movement disorders Flashcards

(42 cards)

1
Q

Direct and indirect pathways

A

D1(direct)= facilitates movement. D2 (indirect)= inhibits movements

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2
Q

Dopamines normal effect on direct/indirect pathways

A

Dopamine turns up direct pathway and turns down indirect pathway

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3
Q

What are hyperkinesias

A

moving too much: tremor, chorea, tics, dystonia

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4
Q

hypokinesias

A

not moving enough: Parkinsonism

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5
Q

Tremor- definition

A

rhythmic oscillatory movement produced by alternating or synchronous contraction of antagonist muscles

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6
Q

tremor- position when happens most

A

resting, action (intentional), postural (sustained)

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7
Q

tremor- frequency, characteristics

A

can be slow or fast, regular or jerky

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8
Q

Drugs that induce tremor

A

theophylline, bronchodilators, amphetamines, antidepressants, caffeine, cyclosporin, steroids, lithium, alcohol, amiodarone, valproate, neuroleptics, metaclopromide, reserpine, anti-nauseants

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9
Q

what is an essential tremor

A

benign/senile tremor. Postural tremor more common than kinetic. Most common in hands, followed by head

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10
Q

Other symptoms occuring with essential tremor

A

gait disorder, parkinsonism, dystonia, impaired smelling or hearing

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11
Q

How do essential tremors change with age

A

get slower and larger

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12
Q

Therapy of essential tremor

A

beta blockers (propranolol), primidone, topiramate, gabapentin, clonazepam, botulinum toxin, assisted devices

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13
Q

surgical options for essential tremor

A

thalamotomy, deep brain stimulation delivering stimulation to thalamus

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14
Q

Parkinsons symptoms

A

resting tremor, bradykinesia or akinesia, rigidity, gait freezing,

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15
Q

compare essential tremor with parkinsons

A

ET: kinetic, bilateral, disabling. Parkinsons: during rest, unilateral, not disabling, plus parkinsons signs

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16
Q

Parkinsons pharmacological treatment

A

Carbidopa/levidopa, dopamine agonists, anticholinergics, COMT-inhibitors, amantadine, and MAO-b inhibitors

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17
Q

What areas of the brain are targeted for deep brain stimulation in parkinsons

A

subthalamic nucleus, internal globus pallidus, Vim

18
Q

Define tics

A

brief, intermittent movements or sounds. Sudden, abrupt, transient. Repetitive and coordinated. Vary in intensity, repeated at irregular intervals. May resemble gestures or normal behavior

19
Q

Diagnostic criteria for tourette syndrome

A

Age of onset 1 yr

20
Q

Tourette syndrome is associated with what other conditions

A

ADHD, OCD and poor impulse control

21
Q

Is tourettes more common in females or males

22
Q

Compare simple and complex tics in tourette syndrome

A

simple: grimacing, blinking, nose twitching lip pouting. Complex: hopping, clapping, touching, throwing, head banging

23
Q

Tourette syndrome treatment

A

habit reversal therapy, treat OCD and ADHD

24
Q

Chorea- definition

A

irregular, brief, dancing like, jerky. Randomly flit from one body part to another.

25
chorea-athetosis
repetitive involuntary, slow, sinuous, writhing movements
26
Diseases associated with chorea
Huntingtons, Sydenham chorea, chorea gravidarum, lupus, antiphospholipid Ab
27
Define dystonia
co-conntraction of muscle agonists and antagonists. Sustained muscle contractions causing twisting, abnormal postures. Can be associated with tremor
28
Causes of dystonia
primary: DYT 1- protein torsin. Secondary: cerebral palsy, neurodegenerative dz (wilsons dz), hypoxic ischemic brain injury, post stroke, post traumatic, meds
29
classifications of dystonia
focal: blepharospasm, oromandibular dystonia, laryngeal, cervical, writers cramp. Segmental. Multifocal. Generalized
30
Task specific dystonias
writers cramp, musicians cramp, golfers dystonia
31
List the different dystonia durations
Can occur while mobile, static, task specific, exercise induced or diurnal
32
Dystonia treatment
Anticholinergics, muscle relaxants, benzos, botulinum toxin type A or type B, deep brain stimulation of internal globus pallidus or subthalamic nuclei
33
akathisia
unpleasant sensation of inner restlessness- inability to sit still or remain motionless
34
ballism
large amplitude, proximal extremity flinging movements
35
hyperekplexia
exaggerated startle
36
myokymia
localized quivering of a few muscle bundles within a muscle, but which are insufficient to move a joint (ie eyelid)
37
myoclonus
sudden, briief, shock like movement
38
stereotypy
repetitive or ritualistic movment, posture or utterance (autism, schizophrenia)
39
Atypical features that suggest a dz is not parkinsons but rather a different parkinsonian type dz
rapid progression, early onset dementia, early onset postural instability, confusion or hallucinations, ataxia, eye movement abnormalities (downgaze), poor response to dopaminergic treatment
40
Atypical parkinsonian syndrome prognosis and treatment
Prognosis is worse than Parkinsons (only 7-10 yr survival). Only 10-15% respond to dopaminergic therapy
41
Progressive supranuclear palsy- characteristics
Progressive, onset >50. Impaired eye movements (downgaze), reptilian or scared look, early onset postural instability (falls within first year), retrocolis.
42
Multiple systems atrophy- responsiveness to dopamine, subtypes
Poor response to dopamine replacement. Subtypes: Parkinsonism (MSA-P), cerebellar symptoms and ataxia (MSA-C) or autonomic symptoms (MSA-A)