movement disorders Flashcards
any movement disorder preceded by feeling you have to do it
tic
inability to stay still
akathisia
excessive muscle contraction
dystonia
superfast shock like muscle movement
myoclonus
random flow of movement
chorea (greek for dance)
oscillatory movement
tremor
must rule out what with parkinson’s disease
wilson’s, vit deficiency, lupus, pregnancy, thryroid dysfx, hyp0/hyperglycemia, basal ganglia stroke, hypoxia…
Diagonsis of parkinson’s
TRAP (requires T or A and at least 2/4) Tremor (CONSPICUOUS at rest) Rigidity Akinesia/Bradykinesia Postural instability
image for parkinsons
loss of pigmented neurons (substantia negra) and replacement of lewy bodies
What drugs do you AVOID with parkinsons
Antiemetics (except ondansetron, domperidone) and anti-psychotics (except seroquel and clozapine)
Parkinson drug for young pt w minor sx
Amantadine (anti-viral yes) Rasagiline (MAOi) or a dopamine agonist (Pramipexole and Ropinirole)
Parkinson’s drug for > 50 with > mild severity?
SA?
Levodopa. Dyskinesias, psychosis, orthostasis. Current: N/V/hypotension/arrhythmia
what is sinemet?
Combo levodopa and carbidopa. Carbidopa inhibits conversion of levodopa to dopa. Lowers SA but doesn’t change on-off phenomenon or other SA
Treatment options for essential tremor (aka, benign, familial ess. tremor)
Orals: 1st line Primidone (anti-convulsant) and Propanolol (ns BB) and Topiramate
and Deep brain stimulation 90% effective
essential tremor clinical features
mostly UE and then head, tongue, LE, and then voice. If not both hands then likely something else. Bilateral, symmetric, goes away with REST
prime examples of dystonia
severe stiffness in neck arm leg, blepharospasm, uncontrollable movements, tremor, abonormal posture (torticollis)
dystonia treatments
every pt considered for levodopa (dopa-responsive dystonia). Also botox, excisional surgery and deep brain stim
What can anti-emetics and anti-psychotics cause? (4)
1) NMS Neuroleptic Malignant Syndrome
2) acute or tardinve dyskinesia
3) parkinsonism
4) acute dystonic reaction
What is NMS and it’s treatment
life-threatening hyperthermia and rigidity and mental status change. Rx w Levodopa
what is acute dystonic reaction and how do you treat
acute DA deficiency (from rx of antagonists or withdrawl from agonists). Tx with benadryl or benztropine (anti-ach)
Serotonin syndrome vs Neuroleptic malignant syndrome
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
tic less than one year duration
transient tick disorder
tic more than one year with motor or vocal (but not both)
chronic tick disorder
criteria for tourette syndrome (4)
- mulitple motor and at least one vocal tic
- waxing waning > 1 yr
- onset before 21 yo (freq 6-7 yo)
- absence of precip disease
untterance of foul language is called
coprolalia (RARE in tourettes)
3 main features of Huntington’s Disease
Motor, cognitive, psychiatric.
Define RLS restless leg syndrome and rx
creepy crawlies usally LE and at night, resolves with moving. Very common (10%). and responds to levodopa
most common cause of ataxia?
meds and etoh. Then stoke, hydrocephalus, migaine in CHILDREN, and infectious (VZV).
