Movement Disorders

Question 1

hypokinesia definition

Answer 1

Slowed movements with increased tone (Parkinsonism)

Question 2

Hyperkinesia definition

Answer 2

Excessive Involuntary movements

Question 3

types of Parkinsonism

Answer 3

Idiopathic Parkinson’s disease
Parkinson’s plus syndromes (MSA, CBD, PSP)
Drug induced (anti-psychotics, anti-emetics, methyldopa, lithium)
Other pathology (tumour, post-encephalitis)

Question 4

What is Parkinsonism?

Answer 4

presence of bradykinesia and one of the following three symptoms:
- Resting tremor
- postural instability
- Rigidity

Question 5

What is Parkinson’s disease?

Answer 5

progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in the substantia nigra

Question 6

What causes tremor and rigidity in Parkinson’s?

Answer 6

Imbalance between acetylcholine and dopamine acting on the basal ganglia

Question 7

Clinical features of Parkinson’s disease

Answer 7

T - tremor (resting ‘pill rolling tremor’), improves with movement
R - Rigidity (‘cog wheel’ rigidity in the arm, ‘lead pipe’ rigidity in the leg)
A - akinesia (bradykinesia), asymmetrical
P - postural instability (shuffling gait with reduced arm swing)

Other features:

Mask-like face
Depression, psychosis
Fatiguing and decrement in rapid continuous movement
Micrographia
Postural hypotension

Question 8

features of drug induced Parkinsonism

Answer 8

features of Parkinsonism BUT

motor symptoms are generally rapid onset bilateral
rigidity and resting tremors are uncommon

Question 9

Features signifying possible Parkinson plus syndromes

Answer 9

Symmetrical presentation
Absence of tremor
Levodopa unresponsiveness
Early falls (within 1st year)
Additional neurological features

Question 10

Features of Multiple System Atrophy (MSA)

Answer 10

Parkinsonism
Characteristically rapid progressive autonomic dysfunction with severe postural hypotension and urogenital dysfunction
Alpha-synuclein + glial cytoplasmic inclusions are found in the basal ganglia
No response to levodopa

Question 11

Features of progressive supra nuclear palsy (PSP)

Answer 11

Parkinsonism
Postural instability with early falls
vertical Supra nuclear gaze palsy
Pseudobular palsy and dementia
Tau deposition in the substantia nigra, sub thalamic nucleus and midbrain

Question 12

Features of corticobasal degeneration (CBD)

Answer 12

Alien limb phenomena
Dementia
myoclonus

Question 13

Types of hyperkinesia

Answer 13

Chorea
Tics
Myoclonus
Dystonia
Tremor

Question 14

What is chorea?

Answer 14

Excessive, irregular movements flitting from one body part to another

Question 15

Myoclonus

Answer 15

Brief electric shock like jerks

Question 16

Dystonia

Answer 16

Sustained muscle spasms causing twisting movements and abdominal positions

Question 17

Features of an essential tremor

Answer 17

Autosomal dominant inheritance
Bilateral, fast, low amplitude, mainly upper limb
Postural: holding glass or cutlery, worse if arm stretched out
Better with alcohol and rest

Question 18

Huntington’s disease mode of inheritance

Answer 18

Autosomal dominant

Question 19

What is Huntington’s disease?

Answer 19

Trinucleotide repeat disorder: increased number of cystine-adenosine-guanine (CAG) trinucleotide repeats on the Huntington gene on chromosome 4

Question 20

Pathophysiological result of the genetics of Huntington’s disease

Answer 20

Degeneration of cholinergic and GABAergic neurones in the striatum of the basal ganglia

Question 21

Clinical features of Huntingtons

Answer 21

Huntington’s Triad:
Dementia
Personality changes (Depression, apathy, irritability) and intellectual impairment
Chorea (irregular, excessive movements from one body part to another)

Saccadic eye movements

Question 22

Investigation for Huntington’s

Answer 22

PCR analysis and gel/capillary electrophoresis