Movement Disorders

Question 1

What is the basic summary of the system that needs to be in place to have effective movement?

Answer 1

Intacy pathway from cortex to NMJ
Fined tuned by functional cerebellum and basal ganglia for fluid movement

Question 2

What are the key features of the movement disorder?

Answer 2

Concerned with the amplitude and degree of movement rather than any weakness within the movement.
Movement that is no longer fluid or controlled

Question 3

What are some common causes of movement disorders?

Answer 3

Stroke
Multiple sclerosis
Motor Neuron Disease
Myasthenia gravis
Metabolic issues

Question 4

What are the two broad descriptive categories of movement disorders?

Answer 4

Hypokinesia - too little movement
Hyperkinesia - too much movement

Question 5

How does the substantia nigra influence the direct basal ganglia pathway?

Answer 5

Dopaminergic projections from the SN act on D1 receptors in the striatum
Has an excitatory effect - increases GABAergic projections from the striatum to the GPi, resulting in disinhibition of the thalamus.
Able to active movement.
Increases activity of the direct pathway

Question 6

How does the substantia nigra influence the indirect basal ganglia pathway?

Answer 6

Has dopaminergic projections from the SN act on D2 receptors in the striatum.
Has an inhibitory effect, reduces GABAeric projections to the GPe.
Results in inhibition of the subthalamic nucleus via GABAergic projections from GPe to ST.
Inhibits the indirect pathway.
Increases activity of the thalamus.

Question 7

What is the effect of an active substantial nigra on the direct and indirect basal ganglia pathway?

Answer 7

Increased activity along the direct pathway
Decreases activity along the indirect pathway.
Overall facilitates movement.

Question 8

What is an examples of hypokinesia movement disorders?

Answer 8

Akinetic-rigid syndromes aka
Parkinsonism

Question 9

What is the quadrad of parkinsonism?

Answer 9

To be diangosed with parkinsonism must have bradykinesia.
Also 1 of:
Rigidity (lead pipe)
Rest tremor
Postural instability.

Question 10

What is meant by lead pipe rigidity in Parkinson disease?

Answer 10

Hypertonicity throughout the range of motion/movement.

Question 11

What is the key feature of bradykinesia to look for in parkinsons disease?

Answer 11

Movement gets smaller and slower over time, ask by testing to clench and release a fist.

Question 12

What is meant by postural instability during Parkinson disease?

Answer 12

The inablity to maintain balance during dynamic and stable movements.

Question 13

What are some key symptoms of Parkinsons disease?

Answer 13

Hypomimic face
Forward tilt of trunk and stooped posture
Global flexion
Rigid back
Reduced arm swing during agit
Shuffling, short and stepped gait.
Hand and leg tremor.

Question 14

What is the basic neuroanatomy of parkinsons disease?

Answer 14

Damage to the substantia nigra - reduces dopamine production
Reduced activity along Dopaminergic projections to the striatum
Less activity at D1 receptors on striatum - less activation of the direct pathway
Less activity at D2 receptors on the striatum - less inhibition of the indirect pathway
Overall leads to greater activity along the indirect pathway, results in hypokinesia.

Question 15

What are the different causes of Parkinson disease?

Answer 15

Idiopathic parkinsons disease
Vascular parkinsonism
Medication that block dopamine
Rarer - dementia with Lewy bodies, Parkinsons plus syndromes (PSP and MSA)

Question 16

What is vascular parkinsonism?

Answer 16

Small strokes are considered the primary cause
Affects small blood vessels in regions of the brain responsible for motor control.
Atypical parkinsons - typically lower body, symettrical, pyramidal signs with out a tremor.

Question 17

How does dementia with Lewy Bodies relate to parkisons?

Answer 17

Lewy bodies accumulate in cortical neurons results in dengeration, lewy bodies causing degenration in the substantial nigra can lead to Parkinsons disease.

Question 18

What is progressive supranuclear Palsy?**

Answer 18

Accumulation of tau proteins - results in degeneration - is a type of Parkinsons plus syndrome
Is a frontotemporal disorder.
Can affect movement, speech, mood and behaviour (including forgetfulness, depression and changes in judgement)

Question 19

What are some examples of hyperkinesia?

