Movement Disorders Flashcards
Bradykinesia=
reduced speed of mvmt.
hypokinesia =
reduced amplitude of mvmt.
akinesia =
lack of mvmt.
sensory ataxia:
Dysfunction of large-fiber sensory nerves and/or posterior columns of spinal cord.
Will have impaired vibratory and position sense in lower extermities.
Evaluate for Vit B12 deficiency.
cerebellar ataxia:
Normal sensory function.
Signs of cerebellar disease: dysarthria, scanning speech, head tremor/titubation or eye movement abnormalities.
Atrophy of caudate nucleus, think this disease:
Huntington’s disease
Lesions in globus pallidus, think this:
carbon monoxide intoxication (parakinsonism/dystonia)
Acute lesions of subthalamic nucleus, think this:
contralateral hemiballismus
Loss of dopiminergic neurons in substantia nigra (pars compacta), think this:
Parkinson’s disease
and or Dementia with Lewy Bodies, but in Lewy bodies dementia the Lewy bodies are widespread through hemishperes
2 examples of trinucleotide repeat expansion disorders:
3 characteristics of these disorders:
- Huntington’s
- Spinocerebellar ataxias (SCAs)
Characteristics: - Autosomal dominant
- More repeats –> earlier onset, higher severity.
- Anticipation: # of repeats can expand with generations. In HD it’s worse through paternal inheritance.
Prevalence of different movement disorders:
Most common to see in general practice: Restless legs syndrome Essential tremor Parkinson's Dystonia and tics
4 cardinal features of parkinsonism:
- Resting tremor
- Bradykinesia
- Rigidity
- Loss of postural reflexes/postural instability
- need at least 2 for diagnosis and bradykinesia is a required feature
Etiologies of parkinsonism:
- Idiopathic: Parkinson’s disease
- Secondary: drugs!
- Atypical parkinsonian disorders:
- Multiple System Atrophy: parkinsonism + autonomic dysfunction
- Progressive Supranuclear Palsy: parkinsonim+falls and eye mvmt abnormalities.
- Corticobasal Degeneration: parkinsonism + dystonia and aparxia; unilateral cortical and basal ganglia features and atrophy on imaging.
- Dementia with Lewy Bodies: parkinsonism + early dementia, visual hallucinations, fluctuations. - Heredodegenerative: more rare, inherited PD
Parkinson’s Disease epidemiology:
Avg age onset: 50-60s
M>F
Younger patients - tremor predominant disease.
Older patients - akinetic-rigidity/PIGD (postural instability gait difficulty)
Slower progression in younger.
PD tremor:
pill-rolling, unilateral resting hand tremor.
ET looks like:
bilateral, low amplitude, faster action tremor.
Non-motor features of PD:
anosmia/hyposmia constipation sleep disorders anxiety/depression cognitive dysfunction
PD medication of the dopamine enhancing type (synthesis):
-Levodopa - precursor of dopamine
-Carbidopa - inhibits enzyme to prevent synthesis of dopamine before crossing BBB.
Dopamine Agonists:
-Pramipexole, Ropinirole, Rotigotine
PD medication of the dopamine inhibiting type (catabolism):
- MAOb inhibitors: selegiline, rasagiline
- COMT inhibitors: tolcapone, entacapone - extend half life of levodopa
Nonspecific PD treatments:
Amantidine - for dyskinesias
Anticholinergics
Surgical - DBS
Essential tremor (ET):
Slowly progressive, bilateral arm action tremor without other significant motor features, and that can also affect the neck and voice. It is often familial ~50%
Improves with EtOH for a couple hrs.
Dystonia is:
A movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Dystonic movements are typically patterned, twisting, and may be tremulous. Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation.
How is dystonia classified?
- Age of onset (younger patients are more likely to have inherited forms)
- Distribution (focal, segmental, hemidystonia, multifocal or generalized).
- Body part involved. Neck = cervical dystonia (or spasmodic torticollis); blepharospasm = dystonia eye closure; oromandibular dystonia involves the jaw, tongue and lips, etc.
Etiologies of dystonia:
Idiopathic (most adult)
Inherited (most childhood onset)
Secondary to brain insult or disease.
- can begin with tremor.
- sensory tricks or geste antagoniste - temporary relief by gentle touch
- task specificity - appear with specific activity
Treatment of dystonia:
For focal/segmental dystonia - botulinum toxin injections.
For generalized dystonia - anticholinergics.
Children with idiopathic dystonia - levodopa.
DBS for specific forms.
Ataxia definition:
“absence of order” or incoordination: lack of accuracy of movement not secondary to paresis, abnormal tone or involuntary movements.
If patient has gait ataxia - determine what?
If it is cerebellar or sensory: tuning fork.
Sensory ataxia is more severe with eyes closed. Cerebellar ataxia not.
Vestibular/unilateral cerebellar syndrome:
Frequent deviation to one side, Vertigo/dizziness
Prominent nystagmus.
Limb ataxia
Kinetic if in movement
Static if in resting state.
Treatable causes of ataxia:
Vitamin B12 or E deficiencies.
Copper deficiency in sensory ataxia.
Chorea =
Involuntary, irregular, purposeless, non-rhythmic, abrupt, rapid, unsustained movements that seem to flow from one body part to another. Movements are unpredictable.
Causes: Huntington’s, Sydenham’s (post-infec), autoimmune (lupus), meds, hemiballism - contralateral cerebrovascular etiology.
