movement disorders Flashcards
Direct and indirect pathways
D1(direct)= facilitates movement. D2 (indirect)= inhibits movements
Dopamines normal effect on direct/indirect pathways
Dopamine turns up direct pathway and turns down indirect pathway
What are hyperkinesias
moving too much: tremor, chorea, tics, dystonia
hypokinesias
not moving enough: Parkinsonism
Tremor- definition
rhythmic oscillatory movement produced by alternating or synchronous contraction of antagonist muscles
tremor- position when happens most
resting, action (intentional), postural (sustained)
tremor- frequency, characteristics
can be slow or fast, regular or jerky
Drugs that induce tremor
theophylline, bronchodilators, amphetamines, antidepressants, caffeine, cyclosporin, steroids, lithium, alcohol, amiodarone, valproate, neuroleptics, metaclopromide, reserpine, anti-nauseants
what is an essential tremor
benign/senile tremor. Postural tremor more common than kinetic. Most common in hands, followed by head
Other symptoms occuring with essential tremor
gait disorder, parkinsonism, dystonia, impaired smelling or hearing
How do essential tremors change with age
get slower and larger
Therapy of essential tremor
beta blockers (propranolol), primidone, topiramate, gabapentin, clonazepam, botulinum toxin, assisted devices
surgical options for essential tremor
thalamotomy, deep brain stimulation delivering stimulation to thalamus
Parkinsons symptoms
resting tremor, bradykinesia or akinesia, rigidity, gait freezing,
compare essential tremor with parkinsons
ET: kinetic, bilateral, disabling. Parkinsons: during rest, unilateral, not disabling, plus parkinsons signs
Parkinsons pharmacological treatment
Carbidopa/levidopa, dopamine agonists, anticholinergics, COMT-inhibitors, amantadine, and MAO-b inhibitors
What areas of the brain are targeted for deep brain stimulation in parkinsons
subthalamic nucleus, internal globus pallidus, Vim
Define tics
brief, intermittent movements or sounds. Sudden, abrupt, transient. Repetitive and coordinated. Vary in intensity, repeated at irregular intervals. May resemble gestures or normal behavior
Diagnostic criteria for tourette syndrome
Age of onset 1 yr
Tourette syndrome is associated with what other conditions
ADHD, OCD and poor impulse control
Is tourettes more common in females or males
males
Compare simple and complex tics in tourette syndrome
simple: grimacing, blinking, nose twitching lip pouting. Complex: hopping, clapping, touching, throwing, head banging
Tourette syndrome treatment
habit reversal therapy, treat OCD and ADHD
Chorea- definition
irregular, brief, dancing like, jerky. Randomly flit from one body part to another.
chorea-athetosis
repetitive involuntary, slow, sinuous, writhing movements
Diseases associated with chorea
Huntingtons, Sydenham chorea, chorea gravidarum, lupus, antiphospholipid Ab
Define dystonia
co-conntraction of muscle agonists and antagonists. Sustained muscle contractions causing twisting, abnormal postures. Can be associated with tremor
Causes of dystonia
primary: DYT 1- protein torsin. Secondary: cerebral palsy, neurodegenerative dz (wilsons dz), hypoxic ischemic brain injury, post stroke, post traumatic, meds
classifications of dystonia
focal: blepharospasm, oromandibular dystonia, laryngeal, cervical, writers cramp. Segmental. Multifocal. Generalized
Task specific dystonias
writers cramp, musicians cramp, golfers dystonia
List the different dystonia durations
Can occur while mobile, static, task specific, exercise induced or diurnal
Dystonia treatment
Anticholinergics, muscle relaxants, benzos, botulinum toxin type A or type B, deep brain stimulation of internal globus pallidus or subthalamic nuclei
akathisia
unpleasant sensation of inner restlessness- inability to sit still or remain motionless
ballism
large amplitude, proximal extremity flinging movements
hyperekplexia
exaggerated startle
myokymia
localized quivering of a few muscle bundles within a muscle, but which are insufficient to move a joint (ie eyelid)
myoclonus
sudden, briief, shock like movement
stereotypy
repetitive or ritualistic movment, posture or utterance (autism, schizophrenia)
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
Atypical parkinsonian syndrome prognosis and treatment
Prognosis is worse than Parkinsons (only 7-10 yr survival). Only 10-15% respond to dopaminergic therapy
Progressive supranuclear palsy- characteristics
Progressive, onset >50. Impaired eye movements (downgaze), reptilian or scared look, early onset postural instability (falls within first year), retrocolis.
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)
