loss of muscle tone)
-Muscle activation can arise, from the cortex, subcortical structures (including brainstem), spinal cord/nerve roots/ plexus

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8
Q

Causes of myoclonus

A

-Genetic (may occur alongside epilepsy, ataxia)
-Neurodegenerative conditions
-Hypoxic brain injury
-Renal or liver failure
-Drug-induced (lithium, carbamazepine)
-Spinal cord/ nerve root/ plexus disorders
-Toxin (lead poisoning)
-Infections (Whipple’s)
-Autoimmune (PERM, paraneoplastic, coeliac)

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9
Q

Treatment of myoclonus

A

-Clonazepam
-Sodium valproate
-Levetiracetam
-Primidone

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10
Q

What is dystonia?

A

-Involuntary muscle spasm that leads to sustained abnormal postures of a body part

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11
Q

Clinical features of dystonia

A

-Can be focal, segmental, multifocal, hemi dystonia, generalised
-Typically mobile rather than fixed
-Due to co-contraction of antagonistic muscles
-Often improved by sensory trick

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12
Q

Causes of isolated dystonia

A

-Genetic (DYT1, DYT5, DYT6)
-Task-specific (writer-s cramp, musicians’)
-Focal (blepharospasm, cervical dystonia)

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13
Q

Causes of combined dystonia

A

-Genetic
-Structural brain lesion (basal ganglia)
-Drugs (dopamine blocking)
-Neurodegenerative conditions (PD, PSP, CBD, MSA)
-Functional
-Paroxysmal dyskinesia’s

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14
Q

Treatment of dystonia

A

-Trihexyphenidyl
-Clonazepam
-Tetrabenazine
-Baclofen
-Botulinum toxin (1)
-Deep brain stimulation (generalised)

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15
Q

What are tics?

A

-Involuntary, brief, stereotyped movements or vocalisations

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16
Q

Clinical features of tics

A

-Suppressible followed by flurry of tics, premonitory urge
-Motor can be simple (blinking, shoulder shrugging) or complex (head shaking, touching, kicking)
-Vocal can be simple (cough, grunt) or complex (words)
-Copropraxia/ lalia…
-Stereotypies longer more complex repetitive behaviours (body rocking, hand wringing)

17
Q

Primary tic disorders

A

-Childhood onset motor tic
-Tourette’s syndrome

18
Q

Secondary tic disorders

A

-Neurodegenerative condition (Wilson’s, Huntington)
-Developmental syndromes (Rett’s syndrome, Lesch-Nyhan)
-Drug-induced (cocaine, amphetamines, methylphenidate)
-Structural lesions (basal ganglia)
-Infection or immune mediated

19
Q

Treatment for Tics

A

-Cognitive behavioural therapy
-Clonidine
-Dopamine blocking drugs (aripiprazole)
-Tetrabenazine

20
Q

What is tremor?

A

-An involuntary, rhythmic, oscillatory movement of a body part

21
Q

Structure of a general examination of a tremor

A
  1. Assess different tremor components
    =Rest (sitting/lying)- cognitive stress (serial 7s)
    =Action (postural like arms out and both hands under chin, and kinetic- finger nose test)
  2. Assess impact of tremor
    =Writing
    =Transferring water between 2 cups
    =Spiral drawing
  3. Assess tremor in other body parts
  4. Complete neurological examination
22
Q

Functional signs in examination

A

-Entrainability
=Tremor frequency changes when patient performs motor task with contralateral hand

-Distractibility
=Cessation of tremor when distracted (mental task or contralateral movement)

-Resolution when performing ballistic movements

23
Q

Describe Essential Tremor

A

-Bilateral upper limb postural and kinetic tremor
-Bimodal age distribution
-Different from enhanced physiological tremor (which normalises after removal of the provoking factors such as anxiety or caffeine)
-Around half of ET patients have positive family history
-Often alcohol responsive
-Typically worsens over time
-Can involve head, voice and other body parts

24
Q

Additional signs and tremor features of Parkinsonism

A

-Bradykinesia and/or rigidity
-Rest tremor (4-7Hz) with or without postural tremor, asymmetric

25
Q

Additional signs and tremor features of cerebellar syndrome

A

-Gait ataxia, limb coordination, slurred speech, eye movement disorder
-Intention tremor

26
Q

Additional signs and tremor features of dystonia

A

-Abnormal posturing (same or different body part)
-Postural or kinetic tremor, irregular, position-dependent

27
Q

Additional signs and tremor features of neuropathy

A

-Weakness, glove and stocking sensory deficits, areflexia
-Mainly postural tremor

28
Q

Causes of drug-induced tremor

A

-Neuroleptics (dopamine blocking)
-Anticonvulsants (sodium valproate, phenytoin)
-Lithium
-Amiodarone
-Antidepressants (SSRI, tricyclics)

29
Q

Metabolic causes of tremor

A

-Hyperthyroidism
-Renal and liver failure
-Rare:
=Phaeochromocytoma (serum catecholamines)
=Wilson’s disease (copper and caeruloplasmin)
=Neurodegeneration with brain iron accumulation (iron studies)
=Toxins (mercury)

30
Q

Indications for DAT scan

A

-Dopamine Transporter imaging= presynaptic dopaminergic deficit

=Drug-induced vs idiopathic PD
=Dystonic tremor vs PD
=Longstanding ET with prominent rest tremor
=PD with prominent functional tremor

31
Q

Tremor treatments

A

Essential tremor
=Propranolol, primidone, topiramate, clonazepam
=Deep brain stimulation
=Focussed MR guided ultrasound

PG
=Dopaminergic therapy

Functional tremor
=Neurophysiotherapy

Neuro (30 decks)

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