movement disorders

Question 1

Direct and indirect pathways

Answer 1

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

Question 2

Dopamines normal effect on direct/indirect pathways

Answer 2

Dopamine turns up direct pathway and turns down indirect pathway

Question 3

What are hyperkinesias

Answer 3

moving too much: tremor, chorea, tics, dystonia

Question 4

hypokinesias

Answer 4

not moving enough: Parkinsonism

Question 5

Tremor- definition

Answer 5

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

Question 6

tremor- position when happens most

Answer 6

resting, action (intentional), postural (sustained)

Question 7

tremor- frequency, characteristics

Answer 7

can be slow or fast, regular or jerky

Question 8

Drugs that induce tremor

Answer 8

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

Question 9

what is an essential tremor

Answer 9

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

Question 10

Other symptoms occuring with essential tremor

Answer 10

gait disorder, parkinsonism, dystonia, impaired smelling or hearing

Question 11

How do essential tremors change with age

Answer 11

get slower and larger

Question 12

Therapy of essential tremor

Answer 12

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

Question 13

surgical options for essential tremor

Answer 13

thalamotomy, deep brain stimulation delivering stimulation to thalamus

Question 14

Parkinsons symptoms

Answer 14

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

Question 15

compare essential tremor with parkinsons

Answer 15

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

Question 16

Parkinsons pharmacological treatment

Answer 16

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

Question 17

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

Answer 17

subthalamic nucleus, internal globus pallidus, Vim

Question 18

Define tics

Answer 18

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

Question 19

Diagnostic criteria for tourette syndrome

Answer 19

Age of onset 1 yr

Question 20

Tourette syndrome is associated with what other conditions

Answer 20

ADHD, OCD and poor impulse control

Question 21

Is tourettes more common in females or males

Answer 21

males

Question 22

Compare simple and complex tics in tourette syndrome

Answer 22

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

Question 23

Tourette syndrome treatment

Answer 23

habit reversal therapy, treat OCD and ADHD

Question 24

Chorea- definition

Answer 24

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

Question 25

chorea-athetosis

Answer 25

repetitive involuntary, slow, sinuous, writhing movements

Question 26

Diseases associated with chorea

Answer 26

Huntingtons, Sydenham chorea, chorea gravidarum, lupus, antiphospholipid Ab

Question 27

Define dystonia

Answer 27

co-conntraction of muscle agonists and antagonists. Sustained muscle contractions causing twisting, abnormal postures. Can be associated with tremor

Question 28

Causes of dystonia

Answer 28

primary: DYT 1- protein torsin. Secondary: cerebral palsy, neurodegenerative dz (wilsons dz), hypoxic ischemic brain injury, post stroke, post traumatic, meds

Question 29

classifications of dystonia

Answer 29

focal: blepharospasm, oromandibular dystonia, laryngeal, cervical, writers cramp. Segmental. Multifocal. Generalized

Question 30

Task specific dystonias

Answer 30

writers cramp, musicians cramp, golfers dystonia

Question 31

List the different dystonia durations

Answer 31

Can occur while mobile, static, task specific, exercise induced or diurnal

Question 32

Dystonia treatment

Answer 32

Anticholinergics, muscle relaxants, benzos, botulinum toxin type A or type B, deep brain stimulation of internal globus pallidus or subthalamic nuclei

Question 33

akathisia

Answer 33

unpleasant sensation of inner restlessness- inability to sit still or remain motionless

Question 34

ballism

Answer 34

large amplitude, proximal extremity flinging movements

Question 35

hyperekplexia

Answer 35

exaggerated startle

Question 36

myokymia

Answer 36

localized quivering of a few muscle bundles within a muscle, but which are insufficient to move a joint (ie eyelid)

Question 37

myoclonus

Answer 37

sudden, briief, shock like movement

Question 38

stereotypy

Answer 38

repetitive or ritualistic movment, posture or utterance (autism, schizophrenia)

Question 39

Atypical features that suggest a dz is not parkinsons but rather a different parkinsonian type dz

Answer 39

rapid progression, early onset dementia, early onset postural instability, confusion or hallucinations, ataxia, eye movement abnormalities (downgaze), poor response to dopaminergic treatment

Question 40

Atypical parkinsonian syndrome prognosis and treatment

Answer 40

Prognosis is worse than Parkinsons (only 7-10 yr survival). Only 10-15% respond to dopaminergic therapy

Question 41

Progressive supranuclear palsy- characteristics

Answer 41

Progressive, onset >50. Impaired eye movements (downgaze), reptilian or scared look, early onset postural instability (falls within first year), retrocolis.

Question 42

Multiple systems atrophy- responsiveness to dopamine, subtypes

Answer 42

Poor response to dopamine replacement. Subtypes: Parkinsonism (MSA-P), cerebellar symptoms and ataxia (MSA-C) or autonomic symptoms (MSA-A)