Movement Disorders

Question 1

A benign essential tremor is one that causes ___________ and ___________ shaking. It is not dangerous HOWEVER it does progress over time. It is most common in people over 40.

_________________ may be more frequent in women.
_________________ may be more severe in men.

About half of the cases of essential tremors are caused by _________________ and other half may be _______________

Answer 1

involuntary, rhythmic

head tremor
postural hand tremor

genetic mutations, environmental factors.

Question 2

_______________ can be done in patients suspected to have tremors- you have the patient place their hand above ground and draw a spiral with their dominant and nondominant hand.

Answer 2

spiral test

Question 3

What is the first line treatment for essential tremors?

Answer 3

beta blockers

Question 4

____________ is a term used to describe the collection of signs and symptoms found in parkinsons disease.
1.
2.
3.

Answer 4

parkinsonism

1. slowness (bradykinesia)
2. stiffness (rigidity)
3. tremor and imbalance (postural instability)

Question 5

_______________________ is a term encompassing several neurodegenerative disorders in which one or more systems in the body deteriorates. The average age of onset is in the mid 50s.
Two major subtypes:
1.
2.
There is no specific treatment, alleviate symptoms.

Answer 5

Multiple system atrophy

1. MSA-P- parkinsonism dominates
2. MSA-C - cerebellar ataxia (incoordination) dominates

Question 6

The most common type of degenerative atypical parkinsonism is ________________________. Age of onset is mid 60s and the symptoms tend to progress more rapidly than PD. People with PSP may __________ frequently early in the course of the disease. Later symptoms include limitations in ______________________ which also contributes to falls.
These pts also have difficulty with
1.
2.
3.
4.
There is no specific treatment, alleviate symptoms.

Answer 6

progressive supranuclear palsy (PSP)
fall
eye movements- up and down

1. dysphagia
2. difficulty producing speech (dysarthria)
3. sleep problems
4. memory and thinking (dementia)

Question 7

____________________ is the least common type of atypical causes of parkinsonism. Usually begins with symptoms affecting _____________________. In addition to parkinsonism, other symptoms can include
1.
2.
3.
4.

Supportive treatment includes:

Answer 7

Corticobasal syndrome (CBS)
one limb
1. abnormal posturing of the affected limb (dystonia)
2. fast jerk movements (myoclonus)
3. difficulty with some major task despite normal muscle strength (apraxia)
4. difficulty with language (aphasia)

supportive treatment: botox (dystonia), antidepressants, speech and physical therapy.

Question 8

Dementia with Lewy body is a progressive, neurodegenerative disorder in which abnormal deposits of a protein called ___________________ builds up in multiple areas.

Answer 8

alpha-synuclein

Question 9

___________________ is second to Alzheimer’s as the most common cause of degenerative dementia that first causes progressive problems with ____________ and fluctuations in _____________ as well as ____________.

There are no treatments.

Answer 9

dementia with lewy bodies
memory, thinking, hallucinations

Question 10

What class of drugs is the main one to cause drug-induced parkinsonism?

Answer 10

antipsychotics

Question 11

A severe onset of parkinsonism immediately following a stroke may indicate _________________. Other signs that indicate VP are
1.
2.

Answer 11

vascular parkinsonism.

prominent early cognitive problems.
lower body issues such as early gait and balance problems.

Question 12

Parkinson’s disease belongs to a group of conditions called ________________, which causes __________________. In PD, brain cells become damaged or due in the part of the brain that produces _______________ a chemical needed to produce smooth, purposeful movements.

Answer 12

motor system disorders, unintended or uncontrollable movements of the body. dopamine

Question 13

What factors seem to play a role in parkinson’s disease?
1.
2.

Changes that occur in the brain of someone with PD?
1.
2.

Answer 13

Factors that play a role
1. genes
2. environmental triggers

Changes that occur
1. lewy bodies
2. alpha synuclein found within lewy bodies

Question 14

What are symptoms of PD?
1.
2.
3.
4.
5.
6.
7.

Answer 14

1. tremor - being in a limb often in hands/fingers - may rub thumb + forefinger back and forth- pill rolling tremor.
2. slowed movement (bradykinesia) - may be difficult to get out of a chair.
3. Rigid muscles
4. impaired posture and balance
5. loss of automatic movements- e.g. blinking, smiling, swinging arms when you walk.
6. speech changes- monotone
7. writing changes

Question 15

What are off periods in parkinson’s disease? What contributes to off periods?

Answer 15

off times are when levodopa is not working optimally and as a result, symptoms return.

Factors that contribute to off periods
1. stress/anxiety
2. lack of sleep
3. pain
4. other mood symptoms

Question 16

1. What are freezing episodes in parkinson’s?
2. When are these episodes most likely seen?
3. What triggers freezing?

Answer 16

1. feeling as though feet are stuck in place, express difficulty getting out of chairs (most common) freezing is temporary, involuntary inability to move. freezing may also affect other parts of the body or speech.
2. These episodes are most often seen during “off” periods or when they are due for meds.
3. walking through doorways, turning a corner, turning around, stepping from one type of surface to another, multitasking, stressful situations.

