Movement Disorders Flashcards
What are the features of essential tremor?
Coarse tremor Jaw and leg tremor Worse on moving Familial No bradykinesia
How is essential tremor treated?
Propanalol
What tremor is worst at rest?
Parkinsonism
What tremors are worse on movement?
Essential tremor Dystonia Hyperthyroidism Drug induced Exaggerated Physiological
What gives an intention tremor?
Cerebellar disease
What are the features of Parkinsonism?
Resting tremor
Bradykinesia
Rigidity
What are the key features of idiopathic Parkinson’s?
Asymmetrical - unilateral
What is the management of IPD?
Levodopa
Physical therapy
What are the key features of vascular Parkinsonism?
Lower body signs
Rigidity predominant
Reduced facial expression
50% respond to levodopa
What are the key features of dementia with Lewy bodies?
- Dementia
- Parkinsonism
- Visual hallucinations
Fluctuations in alertness
Who treats dementia with Lewy bodies?
Psychiatry
Neurology
Geriatrics
What are the features of drug induced Parkinsonism?
Use of dopamine blocking drugs
Symmetrical rigidity
Reduced facial expression
What are the features of multi system atrophy?
Autonomic features - hypotension, urinary incontinence
Symmetrical Parkinsonism
How is multi system atrophy treated?
Levodopa
Supportive treatments
What are the features of progressive supranuclear palsy?
Early falls
Truncal rigidity
Vertical gaze palsy
Need early SALT review
What are the features of normal pressure hydrocephalus?
- Dementia
- Gait disorder
- Bladder instability
How is normal pressure hydrocephalus managed?
Diagnostic LP
CSF removal
Ventriculo-peritoneal shunt
What are the features of cortico basal degeneration?
Asymmetrical Parkinsonism
Dyspraxia
Cortical sensory deficit
Alien limb phenomenon
What are the gait abnormalities in IPD?
Camptocormia Difficulty initiating and stopping Small shuffling steps Loss of arm swing Freezing at obstructions
What are the facial abnormalities seen in IPD?
Reduced expression Reduced blinking Hypophonia Orofacial dyskinesia Blepharospasm
What are the non motor abnormalities seen in IPD?
Constipation Urgency Difficulty controlling saliva Sleep disturbance Low mode Anxiety
What is the treatment for IPD?
Levodopa
Decarboxylase inhibitors
E.g. Cobeneldopa
What can dopamine agonists be used for?
Delay use of l dopa
E.g. Ropinorole
What are the side effects of dopamine agonists?
Confusion
Hallucinations
Impulsive behaviour
What do COMT inhibitors do?
Prolong the effects of l dopa
E.g. Entacapone
What are MOAB inhibitors?
Alternative to dopamine agonists
E.g. Rasagaline
What are the stages of PD?
Pre diagnosis - no overt motor symptoms
Diagnosis - treatment commences, no complications
Complex - development of dyskinesia, cognitiv impairment, psychosis
Palliative - poor drug response, high complications
