Movement disorders Flashcards
what are the 4 things to look for in tremors
frequency
amplitude
exacerbating factors
defining feature of resting tremor
worse at rest
abolished with movement
condition with resting tremor
parkinsons
defining features of intention tremor
large amplitude
worse at end of purposeful acts (e.g. finger pointing)
defining features of postural tremor
absent at rest
presents on maintained posture (hands outstretched)
may persist on movement
causes of postural tremor
benign - autosomal dominant (essential tremor)
thyrotoxicosis
B agonists
anxiety
what helps benign postural tremor
propranolol (treatment)
alcohol
defining feature of re-emergent tremor
postural tremor developing after a delay of approximately 10 seconds
3 features of parkinsonian syndrome
bradykinesia
resting tremor
muscle rigidity
what is parkinsons disease
progressive neurodegenerative disorder due to loss of dopaminergic neurons from mitochondrial dysfunction
where does neuronal loss occur in parkinsons
substantia nigra
what pigment makes substantia nigra black normally
neuromelanin
what is the other pathological feature of parkinsons
lewy bodies
what are lewy bodies
atypically folded alpha synuclein forming eosinophilic intracellular inclusions
how is parkinsons diagnosed
onset of motor symptoms
exclusion of other causes - anaemia, hypothyroid
describe the ‘rolling pill’ tremor
thumb moves backwards and forwards on palm of hand
signs of increased rigidity and tone
flexed, hunched posture
cogwheeling
what is bradykinesia
slow to initiate movements
slow and low aplitude of repetitive movements
signs of bradykinesia
‘mask like’ expressionless face
dysphagia
slow blink rate
slow, shuffling gait (decreased arm swinging, freeze at doors)
what are some non-motor symptoms of parkinsons
depression and hallucinations dementia decreased sense of smell REM sleep disorder autonomic features - postural hypotension, constipation
tremor dominant/non-tremor dominant parkinsons has the fastest progression
non-tremor dominant
why might non-motor symptoms of parkinsons be present first
presence of lewy bodies in PNS and other areas of CNS
parkinsons is typically bilateral/unilateral
unilateral
what are atypical features of parkinsons
early dementia
imbalance
autonomic
first line treatment in parkinsons
levodopa
what does levodopa do and what symptoms does it help
increases intracerebral dopamine (dopamine precursor)
particularly helps rigidity and bradykinesia
what should be given alongside levodopa and why
decarboxylase inhibitor: madopar, sinemet
prevents peripheral breakdown of drug in liver
reduces peripheral side effects
what are side effects of levodopa
nausea/vomiting hypotension psychosis/hallucinations daytime solomnence dyskinesia (long term use)
what can decrease the efficacy of levodopa
protein
what helps tremor in parkinsons
anticholinergics
clozapine
what could be added if levodopa resistant disease
dopamine agonists
SE of dopamine agonists
compulsive behaviours
fibrosis
hallucinations + psychosis
erythromyalgia
what anti-emetic should be used in Parkinsons
domperidone
what drug should be used in parkinsons if hypotensive
mineralcorticoid - fludrocorticone acetate
what medications should be used for depression in parkinsons
tricyclics (desipramine)
SSRI (citalopram)
what medication should be used for psychosis in parkinsons
clozapine
what genetic mutations cause young-onset parkinsons
synuclein
parkin
LRRK2
what can cause secondary parkinsonianism
drug induced (anti-psychotics/anti-emetics) post traumatic vascular disease infection (prion disease, HIV) hydrocephalus parathyroid paraneoplastic
clinical features of vascular parkinsons
predominantly affects lower limbs
tremor uncommon
clinical features of drug induced parkinsons
bilateral
coarse postural tremor
what conditions may mimic parkinsons
multiple system atrophy
progressive supranuclear palsy
dementia with lewy bodies
what is chorea
involuntary, irregular jerking movements affecting limbs and axial muscle groups
suppressed with difficulty - often incorporated into voluntary gestures (facial grimacing, raising shoulders, flexing extending fingers)
what is Sydenham’s chorea
complication of a strep pneumoniae infection
develops weeks-months after primary infection
due to necrotising arteritis in striatum and thalamus
what is dystonia
prolonged muscle contractions causing abnormal posture or repetitive movements (sustained head retraction, sustained inversion of foot)
what mutation causes idiopathic generalized dystonia
DYT1 - autosomal dominant (reduced penetrance)
what group are susceptible to idiopathic generalized dystonia
Ashkenazi Jews
clinical features of idiopathic generalised dystonia
starts in leg affecting gait
spreads to whole body in 5-10 years
