Movement Disorders Flashcards
Movement disorders due to damage/disease of _______.
basal ganglia
Possible causes of movement disorders
AGE, environmental toxins, genetic d/o, metabolic d/o, anti-psychotics, Parkinson’s, stroke
ataxia
lack of coordination often producing jerky movements; due to cerebellum or basal ganglia
dystonia
long lasting spasmodic muscle contraction - slow, sustained, unusual postures
Intention tremor caused by _______ damage and resting tremor caused by ________.
cerebellum
basal ganglia
myoclonus
sudden, brief, shock-like contraction
chorea
irregularly timed, non-repetitive, dance-like movements in random distribution, (fidgeting, exaggerated gestures)
athetosis
slower type of chorea; writhing nature and usually distal extremities
Functional movements disorders
abnormal movements NOT due to neuro disease, inconsistent PE
Sydenham’s chorea
chorea in children due to rheumatic fever; “St. Vitus’ dance”
essential tremor
never stops; kinetic or resting
bilateral
resolves with relaxation
improves with mild alcohol
How to treat essential tremor?
Symptomatic tx: BB, antieptileptic, antidepressant
Pathophysiology of Parkinson’s
death/damage to cells of basal ganglia in substantia nigra that release dopamine
Inadequate dopamine inhibits motor regions of cerebral cortex
Tremor of Parkinson’s
resting tremor
“pill rolling”
unilateral early in disease
resolves with voluntary movement
Main symptoms of Parkinson’s
Resting tremor Bradykinesis Rigidity (cogwheeling, lead pipe) Shuffling gait w/ forward bending torso Mask like face
How does essential tremor differ from Parkinson’s?
Normal gait/balance No bradykinesis No rigidity No masked face Bilateral tremor (Parkinson's unilat early in dz)
What is the earliest sign of Parkinson’s?
fine motor skills (then decreased mental status, then tremor)
Mainstay tx of Parkinsons
Levodopa
Dopamine agonists
What is the problem of Parkinsons therapy?
too much dopamine leads to hallucinations and schizophrenia; must assess risks vs benefits
What symptoms of Parkinson’s are not improved with Levodopa?
sleep disturbances, supranuclear palsy, depression, fatigue, constipation
Highest RF of Parkinson’s
age
When is CT/MRI ordered for suspected Parkinson’s?
if ONE inconsistent finding. may be tumor, hydrocephalus, etc.
Typical patient with Tourette’s syndrome
Male < 15 yo
Psych features of Tourette’s syndrome
obsessions, compulsive behaviors, impulsivity, rage attacks, involuntary cursing
When are Tourette’s symptoms suppressed?
when stared at. if want to see best detected out of corner of eye
Chronic progressive chorea is called ________.
Huntington’s Dz
Age of Huntington’s disease?
30-40 yo
How is Huntington’s diagnosed?
genetic probe since inherited autosomal dominant disease (100% specificity)
Huntington’s tx largely psychiatric?
high risk of suicide
Huntington’s sx
chorea, psych problems, dementia
Life expectancy of Huntington’s
15-20 yrs
signs/sx of restless leg syndrome
paresthesias, dysesthesias that are worse at night, usually legs but can be arms
4 diagnostic criteria
- urge to move legs
- urge worse at night
- sensations unpleasant, not painful
- sensations gone when up and walking, but then recur
Which lab should be ordered in RLS work up?
check serum ferritin for commonly associated iron deficiency anemia
RLS neuro exam findings
normal
RLS management
Lifestyle changes: no caffeine, alcohol, tobacco; exercise; regular sleep patterns; hot back before bed
Meds not needed or prn: dopaminergic agents, benzos, gabapentin, anti-convulsants, opioids
Who is most likely to get Tardive Dyskinesia? Why?
Patients with schizophrenia, bipolar, elderly
likely on long term potent anti-psychotic meds
Main location of movement issues in Tardive Dyskinesia?
facial muscles - grimacing, tongue protrusions, lip smacking, blinking, etc.
