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Neuro Pt 3 > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

Hyperkinesias

A

Moving too much

Tremor
Chorea
Tics
Dystonia
Myoclonus
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2
Q

Hypokinesias

A

Not moving enough

Parkinson’s

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3
Q

Summary of basil ganglia function

A

Responsible for unconscious motor control: smoothness of the movements, coordination between different muscle groups muscle tone etc

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4
Q

What is the key neurotransmitter in the extrapyramidal system, responsible for motor control?

A

Dopamine

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5
Q

What is the most common movement disorder in the general population?

A

Restless leg syndrome (12% in general population)

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6
Q

What is the most common movement disorder seen in clinic?

A

Parkinson’s disease

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7
Q

Tremor

A

Definition: Rhythmic oscillatory movement produced by alternating or synchronous contraction of antagonist muscles

Happens most when resting, action (intentional), postural (with sustained posture)

Frequency- Slow or fast ( ex. PD tremor 6 HZ)

Regular or jerky

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8
Q

Essential tremor

A

Clinical features:

Tremor with posture and action
Upper extremities > lower, head
Insidious onset
Worsens with age
75% respond to alcohol

Usually familial

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9
Q

Tics

A

Definition:

Brief, intermittent movements or sounds 
Sudden, abrupt, transient
Repetitive and coordinated
Vary in intensity, repeated at irregular intervals
May resemble gestures, normal behavior
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10
Q

Tourettes

A

Age of onset 1 year

Clinical features:
Onset in youth, more common males

Associated with:
ADHD,
OCD,
poor impulse control

Tics persist into adulthood 25%

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11
Q

Chin tremor

A

Parkinson’s

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12
Q

Head and voice tremor

A

Essential tremor

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13
Q

Tremor in young pts is suspicious for what?

A

Wilson’s disease

Especially if floppy tremor

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14
Q

Most common movement disorder in children

A

tics

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15
Q

Treatment of Tourettes

A 
Educate family, patient, school
Support groups
Treat tics only if interfering with life
Treat OCD, ADHD
Cognitive-Behavioral Therapy (CBT) (BEST BEHAVIORAL  INTERVENTION THAT HAS BEEN STUDIED)
Biofeedback
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16
Q

Meds for Tourettes

A

Clonidine - antihypertensive
SSRIs: OCD

Neuroleptics:
Fluphenazine, aripiprazole (Side effects: weight gain, sedation)
Tetrabenazine –Dopamine depleting drug,
Clonazepam

17
Q

Chorea

A

Irregular, brief, dancing like, jerky

Move from one body part to another

18
Q

What diseases have Chorea?

A

Huntington disease
Sydenham chorea
Chorea gravidarum
Lupus

19
Q

Dystonia

A

Co-contraction of muscles agonists and antagonists
Sustained muscle contractions causing twisting, abnormal postures
Can be associated with tremor

Position dependent
Presence of “Null point”
Alleviating maneuver (sensory tricks, geste antagoniste)
20
Q

What is the etiology of primary distonia

A

DYT 1 – Protein Torsin

21
Q

Causes of secondary distonia

A

Cerebral palsy

Neurodegenerative disorders (Wilson’s Disease,
Panthokinase-assocoated neurodegeneration (PKND), Other ferritinopathies (NBIA), Neuroacantocytosis)

Hypoxic- ischemic brain injury

Poststroke

Posttraumatic

Medications, toxins

22
Q

3 cardinal symptoms of Parkinson’s

A

Resting tremor
Bradykinesia or akinesia
Rigidity

23
Q

Red flags that a patient might have an atypical form of Parkinson’s

A

Rapid progression of the disease
Early onset of dementia
Early onset of autonomic instability
Early onset or predominance of postural instability
Confusion or hallucinations, unrelated to medications
Ataxia
Downgaze impairment

24
Q

Atypical parkinsonian syndromes

A

Prognosis: average 7-10 years
Worse than Parkinson disease

Treatment:
Only 10-15% respond to dopaminergic therapy

Rare

LBD – Lewy Bodies Dementia
FTDP – Frontotemporal dementia-parkinsonism
PSP – Progressive Supranuclear Palsy
CBD – Corticobasal degeneration
MSA – Multiple Systems Atrophy
FRAXTAS – Fragile X associated Ataxia Tremor syndrome

25
Q

Progressive supranuclear palsy (PSP)

A 
Progressive, onset > 50, 
Impaired eye movements
Downgaze !
“Reptilian” or scared look 
Early onset of postural instability
Falls within the first year !
Retrocollis
26
Q

Multiple systems atrophy (MSA)

A

Average life expectance 7-9 years

Poor response to dopamine replacement treatments ( 25% can be responsive)

27
Q

What is the typical presentation of a movement disorder?

A

Usually start insidiously and progress slowly

Sudden onset is suspecious for psychogenic movement disorder

28
Q

Movement disorders and sleep

A

Usually movement disorders disappear while at sleep

Movement disorders that persist or start during sleep:
REM sleep behavioral disorder
PLMS
Whipple’s disease

RLS is a disorder of restful wakefulness
Hypnogogic myoclonus happen while drowsy

Neuro Pt 3 (22 decks)

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