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NEURO CLERKSHIP > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

What is the most common movement disorder?

A

Parkinsons Disease

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2
Q

What percent of the population is affected by PD?

A

1-2%

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3
Q

Which gender is more commonly affected by PD?

A

Males

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4
Q

What is the second most common neurodegenerative disorder?

A

Alzheimers

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5
Q

What is the second most common neurodegenerative disorder?

A

Parkinsons Disease

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6
Q

Most common age group for the diagnosis of Parkinsons?

A

50-70

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7
Q

What genes have an association to Parkinsons?

A

LLRK2, PARK2, PARK7, PINK1 and SNCA

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8
Q

What are risk factors for Parkinsons Disease?

A
  1. Age
  2. Male
  3. Race (non-Asian)
  4. Family Hx (genes)
  5. Environmental
  6. Trauma
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9
Q

What are environmental risk factors to developing Parkinsons Disease?

A
  1. Herbicides, pesticides
  2. Metals (Mg, Fe) exposure
  3. Well Water, Farming and Rural Residence
  4. Wood Pulp Mills
  5. Steel and Alloy workers
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10
Q

Is smoking a risk or protective of PD?

A

Protective (possibly)

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11
Q

Describe the pathophysiology of PD

A
  1. Loss of dopaminergic cells within the substantial nigra

2. Accumulation of Lewy Bodies and Lewy Neurites (not specific to PD)

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12
Q

Where is the loss of dopaminergic neurons most prominent?

A

Ventral Lateral Substantia Nigra

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13
Q

What percent of dopaminergic neurons must be lost before motor signs of PD?

A

60-80%

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14
Q

What are Lewy Bodies?

A

Eosinophilic, round cytoplasmic inclusions

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15
Q

Where does the substantia nigra project?

A

Striatum

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16
Q

What is the major function of the striatum?

A

Regulation of posture and muscle tone

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17
Q

What are the motor features of PD?

A

Tremor
Rigidity
Akinesia (bradykinesia)
Postural instability

+ stooped posture, shuffling gait, enbloc turning and poor arm swing

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18
Q

What are the features of the tremor associated with PD?

A
  1. Asymmetric onset
  2. Rill rolling or supination/pronation
  3. Affects all limbs (late)
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19
Q

What are the non-motor features of PD?

A
  1. Mood
  2. Memory
  3. Autonomics
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20
Q

What are the mood symptoms of PD?

A

Depression, Anxeity and Hallucinations (late stage, well formed visual hallucinations)

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21
Q

What are the autonomic symptoms of PD?

A
  1. Constipation
  2. Sialhorhea
  3. Urinary frequency
  4. Sweating
  5. Orthostatic Hypotension
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22
Q

What disease may be associated with REM sleep disorder?

A

PD

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23
Q

What are the medications used to treat PD?

A
  1. Sinemet (Levadopa/Carbidopa)
  2. Dopamine Agonists (Ropiranole)
  3. MAOB Inhibitors (rasaGELINE ad seleGILINE)
  4. COMT Inhibitors (entaCapone)
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24
Q

Which Parkinsons medications have been shown to slow the disease progression?

A

MAO-B Inhibitors (rasaGILINE and seleGILINE)

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25
Q

Which PD drug inhibits dopa-decarboxylase?

A

Carbidopa

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26
Q

What is the function of dopa-decarboxylase?

A

Converts L-Dopa to Dopamine

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27
Q

Can Carbidopa cross the BBB?

A

No

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28
Q

Where does Entacapone work?

A

In the periphery to prevent the conversion of L-Dopa to 3OM-dopa

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29
Q

Which Parkinsons drug smoothes the on/off phenomena of the disease?

A

Entacapone

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30
Q

Where do rasagiline and seligiline work?

A

In the brain the prevent the breakdown of Dopamine

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31
Q

Where is a DBS placed in PD to treat dyskinesia and tremor?

A

Subthalamic Nucleus

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32
Q

Where is a DBS placed in PD to treat dystonia and rigidity?

A

Globus Pallidus Externus

33
Q

Where is a DBS placed in PD to treat just tremor?

34
Q

What can be used to treat the postural instability of PD?

A

PT and Occupational Therapy

35
Q

What can be used to treat the constipation of PD?

A

Miralax and herbal remedies

36
Q

What can be used to treat the orthostatic hypotension seen in PD?

A
  1. Fluids

2. Increased salt intake

37
Q

What can be used for the depression in PD?

38
Q

What can be used to treat the REM sleep disturbances in PD?

A

Melatonin or Clonazepam

39
Q

What can be used to treat the dystonia and pain in PD?

A

Botulinum toxin

40
Q

What is used for the dementia in PD?

