Movement disorders Flashcards
Parkinson disease- Eti
- 45-70 yrs onset
- 13.4/100,000
- Rural > urban
Parkinson disease- Sx
TRAP:
- Tremor- resting, pill rolling, unilateral
- Rigidity- Cogwheeling, uncoordinated smooth movements. Tremor +
- Akinesia & bradykinesia- can’t initiate movements- walking, handwriting, swalloing, hypophonia
- Postural instability- shuffling gait, end block turning, unable to catch falls
- Associated: orthostasis, constipation, autonomic disfunction, anosmia
Parkinson disease- Dx
- Clinical, with positive response to L-dopa
- Rule out other causes
Parkinson disease- Tx
- Dopamine- L-dopa/ carbidopa
- Anticholinergics for tremor
- Tx other manifestations
Tourette syndrome- Eti
- Inherited neuropsych disorder
- Onset 1 motor, at least 1 verbal
Tourette syndrome- sx
- Sensory, verbal and motor tics
- Unable to control
Myoclonus- Sx
- Sudden, brief, shock-like movements
- Abrupt muscle contration
- Focal, multi-focal, diffuse
Myoclonus- Eti
- Cerebral anoxia (following cardiac infarction)
- Drugs and alcohol
- Levodopa tx
- Metabolic dysfunction (hepatic)
Benign essential tremor- Eti
- Most common movement disorder
- > 40
- Age and family hx
Benign essential tremor- Sx
- Postural kinetic tremor
- Arms, head and voice
- Unusual in legs, lips or chin
- Slow progression
- Worsens with anxiety, stress, caffeine
- Reduced by alcohol
Benign essential tremor- Dx
Clinical
Benign essential tremor- Tx
- Symptomatic
- Stress reduction, caffeine avoidance
- Propranolol, gabapentin
Restless legs syndrome- Eti
- Idiopathic, anemia, parkinsons, pregnancy
Restless legs syndrome- Sx
- Restlessness
- Curious sensory disturbances
- Irresistible urge to move limbs at periods of rest
- Disturbed nocturnal sleep and excessive daytime somnolence
Restless legs syndrome- Tx
Dopamine agonosts- pramipexole
Cerebral palsy- Eti
- Cerebral insult before birth, during delivery or perinatal period
Cerebral palsy- Sx
- Limb spasticity
- Ataxia- fine coordinated movements of upper extremities
- Mental retardation
- Language, speech, vision, hearing deficits
- Microcephaly
Cerebral palsy- Dx
MRI to asses cerebral injury
- Genetic and metabolic testing
Cerebral palsy- Tx
- PT, OT & ST
Tourette syndrome- Eti
- Begin before 21
- ## Genetic link- autosomal dominant
Tourette syndrome- Sx
- Motor tics most common
- Combination of motor and phonic tics occur in most
- Tics progress over time
- Echolalia, praxia
- Self mutilating in nature
- OCD disorders
Tourette syndrome- Dx
- Normal exam with tic as only abn
Tourette syndrome- Tx
- Clonidine guanfacine
Myoclonus- Dx
- Clinical
Myoclonus- Tx
Valproic acid
Clonazepam
Oculogyric crisis- Eti
- SE to drug tx- neuroleptics
- Most common ocular dystonic reaction
Oculogyric crisis- Sx
- Maximal upward deviation of eyes bilaterally
- Blepharspasm
- Perioorbital twitch
- Protracted staring episodes
- Seizures
Oculogyric crisis- Tx
Diphenhydramine
Torticollis- Sx
- Head turning to one side while walking
- Progresses to continuous
- Scalene, SCM, trap
- Dystonia
- Reduced when laying down
Torticollis- Tx
- Botox injection
Tardive dyskinesia- Eti
- Due to antipsych meds
- Age, cigarettes and CM
Tardive dyskinesia- Sx
- Early: Fine, worm-like tongue movements, facial tics
- Late: Lip smacking, gag reflex, resp distress, cheorathetoid mvmt
- Involuntary sterotyped movements of face, mouth , tongue, trunk and limbs
Tardive dyskinesia- Tx
- Prevent by lower dose psych meds
- Stop anticholinergics
Dyskinesia- Sx
- Involuntary movements
- Chorea, athetosis and hemiballismus
- Due to degenerative disorders, drugs
Dyskinesia- Tx
- Dopamine
- Antocholinergics