Answer 19

Tremor
Chorea - involutnary, irregular, unpredictable rhythmic movements
Dystonia - uncontrolled painful muscle spasm, abrnoml osutre.
Myclonus - sudden bired involuntary twitching, cannot be stopped or suppressed
Tics - sudden involuntary movement or action, can be suppressed temporarily although painful.

Question 20

What is meant by a tremor?
What are the different types?

Answer 20

A rhythmical, sinusoidal (above and below and stationary line), alternativng movement.
Patient describe as shaking.
Can be postural, kinetic, or rest tremor.

Question 21

What is a postural tremor?

Answer 21

Also know as an essential tremor
Can be caused by thyrotoxicosis or salbutamol use
Present on holding a position against gravity.
Tends to be degenerative, common, no effect on lifespan but can be socially embarrassing and even disabling

Question 22

What is an action or kinetic tremor?

Answer 22

Result of cerebellar dysfunction
Due to stoke, genetic, alcohol use or tumour.
Occurs when trying to complete a voluntary action for example an intention tremor

Question 23

What is a rest tremor?

Answer 23

Seen in parkinsonism - described as a pill-rolling tremor.
Occurs when a person is at rest aka not holding body part against gravity and not moving.

Question 24

What is meant by chorea?

Answer 24

Random, dance like movement
Unpredictable, flowing movments from one area to another
Ballism - affects proximal joints so large and lining movements
Hemi-chorea/ballimus - affecting half the body

Question 25

What causes corea in reference to the basal ganglia pathway?

Answer 25

Damage to the striatum - has a more predominant affect on the indirect pathway (reduced GABergic projections to the GPe)
Therefore reduced inhibition of movement - results in chorea.

Question 26

What are the different causes of Chorea?

Answer 26

Any structural lesion of the striaum aka stroke or tumour
Neurodegenerative of genetic - Huntingtons Chorea or Wilsons disease
Immune mediated - sydenham chorea (in response to Group A strep infection)
Drug induced - levodopa induced in dyskinesia in Parkinsons disease.

Question 27

What is dystonia?

Answer 27

Sustained or intermitted muscle contraction resulting in abnormal postural movement
Can be repetitive or task-specific e.g writers cramp.
Can be painful
Gest antagoniste - a sensory trick /voluntary movement to relieve dystonia

Question 28

What are the different types of dystonia?

Answer 28

May be focal - treat with botox
May be general - treat with deep brain stimulation

Question 29

What are some different causes of dystonia?

Answer 29

Idiopathic - over use
Genetic
Part of other condition - parkinsons disease in feet
Structural lesion - trauma, tumour, stroke - in the brain, spinal cord or peripheral nerve
Immune mediated
Post infectious
Drugs (antipsychoctis, antiemetics)

Question 30

What is mycolonus?

Answer 30

Jerky, shock like movements
Multiple causes - normal, medications, epilepsy, dementia
Can be picked up by the EMG.

Question 31

What are tics?

Answer 31

Usually brief, often stereotyped (same every time)
Can be movement or sound
Can be simple or complex
Can be suppressed for short periods of time
Often associated by behavioural co-morbidities.
Tourettes syndrome is the most common.

Question 32

What is wilsons disease?

Answer 32

Copper acculumation
Can cause cirrhosis of the liver
Can cause personality disorders, chorea, dystonia and parkinsonism in the brain.
Identified with a heavily pigmented red brown kayser-Fleischer ring around the eyes
Is important to stop as can prevent further brain damage,

Question 33

What is meany by a functional movement disorder?

Answer 33

Abnormal movement due to nervous system not working properly without an underlying neurological disease.
Can cause:
Gait abnormalities, tremor, jerking movementsna dmimic dystonia.

Question 34

What is the treatment of a functional movement disorder like?

Answer 34

Can stop tremor via distraction or enchantment aka ask to tap along to certain rhythm
‘ distract the tremor’
Are reversible no underlying disease - reassure patients.
Can be curable.