A

Donepezil, Memantine and Rivastigmine

41
Q

What is the triad seen in Normal Pressure Hydrocephalus?

A
  1. Abnormal Gait
  2. Urinary Incontinence
  3. Dementia
42
Q

Which feature of NPH is earliest to present?

A

Abnormal Gait

43
Q

Which feature of NPH is most responsive to treatment?

A

Abnormal Gait

44
Q

Describe the gait in NPH

A

Bradykinetic, broad-based, magnetic and shuffling gait

45
Q

How is NPH diagnosed?

A

CT or MRI; LP with the goal of removing large volumes of CSF

46
Q

What will be seen on neuroimaging of NPH?

A

Dilation of the ventricles out of proportion to sulcal atrophy ; will see transependymal flow

47
Q

What are the treatments for NPH?

A
  1. Ventriculoperitoneal or Lumboperitoneal CSF shunting
48
Q

What are the symptoms of Lewy Body Dementia?

A
  1. Visual Hallucinations
  2. Fluctuations in Cognitive Function
  3. Parkinsonian motor features preceding cognitive features by less than 1 year
  4. Anterograde memory loss
  5. Prominent executive function
49
Q

Describe the cognitive changes associated with Lewy Body Dementia

A
  1. Fluctuations in alertness/attention- Daytime drowsiness
  2. Staring into space
  3. Disorganized speech
50
Q

When is the peak age of incidence for PSP?

A

6th decade

51
Q

What are the clinical manifestations of PSP?

A
  1. Supranuclear Ophthalmoplegia (downward gaze first)
  2. Pseudobulbar Palsy
  3. Prominent Neck Dystonia
  4. Parkinsonism
  5. Behavioral and Cognitive disturbances
  6. Frequent backwards falls
52
Q

Describe the parkinsonism in PSP

A

More bradykinesia and less tremor or rigidity symptoms compared to PD

53
Q

What is the genetics of Huntington’s Disease?

A

Autosomal Dominant Chromosome 4

54
Q

What trinucleotide repeat is associated with Huntington’s Disease?

55
Q

What genetic feature is associated with HD?

A

Genetic Anticipation

56
Q

Describe the Westphall Variant of Huntington’s Disease?

A

A variant of HD seen in younger children that has symptoms more similar to PD

57
Q

What are the early symptoms of HD?

A
  1. Chorea
  2. Dystonia
  3. Motor Impersistance
  4. Gait Instability
58
Q

What is the age of onset for HD?

59
Q

What are the later cognate and psychiatric symptoms of HD?

A
  1. Depression
  2. Anxiety
  3. Apathy
  4. Impulsivity
  5. Dementia
60
Q

How long do patients survive after being diagnosed with HD?

A

10-15 years

61
Q

What region of the brain is most affected by HD?

A

Caudate Nucleus with “box car appearance”

62
Q

What is the microscopic finding of HD?

A

Loss of the spiny striatal neurons with gliosis

63
Q

What are the medical treatments for HD?

A
  1. Tetrabenazine (depleted dopamine)
  2. SSRIs
  3. Antipsychotics
64
Q

What are the side effects of Tetrabenazine?

A

Depression and orthostatic hypotension

65
Q

What is the most common cause of postural or action tremor?

A

Essential Tremor

66
Q

What percent of the population has an essential tremor?

67
Q

Is Essential tremor symmetric?

A

No, but usually bilaterally

68
Q

When is essential tremor most severe?

A

When arms are outstretched during goal-directed movements

69
Q

How is Essential Tremor affected by Alcohol?

A

It improves

70
Q

What are the 3 components of Essential Tremor?

A
  1. Bilaterally action tremor
  2. No other neuro signs (except cog wheeling)
  3. May have head tremor with no signs of dystonia
71
Q

What are the secondary criteria for Essential Tremor?

A
  1. > 3 years
  2. Positive Family History
  3. Benefit from alcohol
72
Q

What is the age of onset of Essential Tremor?

A

Bimodal (2nd Decade and 6th Decade)

73
Q

Which has a higher correlation with family history, PD or ET?

A

Essential Tremor

74
Q

Which type of tremor is usually asymmetric?

A

Parkinsons Disease

75
Q

What are the frequencies of PD and ET?

A

PD- 4-6Hz

ET- 4-10Hz

76
Q

What is the type of tremor in PD or ET?

A

PD- supination + pronation

ET- flexion + extension

77
Q

What are associated features of ET?

A

Deafness, dystonia and parkinsonism

78
Q

What is the treatment for ET?

A
  1. Propranolol
  2. Topiramate
  3. Primidone (Barbituate)
79
Q

What is the treatment for ET when medical therapy fails?

A

DBP with electrodes to the VIM of the Thalamus

NEURO CLERKSHIP (10 decks)

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