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Movement Disorders Flashcards

1
Q

purpose of the basal ganglia

A
  • make movements & prevents unwanted movements
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2
Q

which is excitatory? which is inhibitory?
* GABA
* Glutamate

A
  • GABA: inhibitory
  • Glutamate: excitatory
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3
Q

describe the direct pathway

A

promotes voluntary movement in trageted muscules (from through to the actual movement)

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4
Q

describe the indirect pathway

A

inhibition of movements in other muscles that do not contribute to the overall wanted movement

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5
Q

in normal movement, what acts on the pathways?

A

dopamine

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6
Q

in normal pathways what does dopamine act on? what after that?

A

thalamus which then excites the motor cortex

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7
Q

vocab

dyskinesia

A

any involuntary movement

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8
Q

vocab

athetosis

A

abnormal muscle contractions cause involuntary writhing movement

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9
Q

vocab

bradykinesia

A

slowness of movements

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10
Q

vocab

chorea

A

jerky involuntary movements affecting especially the shoulders, hips, and face (dance like movements)

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11
Q

vocab

dysmetria

A

misjuding distance to a target

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12
Q

vocab

hyposmia

A

reduced ability to smell

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13
Q

vocab

hemiballismus

A
  • type of chorea
  • usually involving violent, involuntary flinging of one arm/leg
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14
Q

vocab

akathisia

A

restlessness

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15
Q

vocab

titubation

A

shaking of the trunk and head

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16
Q

vocab

rigidity

A

stiffness, noted as increased muscle tone on examination

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17
Q

vocab

tardive dyskinesia

A

involuntary movements due to dopamine antagonists

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18
Q

Tic Disorders

describe tic disorders

A

neuropsychiatric diseases which are common in children

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19
Q

Tic Disorders

characterized by

A
  • sudden twitches
  • movements (motor tic)
  • sounds that people do repeatedly (vocal tic)
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20
Q

Tic Disorders

describe simple motor tics

A
  • appears in one muscle group
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21
Q

Tic Disorders

examples of simple motor tics

8

A
  • nose twitching
  • blinking/rolling eyes
  • neck/head spasms
  • head shaking
  • head leaning back
  • lip biting
  • face grimacing
  • shoulder struggling
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22
Q

Tic Disorders

describe complex motor tics

A
  • simultaneously in more than 2 muscle groups
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23
Q

Tic Disorders

examples of motor tics

4

A
  • kicking, skipping, or jumping while walking
  • imitating others’ movements
  • flaring nostrils and sniffing
  • self hitting/twirling in place
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24
Q

