Movement Disorders

Question 1

Movement descriptive categories

Answer 1

• Rhythmicity
• Speed
• Duration
• Onset
• Pattern
• Induction
• Complexity
• Suppressibility
• Provoking factors

Question 2

Types of rhythmicity/speed of movements

Answer 2

• fast vs. slow
• measured in hz

Question 3

Types of movement duration

Answer 3

• constant
• intermittent
• periodic
• episodic

Question 4

Types of onset of movement-related sx

Answer 4

• insidious (most disorders)
• sudden = very unusual ==> indicates possible brain insult of psychogenic disorder

Question 5

Types of movement patterns

Answer 5

• repetitive
• flowing
• continual
• paroxysmal
  
  • = a sudden recurrence or attack of a disease; a sudden worsening of symptoms
• diurnal
  
  • = of or during the day

Question 6

Types of inductiosn of movement-related sx

Answer 6

• stimuli-induced
• action-induced
• exercise-induced

Question 7

Evaluation of suppressibility of movement-related sx

Answer 7

• voluntary suppression
• sensory tricks used for suppression
• what makes sx better or worse

Question 8

Types of provoking factors of movement-related disorders

Answer 8

• sensory
• physical
• psychological

Question 9

Examples of hyperkinesia

Answer 9

• hyperkinesia = excess movement
• Tremor
• chorea
  
  • common in HD
• tics
• dystonia
  
  • sustained muscle contractions ==> repetitive movements or abnormal postures
• myoclonus
  
  • quick, involuntary muscle jer

Question 10

Examples of hypokinesia

Answer 10

• hypokinesia = depressed movements
• Parkinsonian

Question 11

Characteristics/evaluation of tremor

Answer 11

• Are rhythmic.
• Find out when/position that it happens in the most (rest, action, postural)?
• is the frequency slow or fast?
• regular vs. jerky?

Question 12

Tremor characteristics related to syndromes

Answer 12

• Resting tremor = Parkinson’s
• Action-induced = Essential/Benign Familial Tremors
• Fine + Fast = medication induced (iatrogenic)
• Jerky = myoclonus or dystonia
• flapping tremor/coarse tremor = Wilson’s disease

Question 13

Characteristics of Essential Tremor

Answer 13

• Tremor with posture and action
• upper extremities > lower, head
• Insidious onset
• Worsens with age
• 75% respond to alcohol

Question 14

Treatment of Essential Tremor

Answer 14

• Possible pharmacologic treatments:
• primidone and _topiramate (_anti-epileptics)
• propranolol
• gabapentin (anticonvulsant)
• clonazepam (benzodiazepines)
  
  • used to control some seizures and panic attacks
• occupational therapy
• deep brain stimulation therapy

Question 15

Characteristics of Tics

Answer 15

• Brief, intermittent movements or sounds
• sudden, abrupt, transient
• repetitive and coordinated
• vary in intensity, repeated at irregular intervals
• may resemble gestures, normal behavior

Question 16

Characteristics of Tourette’s Syndrome

Answer 16

• Age of onset <16 yo
• Onset in youth, more common in males
• Associated with
  
  • ADHD
  • OCD
  • Poor impulse control
• Multiple types of tics (motor, vocal: coprolalia is rare and socially disabling)
• Suppressible
  
  • last > 1 year
• Tics persist into adulthood 25% of time
• Genetic or idiopathic

Question 17

Treatment of Tourette’s Syndrome

Answer 17

• Treatment: educate patient, family, school, support groups,
• treat tics only if interfering with their life, treat OCD and ADHD with CBT + Biofeedback
• Clonidine, SSRI, neuro-epileptics, tetrabenazine, clonazepam
• Tetrabenazine is a drug for the symptomatic treatment of hyperkinetic movement disorder

Question 18

Characteristics of Chorea

Answer 18

• Irregular, brief, dancing like jerky
• Move from one body part to another
• Diseases
  
  • HD, variants include westphal which happens in youth and looks more parkinsonian, less dancing movements, gait + balance issues.
  • Sydenham chorea
  • Chorea gravidarum
  • Lupus - behavioral and cognitive deficits (1), seizures (2), chorea (3) ← neuro deficits

Question 19

Characteristics of dystonia

Answer 19

• Co-contractions of muscle agonists and antagonists
• Sustained muscle contractions causing twisting, abnormal postures
• Can be associated with tremor
• Primary etiology: DYT 1-12 protein
• Secondary: Cerebral palsy, neurodegenerative disorders, hypoxic/ischemic brain injury, poststroke, posttraumatic, medications, toxins
• Types of localization: Focal, Segmental, multifocal, generalized
• Types of duration: static, fixed, mobile, task specific, exercise induced

Question 20

Motor symptoms of Parkinson’s disease

Answer 20

• resting tremor
• bradykinesia/akinesia
• rigidity
• postural instability/stooped posture
• festinating gait
• propulsion and retropulsion
• masked face
• disarthria, hypophonia
• dysphagia
• micrographia

Question 21

Nonmotor symptoms of Parkinson’s disease

Answer 21

• Anosmia = inability to perceive odor
• Constipation
• Depression, Anxiety
• Cognitive impairment
• Drooling
• Visual disturbances
• Sensory changes: parasthesias, muscle cramps, pain
• Autonomic instability: orthostatic hypotension, diaphoresis, thermal dysregulation, erectile dysfunction
• Sleep disturbances