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Neurology pro +1060 > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q
  1. What are movement disorders caused by? 2

2. What modulates motor cortical activity but also the activity of the association cortex, in the frontal lobes?

A
    • extrapyramidal (basal ganglia)
    • cerebellar dysfunction.
  2. Basal ganglia
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2
Q

Huntington’s Disease

  1. How is it acquired?
  2. What does it affect? 3
  3. Mean onset is at what age?
  4. What is the mean duration of illness?
A
  1. Progressive autosomal dominant
  2. Affects
    - motor function
    - cognition
    - behavior
  3. Mean onset is age 40
  4. Mean duration of illness is 20 years
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3
Q
  1. Huntington’s Disease Pathophysiology?

2. Where is the disease at? 2

A
    • brain cells are wasting away/localized cell death
    • Decrease of GABA and GABA receptors in the basal ganglia
  2. cauda nucleus/putemen of basal ganglia
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4
Q

What is Huntingtons disease characterized by?

3

A
  1. Chronic progressive chorea
  2. Psychological changes
  3. Dementia
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5
Q

Decrease of GABA and GABA receptors in the basal ganglia is part of the pathophysiology of Huntington’s. What does this cause and why?

A

GABA is an inhibitory neurotransmitter. So without the GABA theres nothing to stop movement = chorea.

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6
Q

Huntington’s adult onset clinical presentations? 6

Juvenile onset? 4

A
  1. Chorea affects the limbs and trunk
  2. Dystonia- twisting and loss of movement
  3. Rigidity
  4. Postural instability
  5. Myoclonus
  6. Nystagmus
  7. Very rare
  8. Bradykinesia
  9. Rigidity
  10. Quicker progression
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7
Q

Early psychological manifestations of Huntington’s Disease?

10

A 
1. Depression
Personality changes
2. Memory loss
3. Impulsive behavior- too much 4. dopamine
5. Moodiness
6. Antisocial behavior
7. Emotional outbursts
8. Lack of initiative
9. Loss of spontaneity
10. Inability to concentrate
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8
Q

Early physical signs of Huntingtons? 2

Lateral physical signs of Huntingtons? 5

A

Early physical signs:

  1. Fidgeting
  2. Restlessness

Later physical signs:

  1. Chorea
  2. Dystonic posturing
  3. Progressive rigidity
  4. Akinesia
  5. Dementia
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9
Q

Diagnostic Studies for Huntingtons?

A
  1. MRI
  2. PET
  3. Genetic testing
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10
Q

Huntington’s Disease
What would the following show?
1. MRI?
2. PET?

A

MRI
1. Caudate atrophy

PET
2. Abnormal metabolic changes in the caudate

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11
Q

Huntington’s Treatment?

3

A

Treatment of symptoms only, no medication will change the course of Huntington’s

  1. Tetrabenazine (VAMT Inhibitor)
  2. Antidopaminergic agents (Phenothiazine, Haloperidol)
  3. Antipsychotics (Resperidone, Olanzapine)
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12
Q

What is tetrabenazine used to treat in parkinson’s?

A

dyskinesia

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13
Q
  1. In Huntingtons what are we mostly treating?

2. What other things are we treating?

A
  1. Chorea
    • Postural instability
    • Rigidity worsen
    • Treatment of depression
    • Psychosis
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14
Q
  1. What are the anticonvulsants used for Huntington’s? 2
  2. What are the antipsychotics used for Huntington’s? 2
  3. What are the antidepressants used for Huntington’s? 3
A
    • Clonazepam (Klonopin)
    • Valproic Acid (Depakote)
    • Resperidone (Resperdal)
    • Olanzapine (Zyprexa)
    • Fluoxetine (Prozac)
    • Sertraline (Zoloft)
    • Nortriptyline (Aventyl, Pamelor)- Tricyclic antidepressant
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15
Q

What is the risk of TCAs?

2

A

suicide risk and also really dangerous in a overdose.

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16
Q

Side effects from many of the drugs used to treat the symptoms of Huntington’s disease may include what?
3

A
  1. hyper-excitability,
  2. fatigue
  3. restlessness.
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17
Q

Antipsychotic drugs may cause side effects that mimic the signs of what disease?

