Movement Disorders

Question 1

What are the features of essential tremor?

Answer 1

Coarse tremor
Jaw and leg tremor 
Worse on moving 
Familial 
No bradykinesia

Question 2

How is essential tremor treated?

Answer 2

Propanalol

Question 3

What tremor is worst at rest?

Answer 3

Parkinsonism

Question 4

What tremors are worse on movement?

Answer 4

Essential tremor
Dystonia
Hyperthyroidism 
Drug induced
Exaggerated 
Physiological

Question 5

What gives an intention tremor?

Answer 5

Cerebellar disease

Question 6

What are the features of Parkinsonism?

Answer 6

Resting tremor
Bradykinesia
Rigidity

Question 7

What are the key features of idiopathic Parkinson’s?

Answer 7

Asymmetrical - unilateral

Question 8

What is the management of IPD?

Answer 8

Levodopa

Physical therapy

Question 9

What are the key features of vascular Parkinsonism?

Answer 9

Lower body signs
Rigidity predominant
Reduced facial expression

50% respond to levodopa

Question 10

What are the key features of dementia with Lewy bodies?

Answer 10

1. Dementia
2. Parkinsonism
3. Visual hallucinations

Fluctuations in alertness

Question 11

Who treats dementia with Lewy bodies?

Answer 11

Psychiatry
Neurology
Geriatrics

Question 12

What are the features of drug induced Parkinsonism?

Answer 12

Use of dopamine blocking drugs
Symmetrical rigidity
Reduced facial expression

Question 13

What are the features of multi system atrophy?

Answer 13

Autonomic features - hypotension, urinary incontinence

Symmetrical Parkinsonism

Question 14

How is multi system atrophy treated?

Answer 14

Levodopa

Supportive treatments

Question 15

What are the features of progressive supranuclear palsy?

Answer 15

Early falls
Truncal rigidity
Vertical gaze palsy

Need early SALT review

Question 16

What are the features of normal pressure hydrocephalus?

Answer 16

1. Dementia
2. Gait disorder
3. Bladder instability

Question 17

How is normal pressure hydrocephalus managed?

Answer 17

Diagnostic LP
CSF removal
Ventriculo-peritoneal shunt

Question 18

What are the features of cortico basal degeneration?

Answer 18

Asymmetrical Parkinsonism
Dyspraxia
Cortical sensory deficit
Alien limb phenomenon

Question 19

What are the gait abnormalities in IPD?

Answer 19

Camptocormia 
Difficulty initiating and stopping 
Small shuffling steps 
Loss of arm swing 
Freezing at obstructions

Question 20

What are the facial abnormalities seen in IPD?

Answer 20

Reduced expression 
Reduced blinking 
Hypophonia 
Orofacial dyskinesia 
Blepharospasm

Question 21

What are the non motor abnormalities seen in IPD?

Answer 21

Constipation 
Urgency 
Difficulty controlling saliva 
Sleep disturbance 
Low mode 
Anxiety

Question 22

What is the treatment for IPD?

Answer 22

Levodopa
Decarboxylase inhibitors

E.g. Cobeneldopa

Question 23

What can dopamine agonists be used for?

Answer 23

Delay use of l dopa

E.g. Ropinorole

Question 24

What are the side effects of dopamine agonists?

Answer 24

Confusion
Hallucinations
Impulsive behaviour

Question 25

What do COMT inhibitors do?

Answer 25

Prolong the effects of l dopa

E.g. Entacapone

Question 26

What are MOAB inhibitors?

Answer 26

Alternative to dopamine agonists

E.g. Rasagaline

Question 27

What are the stages of PD?

Answer 27

Pre diagnosis - no overt motor symptoms
Diagnosis - treatment commences, no complications
Complex - development of dyskinesia, cognitiv impairment, psychosis
Palliative - poor drug response, high complications