Tic Disorders

examples of simple vocal tics

7

A
  • dry cough
  • chocking sound
  • throat clearing
  • making animal noises
  • sniffling
  • muttering
  • saying syllables
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25
# Tic Disorders examples of complex vocal tics
* palilalia * echolalia * stuttering * coprolalia
26
# Tic Disorders what is palilalia
repletion of one's own spoken words or sentences
27
# Tic Disorders what is echolalia
repletion of words spoken by others
28
# Tic Disorders what is coprolalia
saying obscene words or searing
29
# Tic Disorders 5 tic disorders
1. transient tic disorder 2. chronic tic disorder 3. complex tic disorder 4. tourette's syndrome 5. unclassified tic disorder
30
# Tic Disorders describe transient tic disorder
when the tic sx temporarily and repeatedly appears and disappear before the age of 18
31
# Tic Disorders describe chronic tic disorders
when either one of motor or vocal tic repeatedly appears and disappears continuously for more than a year
32
# Tic Disorders describe complex tic disorder
when vocal and motor tics are combined
33
# Tic Disorders describe tourette syndrome
when the symptoms of a complex tix last more than a year
34
# Tic Disorders what % of kids experience tics? more common in who?
1 in 5 kids 3x more common in boys than girls
35
# Tic Disorders 4 potential causes
* dopamine system dysregulation * genetic factor * environmental factors * psycholgoical factors
36
# Tic Disorders what meds can be given? | class + 3 drugs
anti-psychotic drugs * haloperidol * pimozide * risperidone
37
# Tic Disorders what does behavioral therapy consist of? | 3
* relaxation training * habit reversal * family education
38
# Tic Disorders what operations to consider | 2
* deep brain stimulation * nerve surgery
39
# Tic Disorders what alternative treatments are available? | 2
* cranio-scaral balance therapy * TMJ balancing
40
# Tremors describe them
non-intentional rhythmic and oscillatory movements of a body part, which result from alternating or irregular synchronous contractions of muscles that have an opposite effect on a joint
41
# Tremors how are tremors classified | 4
* distribution: which body part is affected * state-dependent: action (essential tremor), rest (Parkinson's disease) * tremor frequency (number of oscillations/sec) * amplitude (distance of movement)
42
# Tremors what 3 disorders are action tremors
* postural * kinetic * isometric
43
# Tremors what disorder is a rest tremor?
parkinson's
44
# Postural Tremor describe
postural tremor happens when you try to hold a body part still, against the force of gravity
45
# Postural Tremor which is most common?
physiologic
46
# Postural Physiologic Tremor typically affects what parts of the body?
* upper limbs * hands
47
# Postural Physiologic Tremor potential causes
* exaggerated physiologic responses (anxiety, fatigue, fright) * drugs (amphetamines, alc withdrawal, caffeine, amiodarone) * metabolic disorders (hypoglycemia, pheochromocytoma, thyrotoxicosis) * toxins (mercury)
48
# Postural Essential Tremor most commonly impacts what areas of the body?
* hands and arms * individually usually is worse on one side * head, voice also possible
49
# Postural Essential Tremor risk factors
* male * family hx
50
# Postural Essential Tremor age of onset
bi-modal * 10-20 * 40-60
51
# Postural Essential Tremor what can help alleviate these?
alcohol
52
# Postural Essential Tremor how do these change with age?
* amplitude increases * frequency decreases
53
# Postural Essential Tremor dx
clinical dx
54
# Postural Essential Tremor testing to r/o other differentials | 5
* review med list * review potential for alcohol/drug withdrawal * consider TFTs in pts with hx of hyperthyroidism * consider imaging w/ neurologic deficits * EMG for tremor analysis
55
# Postural Essential Tremor Describe alcohol as a tx
* can use prophylactically (60 mL 10-15min prior to triggering event) * alc potentiates GABA * regular alc consumption not recommended
56
# Postural Essential Tremor what other meds are posisble for tx
* propanolol (most effective) * primodine * benzodiazapines
57
# Kinetic Tremor describe
occurs when doing something goal oriented and the tremor becomes worse when closer to the goal (ex: drinking from a cup)
58
# Cerebellar Kinetic Tremor associated with lesions/diseases where?
* cerebellum * cereberal outflow pathways
59
# Cerebellar Kinetic Tremor where are tremors located?
ipsilaterally
60
# Cerebellar Kinetic Tremor what is it called if someone has these AND postural tremors?
head titubation tremor
61
# Cerebellar Kinetic Tremor what PE can you do to r/o?
* finger to nose test * finger to finger test * heel to shin test
62
# Cerebellar Kinetic Tremor which meds?
none have been proven to help!
63
# Isometric Tremor describe
occurs when contracting a muscle against an unmoving object (ex: when doing push ups at gym & hands are on floor and start shaking)
64
# Rest Tremors what are resting tremors due to? | like in the brain
* abnormal synchronicity of basal ganglia and thalamic neuronal activity
65
# Rest Tremors signs/sx | 6 components
* pill rolling w/ hands * symmetric tremor * tremor stops w/ movement but can resume once settled in new position * leg, tongue, lip, jaw may be involved * tremors worsen w/ emotional stress * tremors get better with anti-parkinson meds
66
# Parkinson's Disease describe
progressive neurodegenerative condition resulting in disorder of movement, autonomic functioning, and potentially cognition
67
# Parkinson's Disease cardinal signs | 4
TRAP * Tremor (resting) * Rigidity of trunk/limbs * Akinesia or bradykinesia * Postural instability
