movement disorders Flashcards
Two types of movement disorders
1) hypokinesias = move too little
2) hyperkinesia = move too much
define tremor
position when happens most classifications
where to see each
rhythmic oscillatory movement from alternating or synch contraction of antag muscles
- resting
- action
- postural
resting = parkinson’s
action = essential = benign familial tremor
postural (with sustained posture) = parkinson, dystonic
Hyperkinesias Dystonia 1) mech and nature of movement 2) assoc with 3) cause 4) treatment
1) contract muscle agonists and antag
sustained muscle contractions cause twisting, abnormal posture
2) assoc with tremors
3) DYT 1-12 protein = primary
secondary = neurodegenerative, ischemic brain, poststroke, posttrauma, meds, toxins
4) botox
focal dystonia include what symptoms
duration
focal
1) blepharospasm (eyelid twitch)
2) hemifacial spasm
3) oromandibular dystonia
4) laryngeal dystonia
5) spasmodic torticollis = cause neck to turn all directions = cervical dystonia (most common)
duration = mobile, static, task specific (wwriter, musician)
Hyperkinesias
tremors
1) ask patient what?
ask about when/position happens most (rest, action, postural)
frequency (slow/fast)
regular or jerky
think of
resting tremor action tremor fine and fast tremor jerky tremor flapping tremor/coarse tremor
resting = parkinson's action = essential/benign familial fine + fast = medication jerky = myoclonus or dystonia flap/coarse = Wilson's
hyperkinesias
essential tremor
1) mech and nature of movement
2) assoc with
3) cause
1) intention tremor = with posture/action
affects UE > LE/head
insidious, progress with age
can cause degeneration
2) -
3) familial and idiopathic; oscillator in thalamus and some role of cerebellum
treatment essential tremor
first = primidone or topiramate (anti-epileptics), propranolol, gabapentin (anticonvulsant), clonazepam
surgery = thalamic DBS
occupational = adaptive
75% respond to alcohol
hyperkinesias
postural tremor
1) mech and nature of movement
2) assoc with
3) cause
1) emergent postural; tremor after 30sec or more
2) assoc with parkinson’s
3) loss of DA neuron in direct/indirect path
postural tremor treatment
1) sinemet (L-DOPA+carbidopa)
2) DA agonists
3) amantidine
4) anticholinergic drugs
5) MAO/COMT inhib
6) DBS
hyperkinesias
chin tremor
1) mech and nature of movement
2) assoc with
3) cause
1) invariable facial expression
2) assoc with parkinson’s
3) loss of DA neurons in direct/indirect
treatment chin tremor
same as postural tremor
hyperkinesias
flapping tremor/asterixis
1) mech and nature of movement
2) assoc with
3) cause
1) hold arm up with palm forward and tell “stop” see tics
seen mostly in young people
2) wilson’s disease, liver failure, uremia/kidney failure
3) coppper accum in lentiform nucleus –> basal ganglia degenerate
treat flap tremor
chelating agents (pencillamine)
hyperkinesias
chorea
1) mech and nature of movement
2) assoc with
3) cause
1) irregular, brief, dancing, jerky movements
move from one body part to another
2) assoc with huntington’s, syndenham’ chorea, chorea gravidarum, lupus
3) Huntington = CAG repeat on chrom 4, near 100% penetrant
syndenham = post strep
