Movement Disorders

Question 1

Tremor

Answer 1

rhythmic oscillatory movement produced by alternating or synchronous contraction of antagonist muscles.
•Position when it happens the most? Resting, action (intentional), postural?
•Frequency? Slow or fast → PD tremor → 6 Hz
•Regular or jerky

Question 2

Dystonia

Answer 2

• Focal (blepharospasm—eyes, hemifacial spasm, oromandibular dystonia, laryngeal dystonia, spasmodic torticolis/cervical dystonia), segmental, multifocal or generalized.
• Can be task-specific
• Duration: mobile, static, task specific.

Question 3

Atheotosis

Answer 3

Slow, distal twisting movement

Question 4

Myoclonus

Answer 4

Sudden brief, shock-like movement

Question 5

Ataxia

Answer 5

Poorly coordinated, clumsy movement

Question 6

Essential Tremor

Answer 6

Tremor with posture and action. Affects UE>LE and head
Insidious onset, progresses with age
Can cause degeneration
Familial and idiopathic. Unknown pathogenesis

Treatment: Primidone (anti-epileptic), Propranolol, Topamax (anti-epileptic)
Surgery (Thalamic deep brain stimulation

Question 7

Postural Tremor

Answer 7

Emergent postural tremor; tremor kicks in after 30 sec or more

Usually associated with PD

Caused by loss of dopaminergic neurons in the direct and indirect pathways

Treatment: Sinemet (L-DOPA + Carbidopa), Dopamine receptor agonists, Amantidine, Anticholinergic drugs, MAO/COMT Inhibitors, Deep brain stim

Question 8

Chin Tremor

Answer 8

Invariable facial expression

Usually assoicated with PD

Loss of dopaminergic neurons in the direct and indirect pathways

Treatment: Sinemet (L-DOPA + Carbidopa), Dopamine receptor agonists, Amantidine, Anticholinergic drugs, MAO/COMT Inhibitors, Deep brain stim

Question 9

“Flapping Tremor” asterixis

Answer 9

Hold arms up with palms forward and tell patients to “stop”- see tic of hands

Not frequent, seen mostly in young people

Assicated with Wilson’s Disease, liver failure, uremia/kidney failure

Can be caused by copper accumulation in the lentiform nucleus causing basal ganglia degeneration

Treatable with chelating agents such as penicillamine

Question 10

Tics

Answer 10

Brief, intermittent movements or sounds that are sudden, abrupt or transient. Repetitive, coordinated. Vary in intensity. Repeated at irregular intervals. May resemble gestures or normal behavior. Sometimes suppressible.

Associated with Tourette Syndrome

SLITRK1 Gene on chromosome 13. AD in other cases. Otherwise idiopathic

Treatment with Clonidine, SSRIs (for OCD), Neuroleptics, Tetrabenazine, Clonazepam

Question 11

Chorea

Answer 11

Irregular, brief, dancing-like, jerky movements. Move from one body part to another

Associated with Huntington’s.

Sydenham chorea is the most common type in kids. Caused by post-strep immune reaction

Associated with Lupus&raquo_space; 3rd most common neurologic presentation of Lupus

Question 12

Dystonia

Answer 12

Contraction of muscle agonists and antagonists. Sustained muscle contractions cause twisting, abnormal posture.

Can be associated with tremor

Primary etiology is DYT 1-12.
Secondary etiology is from many causes, including neurodegenerative disorders, Ischemic brain injury, PTSD, Meds, Toxins

Botox helps a lot!

Question 13

Tourette Sydrome

Answer 13

•Age of onset

Question 14

Progressive supranuclear palsy

Answer 14

• Progressive
• Onset > 50 years old
• Impaired eye movements: can’t look down
• Reptilian or scared look
• Falls within the first year

Question 15

Motor symptoms in Parkinson’s Disease

Answer 15

• Resting tremor
• Bradykinesia or akinesia
• Rigidity
• Non motor symptoms: autonomic instability, sleep disturbances