Movement Disorders

Question 1

What are types of parkinsonism?

Answer 1

tremor, myoclonus, dystonia, chorea/ballism/athetosis, tics, restless legs

Question 2

What are the cardinal motor features of parkinsonism?

Answer 2

tremor at rest
rigidity
akinesia/bradykinesia
postural instability

Question 3

What are the characteristics of atypical parkinsonism?

Answer 3

motor fluctuations
wearing off between doses
peak dose dyskinesias
freezing of gait
falling
narrowing of therapeutic window

Question 4

What are the nonmotor characteristics of parkinsonism?

Answer 4

RESTLESS LEG SYNDROME
cognitive trouble (word finding)
depression
anxiety
apathy
hallucinations
sleep disorders
constipation

Question 5

What is the average onset of PD?

Answer 5

60 yo

Question 6

supporting features of parkinsonism:

Answer 6

Stooped posture
Masked facies
Micrographia
Drooling
Dysphagia
Hypophonia (low voice)
Shuffling, Festinating Gait
Decreased arm swing (“frozen shoulder”)
Freezing of gait

Question 7

What suggests a diagnosis other than PD?

Answer 7

Poor response to adequate dosages of levodopa
Early onset of postural instability
Axial more than appendicular rigidity
Early dementia
Supranuclear gaze palsy

Question 8

Progressive supranuclear palsy

Answer 8

Parkinsonism (Symmetric)
–Early gait/balance, Falls in 1st year
Extra Ocular Movements
–Supranuclear gaze palsy with square wave jerks
Other motor
–Neck extension, Limb dystonia, Bulbar dysfunction
Frontal dementia

Question 9

Diffuse Lewy body disease

Answer 9

2nd most common degenerative dementia

Differentiation from PD dementia evolving
Core features Parkinsonism & Dementia within one year
Fluctuating level of consciousness
Hallucinations (mainly visual)
Extreme sensitivity to neuroleptics

Question 10

chorea

Answer 10

Chorea: involuntary, continuous, abrupt, rapid, brief, unsustained, irregular movements that flow randomly from one body part to another

Question 11

ballism

Answer 11

Ballism: forceful, flinging, high amplitude, coarse chorea

Question 12

athetosis

Answer 12

Athetosis: writhing movements resembling dystonia, but unlike dystonia, the movements are not sustained, patterned, repetitive or painful

Question 13

Main features of dystonia

Answer 13

Relatively long duration (unlike chorea or myoclonus)
Simultaneous contractions of agonist and antagonist muscles
Results in twisting of a body part
Same muscle groups are involved
Primary dystonia almost always begins by affecting a single part of the body
The younger the age at onset, the more likely to spread
Sensory tricks (geste antagoniste)
Pain is not very common except in cervical dystonia

Question 14

Tardive dyskinesia

Answer 14

Involuntary movement that is induced by medication
Usually dopamine blocking medicine like neuroleptics or certain nausea medicines
Often involves orobuccal movement (lip smacking, tongue protrusion) or retrocollis