Movement Disorders Flashcards
How would Parkison’s Disease be defined
A chronic, idiopathic, progressive neurodegenerative movement disorder where symptoms continue to worsen over time
Describe the etiology of Parkinson’s
- loss of dopaminergic neurons in the substantia nigra (excessive inhibition of the thalamus leads to reduced cortical motor activation)
- loss of melanin from the pars compacta
+/- the presence of lewy bodies
What are the cardinal signs of Parkinson’s
- resting tremor
- cogwheel rigidity
- bradykinesia
- postural instability
other syx include: intrinsic muscle issues, stiffness, voice fluctuations, instability, micrographia, stooped/flexed posture, propulsion/retropulsion
How do symptoms of Parkinson’s typically start
unilateral tremor
What are some characteristics of Parkinson’s that may be seen on physical exam
- pill rolling, resting tremor
- bradykinesia, gait impairment
- postural reflexes impaired
- ask about onset of symptoms and progression
What is the difference between Parkinsonism and Parkinson’s Disease
Parkinsonism = 2 or 3/4 cardinal signs
Parkinson’s Disease = 4/4 cardinal signs
What diagnostic testing may be done in Parkinson’s disease
- no specific biomarker
- Lewy bodies may be seen on MRI
- olfactory testing
Describe the treatment of Parkinson’s Disease
- provide symptom relief
- levodopa-carbidopa
- Entacapone (COMT Inhibitors)
- MAO-B inhibitors
- Anticholinergics
What are some hyperkinetic disorders
- essential tremor
- dystonia
- Huntington’s Disease
- Wilson’s Disease
- Tardive Dyskinesia
- Restless leg syndrome
Etiology of essential tremor
- sporadic or familial (autosomal dominant)
- most common movement disorder
- onset childhood to elderly (usually 45)
What is the clinical presentation of essential tremor
-postural tremor with/without kinetic component
- tremor only
- bilateral and symmetric, usually upper extremity
- normal muscle tone
What may improve essential tremor symptoms
alcohol, only for 30-60 mins
What is the major differential for essential tremor
Wilson’s disease
What is the first line treatment for essential tremor
beta blockers: propranolol
refer to neuro if contraindicated for benzos
Define tremor
involuntary rhythmic oscillating movement of a body part secondary to intermittent muscle contraction
Describe the handwriting effects of essential tremor
gets bigger, shaky, no resting tremor
Describe the pathophys of dystonia
primarily unknown
- basal ganglion dysfunction
- excitability of motor cortex
Describe the 3 types of dystonia
- primary
- focal (MC)
- secondary (drugs, neuro disorders)
Describe the major types of focal dystonia
- blepharospasm
- oromandibular dystonia
- spasmodic dysphonia
- cervical dystonia
- limb dystonias
describe the clinical presentation of dystonia
worse with emotional/physical stress or fatigue, decreases with sleep and rest
Describe the diagnostic process for dystonia
- rule out parkinson’s and Wilson’s
Describe the management of dystonia
- levodopa first line
- muscle relaxers, pumps, botox, baclofen, DBS
Describe the etiology of Huntington’s
progressive neurodegenerative disorder of the CNS - atrophy of the caudate nucleus head, putamen, cerebral cortex
- autosomal dominant
Is Parkinson’s direct or indirect pathway?
direct
