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
hyperkinesias
tics
1) mech and nature of movement
2) assoc with
3) cause
1) brief, intermittent movements, sudden, abrupt, transient
repetitive, vary intensity, irregular intervals,
2) assoc with tourette’s
3) SLITRK1 gene on chrom 13
Alzheimer’s
idiopathic
tics treatment
1) clonidine (anti-HTN) SSRI (for OCD) neuroleptics tetrabenazine clonazepam
educate
support
tourette’s syndrome
age onset
male or female
assoc with
which tics are suppressible
treatment
age less than 16
males
assoc with ADHD, OCD, poor impulse control
motor (grimace, blink, lip pout, hop, clap, touch) and vocal tics (bark, sniff, swearing) suppressible but waxes and wanes into 25% adults
educate
support
treat tics only if interfering,
treat OCD and ADHD with CBT + biofeedback
hypokinesias
parkinson’s symptoms
motor and nonmoto
motor = rest tremor, bradykinesia or akinesia, rigidity, dysphagia, dysarthria, festinating gait
nonmotor = autonomic instab, sleep disturb, anosmia, depression, drooling, orthostatic hypotension, erectile problem, sweat
hypokinesias progressive supranuclear palsy 1) onset 2) impaired what 3) what kind of look 4) symptoms
progressive
1) onset more than 50 y/o
2) impaired eyes can’t look down
3) scared look
4) falls
basal ganglia function
unconscious motor control, smoothness of movements, coord btwn diff muscle groups
compare ET vs PD
ET = kinetic, bilateral, disabling
PD = rest, unilateral, not disabling, + PD signs
tremor in young person
tremor in chin
tremor in head and neck= ?
most common movement disorder in children
esp flopping tremor = wilson
unless otherwise
ceruloplasm and copper level
= parkinson’s
= parkinson’s
= tics
diagnostic criteria of tourette’s
age of onset les sthan 16
motor and vocal tics
last more than 1 years
best behavioral intervention for tourette’s
CBT
pharm treatments for tourette’s
clonidine- anthtn
ssris, ocd
neuroleptics = fluphenazine, aripiprazole
side effect = weight gain, sedation
tetrabenazin= dopamine depleting
clonazepam
3 most common neuro complications of lupus
1) abnormal movements incl chorea
2) behavioral problems, mood problems
3) epilepsy
earliest sign of neuro problems in llupus
unable to maintain tongue sticking out
Levodopa-induced dyskinesias
treatment
choreiform movements
levodopa can induce hyperkinesias
can treat with DBS
Oppenheim chorea
chorea early on; slowness and parkinsonism late in disease
meige syndrome
blepharospasm and facial dystonia
treated with botox
camptocormia
forward bending at torso = dystonia at trunk
corticobasal degeneration
hand apraxia = alien hand syndrome
more symmetric
in parkinson’s (asymm or symm disorder)
asymmetric
