Movement disorders

Question 1

What two systems control movement?

Describe what they do briefly.

Answer 1

Pyramidal: control of conscious movement

Extrapyramidal: unconscious control of tone and posture, maintains centre of gravity

Question 2

What is the difference between the pyramidal and extra-pyramidal system?

Answer 2

Pyramidal:

• neurons travel through the pyramids of the medulla
• control of conscious movement

Extrapyramidal:

• don’t travel through pyramids of medulla
• unconscious control of tone, posture and centre of gravity

Question 3

Describe how the extrapyramidal system works?

Answer 3

Modulation and regulation of the anterior horn cells

To maintain posture and centre of gravity

Question 4

What is dystonia?

Answer 4

A name for a number of types of muscle disorder

Distortion of posture or repetitive movements caused by prolonged spasms of muscle contraction

The muscle holds the body part it supplies in a fixed position

For example the neck is fixed in a looking down position

Question 5

When does dystonia usually start?

Answer 5

After adolescence

Question 6

What is geste antagonistique?

Answer 6

Sometimes, when the patient touches the muscle affected with dystonia the symptoms are relieved

Question 7

What types of dystonia are there?

Answer 7

Idiopathic generalised dystonia

Focal dystonia

Writer’s cramp

Acute dystonia

Question 8

What is writer’s cramp?

Answer 8

Affects people who write a lot

Postural distortion of the hand, for example a finger extending abnormally when writing

It is limited to certain movements of the body, so writing only

Question 9

What is idiopathic generalised dystonia?

Answer 9

Dystonia affecting one muscle, such as one in the leg, the dystonia spreads over many years

Question 10

What is focal dystonia?

Answer 10

Dystonia confined to one part of the body, i.e. the neck

Question 11

What are muscle spindles?

Answer 11

Sensory receptors within a muscle that detect changes in the length of this muscle

They convey length info to the CNS via sensory neurons.

This information can be processed by the brain to determine the position of body parts

Question 12

Management of dystonia?

Answer 12

Botox can temporarily weaken muscles and reduce spasm

Medication:

• anti-cholinergics
• muscle relaxants

Surgery if no other methods are sucessful

Question 13

What is parkinsonism?

Answer 13

When people have Parkinson features but not actual Parkinson’s disease

It is usually asymmetric and does not respond to Parkinson medication

Question 14

What are the features of parkinsonism?

Answer 14

Bradykinesia
Rigidity
Tremor

PLUS
Gait apraxia
Autonomic features

Question 15

What is bradykinesia?

Answer 15

Extreme slowness of movements and reflexes

Question 16

What does apraxia mean?

Answer 16

A disorder of sequencing movements

A loss of the ability to perform complex co-ordinated movements, such as dressing

Question 17

What would gait apraxia look like?

Answer 17

Difficulty walking, poor balance, shuffling, shaky walking

Question 18

What causes Parkinsonism?

Answer 18

Toxins
Metabolic diseases
Some neurological conditions

Vascular parkinsonism

But not Parkinson’s

Question 19

What is the purpose of CSF?

Answer 19

It stops you getting a gait apraxia

When blood enters the brain, some fluid has to leave, otherwise pressure would rise in the brain causing damage

When blood enters, CSF squirts out of the foramen magnum, meaning inter-cranial pressure stays constant

Question 20

What is vascular parkinsonism?

Answer 20

Gait apraxia caused by normal pressure hydrocephalus

Mainly affects lower half of body

Likely caused by basal ganglia ischaemia

Question 21

What is normal pressure hydrocephalus?

Answer 21

With age, and with some other conditions there is an impairment of the ejection of CSF out of the cranium as arterial blood enters

Pressure builds up = hydrocephalus

Question 22

What does chorea mean?

Answer 22

A type of dyskinesia

Brief, irregular movements that are not repetitive or rhythmic,

Appear to flow from one muscle to the next

Question 23

What causes chorea?

Answer 23

Huntington’s Chorea
Wilson’s disease (excess copper)
Rheumatic fever
Many more

Question 24

What does dyskinesia mean?

Answer 24

Umbrella term for abnormal involuntary movements

Question 25

What does athetosis mean?

Answer 25

Slow, purposeless, involuntary movements

Often caused by cerebral palsy

Question 26

What types of tremors are there?

Answer 26

Postural

Intention

Rest

Question 27

What causes postural tremors?

Answer 27

Muscle spindle problem

Question 28

What causes resting tremors?

Answer 28

Basal ganglia disease, like Huntington’s, Parkinson’s

Question 29

What is myoclonus?

Answer 29

Sudden involuntary focal or general jerks arising from the CNS

This has many causes, but most often it is benign

Question 30

What is akathasia?

Answer 30

A feeling of restlessness, inability to stay still

Question 31

What is hemiballismus?

Answer 31

Large amplitude, flinging movements on one side of the body

Arm hits the body

Contralateral to the lesion

Question 32

What is a tic?

Answer 32

Brief, repeated movements

Like winking, arm movements, pulling faces

Question 33

Describe what a tic disorder feels like?

Answer 33

A build up of a compulsion to do the movement

You can’t resist it so you have to do the movement

Then the compulsion goes away

But it begins building up again