Movement Disorders Flashcards
Types
Hypokinesia- PD, Parkinsonism, parkinson plus syndrome
Hyperkinesia- Huntington’s, dyskinesia, dystopia, tremors
Parkinsonism
Atypical Parkinson’s disease
Multiple symptoms atrophy/shy drager syndrome
Progressive supranuclear palsy
Chorea, dystonia
Can be Drug induced or vascular induced
Corticobasal degeneration
Dementia with Lewy bodies
Essential tremor
Multiple system atrophy
3 clinical syndromes-olivopontocerebrallar atrophy, shy drager syndrome, striatonigral degeneration
Parkinsonism plus autonomic failure and cerebellar dysfunction
Orthostatic hypotension ***
Progressive supranuclear palsy
Impairments of voluntary, vertical gaze that progress
Akinetic rigid form early loss of postural balance-backwards falls
Spasticity, dystonia, dysarthria, dysphagia, dementia
Incapacity within 3-5 years, death 6-8 year
More rapid progression than PD
Chorea
Continuous random movement that migrate from one part of the body ti another
HD, drugs, stroke or aging
TX- dopamine receptor blockers-haloperidol or risperidone, terbenazine or deutertrabanzine- HD
Dystonia
Hyperkinetic movement with prolong muscle contraction
Cervical dystonia, blepharospasm, spasmodic dysphonia, focal hand dystonia
TX- anticholinergics-baclofen or trihexyphenidy, botox
Drug induced movement disorders
Antipsychotic, regular, compazine, phenergan
TD develops
Reduce or DC drug
Can try Botox, anticholinergics, baclofen, trihexyohenidyl, tetrabenazine
Essential tremor
Limbs are in active use
Common in arms
Worse with anxiety, caffeine, fatigue, relieved by alcohol
Family history **
TX- BB, gaba, baclofen, mirtzapine, lyrica, topiramate, botox
Parkinson’s S/S
TRAP-tremor, rigidity, akinesia/bradykinesia, postural instability
Anxiety, depression, dementia, hallucinations, delusions, anosmia, orthostatic hypotension, fatigue, pain, sexual dysfunction, urinary symptoms, sleep disturbances
Resting tremor ***, writing smaller, slowness, stiff limbs, shuffle walk, Myersons sign, drooling, mask like face
PD etiology
Genetics, mutations, environmental, pesticides, and heavy metal exposure, TBI, DM
PD patho
Loss of function in substantia nigra, non dopamine pathways are thought to cause non motor S/S
Lewy bodies
Usually idiopathic
PD stages
1-unilateral symptoms
2-bilateral symptoms without balance issues
3-bilaterally disease with balance impairment, independent still
4-severe disabling disease, still can walk or stand unassisted
5-majority of time spent in a wheelchair or bed
PD treatment
Maximize QOL, PT
Levodopa/carbidopa, can add adjunct dopamine products or MOA B inhibitors or COMT
Dopamine agonist- used in younger pt with mild disease, slow titration
MOAB- rasagiline, selegiline, safinamide
COMT- catechol O methyl transferase-entacapone, talcapone, opicapone
Can also use anticholinergics, antiglutaminergics, adenosine A2 receptor antagonist
Deep brain stimulation
Management of non neuro symptoms
Your patient with PD is currently taking Reglan 10 mg QID, for GERD the patient is likely to experience a drug interaction with Levodopa in which
All of the above- efficacy of levodopa is lessened, symptoms of PD may worsen; dopamine blockage may occur
When the dopamine concentration in the body is too high it causes
Dyskinesia
Predictable deterioration in drug effectiveness that occurs prior to a schedule dose is called
Wearing off
Symptoms that are most likely to respond to sinemet therapy include
Rigidity and tremor
Counseling points for patients on MAO b inhibitors include which of the following
Patients should not exceed the maximum daily dosage recommendations or limits and for patients on sinemet therapy Azilect may have been prescribed to prevent wearing off
Many patients with Parkinson’s disease experience, low blood pressure a non-drug therapy option for this debilitating symptom is
Eating smaller meals
Data regarding therapy for constipation associate with Parkinson’s disease favors, which class of drugs for chronic use
Osmotic laxatives
Margaret IS 75-year-old woman with a tremor for the last 20 years she states that improves after a glass of wine which of the following medication would be best to treat this patient
Nadolol and mysoline