68
# Parkinson's Disease hx findings
* onset is usually asymmetric and gradually spreads * restlessness during sleep or sleepwalking is common * reduction in smell
69
# Parkinson's Disease sx (besides cardinal TRAP) | 5
* decreased blinking * sleep disturbances * autonomic dysfunction (constipation, sweating, sex) * bradyphrenia * dementia
70
# Parkinson's Disease dx
Clinical Diagnosis, testing to r/o other diseases
71
# Parkinson's Disease what dx tools to consider
* CT/MRI if pt younger than 55 or presents abnormally for parkinson's * SPECT scan: distinguishes essential tremor from parkinson's
72
# Parkinson's Disease criteria for diagnosis
two plus of the following: * resting tremor * rigidity * bradykinesia
73
# Parkinson's Disease tx
gold standard: carbadopa, levodopa (can do benztropine, amantadine, COMT inhibitors, MAO-B inhibitors)
74
# Parkinson's Disease when is an anticholinergic the first choice?
* higher functioning * no significant postural instability * pt is under 60 y/o
75
# Parkinson's Disease when is amantadine the first choice tx?
* higher functioning * no significant postural instability * pt over 60 y/o
76
# Parkinson's Disease out patient management
* regular follow ups w/ PCP & neurologist * screen for depression, mood disorders * exercise & speech therapy * assistive devices for home
77
# Parkinson's Disease describe parkinson's plus conditions
characterized by the primary features of Parkinson disease, but also include additional features such as dementia, cognitive deficits, and cranial nerve impairment
78
# parkinson's plus conditions describe normal pressure hydrocephalus
* sx: wet, wobbly, wacky * dx: CT * tx: lumbar puncture drainage
79
# parkinson's plus conditions describe Wilson's disease
* genetic condition (autosomal recessive) * psychiatric disturbances, liver failure, KF rings
80
# parkinson's plus conditions describe postencephalitic parkinsonism
occurs following encephalitis
81
# parkinson's plus conditions describe progressive supranuclear palsy
* parkinsonian sx PLUS vertical gaze palsy * tremor may not be as prominent
82
# parkinson's plus conditions describe shy-drager syndrome
* parkinsonian sx PLUS severe autonomic instability, gain issues, nystagmus * dx: imaging to look for atrophy of brainstem/cerebellum
83
# parkinson's plus conditions examples of autonomic dysfunction
* orthostatic hypotension * UMN lesion sx (hyperreflexia, primitive reflexes) * cerebellar sx (nystagmus)
84
# parkinson's plus conditions describe lewy body dementia
* parkinsonian sx PLUS prominent dementia coinciding w/ onset of parkinsonian sx
85
# Huntington's Disease describe overall
* CAG repeats create a mutant, damaging protein * autosomal dominant genetic disorder * gross atrophy of the caudate and putamen
86
# Huntington's Disease what correlates with severity of sx?
extent of brain damage
87
# Huntington's Disease avg age of onset? what impacts age of onset?
* 32 to 38 y/o * onset becomes earlier w/ more CAG repeats
88
# Huntington's Disease hx findings
* most pts know there is a family hx of huntington's * others may say they have family hx of "early onset dementia"
89
# Huntington's Disease movement sx | 5
* fidgetiness * ballism or hemiballismus * chorea * parkinsonian features * rigidity
90
# Huntington's Disease cognitive sx | 5
* anhedonia * apathy * untidiness * short term memory loss * dementia
91
# Huntington's Disease behavioral symptoms | 5
* change in affect * mood disorders (depression, OCD) * suicide * psychosis
92
# Huntington's Disease PE findings | 4 components
* chorea (uncontrollable, jerky movements) * hemiballismus (violent flinging of one arm) * athetosis (abnormal, involuntary writhing movements) * parkinsonian sx
93
# Huntington's Disease dx
* clinical * genetic testing (gold standard) * imaging will show increased bicaudate diameter
94
# Huntington's Disease tx
* no cure for the disease, just manage individual sx
95
# Huntington's Disease what med options for: * ballismus/choreathetosis * parkinsonian sx * depressive disorder * psychosis
* benzodiazepines * levo/carbo * SSRIs * atypicals
96
# Ataxia describe
loss of control of body movements
97
# Ataxia 3 causes
1. inherited/genetic 2. acquired 3. idiopathic (unk cause)
98
# Ataxia describe input pathway to cerebellum
peripheral nerve --> dorsal root ganglia --> spinal cord --> dorsal column --> spinocerebral pathway --> cerebellum
99
# Sensory Ataxia describe
problems w/ the proprioceptive pathway
100
# Sensory Ataxia PE finding
* inability to stand w/ eyes closed (Romberg test pos)
101
# Sensory Ataxia sx
* limb ataxia * vibration defects * proprioception defects
102
# Genetic Ataxia (Friedrich) age of onset
5-25 y/o
103
# Genetic Ataxia (Friedrich) sx | 2
* progressive ataxia * nystagmus
104
# Genetic Ataxia (Friedrich) PE Findings | 4
* axonal neuropathy * distal atrophy * absent LE tendon reflexes * upgoing toes w/ Babinski
105
# Genetic Ataxia (Friedrich) MRI findings
no cerebellar atrophy
106
# Ataxia Dx of ataxia | 6 components
1. PMH, FH of neurology (including durgs/toxins) 2. blood test to r/o drugs/toxin/deficiencies 3. UA for mercury 4. MRI or CT of brain 5. neuroimaging of spinal cord 6. Electrophysiologic testing if sx of peripheral nerve dysfunction
107
# Ataxia Tx of ataxia | 4 components
1. medication has minimal impact unless caused by nutrional deficiences 2. Some meds can reduce leg spasticity and address cerebellar tremors 3. PT/OT 4. Assistive devices
108
# Ataxia what are pts w/ ataxia more likely to do?
* mix meds * fall * become ill w/ aspiration pneumonia

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