movement disorders

Question 1

any movement disorder preceded by feeling you have to do it

Answer 1

tic

Question 2

inability to stay still

Answer 2

akathisia

Question 3

excessive muscle contraction

Answer 3

dystonia

Question 4

superfast shock like muscle movement

Answer 4

myoclonus

Question 5

random flow of movement

Answer 5

chorea (greek for dance)

Question 6

oscillatory movement

Answer 6

tremor

Question 7

must rule out what with parkinson’s disease

Answer 7

wilson’s, vit deficiency, lupus, pregnancy, thryroid dysfx, hyp0/hyperglycemia, basal ganglia stroke, hypoxia…

Question 8

Diagonsis of parkinson’s

Answer 8

TRAP (requires T or A and at least 2/4)
Tremor (CONSPICUOUS at rest)
Rigidity
Akinesia/Bradykinesia
Postural instability

Question 9

image for parkinsons

Answer 9

loss of pigmented neurons (substantia negra) and replacement of lewy bodies

Question 10

What drugs do you AVOID with parkinsons

Answer 10

Antiemetics (except ondansetron, domperidone) and anti-psychotics (except seroquel and clozapine)

Question 11

Parkinson drug for young pt w minor sx

Answer 11

Amantadine (anti-viral yes) Rasagiline (MAOi) or a dopamine agonist (Pramipexole and Ropinirole)

Question 12

Parkinson’s drug for > 50 with > mild severity?

SA?

Answer 12

Levodopa. Dyskinesias, psychosis, orthostasis. Current: N/V/hypotension/arrhythmia

Question 13

what is sinemet?

Answer 13

Combo levodopa and carbidopa. Carbidopa inhibits conversion of levodopa to dopa. Lowers SA but doesn’t change on-off phenomenon or other SA

Question 14

Treatment options for essential tremor (aka, benign, familial ess. tremor)

Answer 14

Orals: 1st line Primidone (anti-convulsant) and Propanolol (ns BB) and Topiramate
and Deep brain stimulation 90% effective

Question 15

essential tremor clinical features

Answer 15

mostly UE and then head, tongue, LE, and then voice. If not both hands then likely something else. Bilateral, symmetric, goes away with REST

Question 16

prime examples of dystonia

Answer 16

severe stiffness in neck arm leg, blepharospasm, uncontrollable movements, tremor, abonormal posture (torticollis)

Question 17

dystonia treatments

Answer 17

every pt considered for levodopa (dopa-responsive dystonia). Also botox, excisional surgery and deep brain stim

Question 18

What can anti-emetics and anti-psychotics cause? (4)

Answer 18

1) NMS Neuroleptic Malignant Syndrome
2) acute or tardinve dyskinesia
3) parkinsonism
4) acute dystonic reaction

Question 19

What is NMS and it’s treatment

Answer 19

life-threatening hyperthermia and rigidity and mental status change. Rx w Levodopa

Question 20

what is acute dystonic reaction and how do you treat

Answer 20

acute DA deficiency (from rx of antagonists or withdrawl from agonists). Tx with benadryl or benztropine (anti-ach)

Question 21

Serotonin syndrome vs Neuroleptic malignant syndrome

Answer 21

SS- 5HT or DA excess with hyperreflexia and myoclonus and with occ NMS sx

NMS- DA deficiency with hyperthermia, rigidity, altered LOC, leukocytosis, incr CPK

Question 22

tic less than one year duration

Answer 22

transient tick disorder

Question 23

tic more than one year with motor or vocal (but not both)

Answer 23

chronic tick disorder

Question 24

criteria for tourette syndrome (4)

Answer 24

• mulitple motor and at least one vocal tic
• waxing waning > 1 yr
• onset before 21 yo (freq 6-7 yo)
• absence of precip disease

Question 25

untterance of foul language is called

Answer 25

coprolalia (RARE in tourettes)

Question 26

3 main features of Huntington’s Disease

Answer 26

Motor, cognitive, psychiatric.

Question 27

Define RLS restless leg syndrome and rx

Answer 27

creepy crawlies usally LE and at night, resolves with moving. Very common (10%). and responds to levodopa

Question 28

most common cause of ataxia?

Answer 28

meds and etoh. Then stoke, hydrocephalus, migaine in CHILDREN, and infectious (VZV).