Question 17

In the diagnosis of PD, a patient will get a detailed neuro exam and a neurologist will ask to perform tasks to assess the agility of arms and legs, muscle tone, gait and balance to see if:
1.
2.
3.
4.

Answer 17

1. expression and speech are animated
2. tremor can be observed in extremities at rest or in action
3. stiffness in extremities or neck
4. maintain balance

Question 18

What is Unified Parkinson’s Disease Rating Scale (UPDRs) ?

Answer 18

a universal scale used by neurologists and movement disorder specialists to assess/document exam of person with PD at baseline, judge the effect of meds and track the progression of disease during future visits.
Score 0-5
Cons: doesnt take into consideration other functions

Question 19

What is DaTscan?

Answer 19

an imaging technology that uses small amounts of radioactive drug to help determine how much dopamine is available in a persons brain. A negative result DOES NOT rule out PD but a positive result CONFIRMS it BUT it doesnt differentiate PD from other forms of parkinsonism. can differentiate from essential tremor and PD

Question 20

What are the complications associated with PD?

Answer 20

thinking difficulties, depression/emotional changes, swallowing problems, chewing/eating problems, sleep problems/sleep disorders, bladder problems, constipation, BP changes, smell dysfunction, fatigue, pain, sexual dysfunction

Question 21

What are the treatment options for PD?

Answer 21

1. Levadopa - DYSKINESIA IS THE MAIN SIDE EFFECT usually experience this 3-5 years after starting the medication.
2. Amantadine- used with levadopa/carbidopa to help with tremor
3. COMT inhibitors- prolongs effect of levidopa- only effective when used in combo with it.
4. Anticholinergic drugs- tremors/dystonia
5. DBS!!!!!- blocks abnormal nerve signals that cause tremors and PD symptoms
6. Dupoa- for those who cant tolerate oral meds- form of cabidpoa/levodopa delivered in gel form rather than pill.

Question 22

_________ onset is most common in Huntington’s disease. It is an inherited disorder that causes _________ to die in various areas of the brain, including those that help to control voluntary movement. An earlier onset of juvenile HD occurs under age 20. Symptoms differ from adult onset HD.

Answer 22

adult. neurons

Question 23

Huntington is a disease caused by a mutation in the gene for a protein called ___________________. The defect causes cytosine, adenine, guanine (CAG) building blocks of DNA to repeat many more times than normal. Each child of a parent with HD has a ___________ chance of inheriting the HD gene.

Answer 23

huntington.
50/50

Question 24

What are the symptoms of HD? How is it diagnosed and what is the treatment?

Answer 24

1. uncontrolled movements (chorea) - HALLMARK
2. abnormal body postures
3. changes in behavior, emotion, judgement, cognition
4. impaired coordination
5. slurred speech
6. difficulty feeding and swallowing

It is diagnosed in a person who
1. carries a known CAG-expanded allele of the HD gene or has a family history of HD
2. develops motor symptoms that are unequivocal signs of HD

The treatment involves management of symptoms. Nothing will help progression.

Question 25

RLS, also known as Willis-Ekbom disease is a condition that causes an uncontrollable urge to move the legs usually because of an ________________. It typically begins in the ______________ when youre ______________. moving eases the unpleasant feeling temporarily. It worsens as you age and it can disrupt sleep. This can also present with nightime leg twitching while you sleep.

Answer 25

uncomfortable sensation.
evening/nighttime hours
sitting/lying down

Question 26

What are the two main medications that are used in the treatment of RLS? One thing to know about meds for RLS is that after a while they become ineffective

Answer 26

rotigotine
pramiprexole

Question 27

_____________ is another type of hypertonia. Characteristic features are stiffness, inflexibility, and the inability to bend, twist or stretch ______________ and ______________ are the main features of rigidity.

Answer 27

rigidity
muscle tension, rigor

Question 28

What are the two types of rigidity?

Answer 28

1. cogwheel rigidity- results in intermittent increase in muscle tone. also occurs due to coexistance of basal ganglia diseases and tremor diseases.
2. lead pipe rigidity- uniform increase in tone. occurs due to neuroleptic malignant syndrome.

Question 29

Bradykinesia= __________________
What are the causes?

Answer 29

slowness of movement
the causes are
1. stroke
2. tumor
3. parkinson’s
4. exposure to toxins
5. hypothyroidism
6. use of meds to treat psychosis
7. multiple system atrophy
8. hydrocephalus

Question 30

Acquired dystonia is damage to the __________________. It is characterized by painful prolonged muscle contractions that result in abnormal movements and postures. It is a result of:

Answer 30

basal ganglia

1. brain tumor
2. stroke
3. tumor
4. oxygen deprivation
5. infection
6. drug reactions
7. poisoning caused by lead or CO

Question 31

What are the treatment options for dystonia?

Answer 31

levadopa/carbidopa
valium/baclofen
benztropine
tetrabenazine
botox