A

Parkinson’s disease, including involuntary twitching in the face and body (tardive dyskinesia).

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18
Q

What is the most common cause of tremors?

A

Essential tremors

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19
Q

Essential Tremors

  1. How is it acquired?
  2. What are the ranges of presentation?
  3. Unilateral or Bilateral?
  4. More prominent with action or with rest?
  5. Describe the frequency of the tremor?
A
  1. Inherited
  2. Ranges from cosmetic to disabling
  3. Affect both sides of the body symmetrically**
  4. More prominent with action than rest**
  5. Frequency of tremor is constant***
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20
Q
  1. Essential Tremor affects what parts of the body? 3
  2. Tremor (increased amplitude) aggravated by? 3
  3. What relieves essential tumor?
  4. Describe the onset compared to parkinson’s?
A
    • Neck and head muscles
    • Muscles of the voice
    • Muscles of the arms and hands
    • Stress
    • Sleep deprivation
    • Stimulants
  3. ETOH
  4. Usually starts earlier than parkinson’s
21
Q

Treatment for essential tumor? 3

Treatment for essential tumor for pts with asthma or bronchospasm? 1

A
  1. Propranolol (Inderol) – Beta Blocker
  2. Mysoline (Primidone) – Anticonvulsant
  3. Gabapentin (Neurontin) - Anticonvulsant
  4. Atenolol (Tenormin) – Beta Blocker of choice for those with asthma or bronchospasm
22
Q

Parkinson’s Disease
A progressive neurodegenerative disorder characterized by? 4

TRAP

A
  1. Resting and postural Tremor – T
  2. Rigidity – R
  3. Akinesia (Bradykinesia) – A
  4. Postural instability – P
23
Q

Describe the Pathophysiology of Parkinson’s disease?

A
  1. Marked loss of dopaminergic nerve terminals in the substantia nigra***
    - -Relative increase in cholinergic interneuron activity occurs due to degeneration of dopamine pathways, which contributes especially to tremor.
24
Q

Possible causes and risk factors?

7

A
  1. Primary cause is unknown
  2. Genetics – 2004- Parkin gene found with early-onset Parkinson’s.
  3. Defective alpha-syneclein and Lewy bodies
  4. Complex l and oxygen free radicals**
  5. Immune factors
  6. Viral infections/Environmental exposures
  7. Aging
25
Cardinal Manifestations of Parkinson's?
Tremor | Rigidity
26
Parkinson's Tremor? 1. Affects what part of the limbs? 2. What sign do you see often? 3. Unilateral or Bilateral? 4. Appears at rest or with action? 5. Disappears with what? 2
1. Affects distal segment of the limbs 2. “Pill rolling” 3. Usually unilateral 4. Appears at rest 5. Disappears with movement and sleep
27
Cardinal Manifestations: Rigidity. How does this manifest? 4
1. Resistance to movement 2. Cog-wheel movements 3. Ratchet-like movements 4. Starts unilateral, progresses to involve both sides of the body
28
Cardinal manifestation: Akinesia. How does this manifest? 5
1. Most debilitating symptom 2. Slowness in initiating and performing movements 3. Difficulty in sudden, unexpected stopping of voluntary muscles 4. Difficulty turning 5. Feel frozen in place, especially when moving through a doorway or preparing to turn
29
Cardinal Manifestations: Postural Instability How does this manifest? 3
1. Lean forward to maintain center of gravity 2. Take small “shuffling” steps without swinging the arms 3. Prone to fall, especially backwards
30
Parkinson’s Disease Other symptoms? 15
1. Emotional and voluntary facial movements become limited and slow leading to a “mask like” facies. 2. Loss of blinking reflex 4. Tongue, palate and throat muscles become rigid l/t drooling 5. Uncontrolled sweating 6. Sebaceous gland secretion 7. Seborrhea 8. Micrographia 9. Hypophonia 10. Depression 11. Orthostatic hypotension 12. Constipation 13. Impotence 14. Urinary incontinence 15. Dementia
31
Parkinsons Diagnosis: 1. The practical diagnosis of PD during life is based on what? 2. What things will not show signs of parkinsons disease? 3. What is the gold standard of diagnosis? 4. What is the generally accepted way to diagnosis PD? 3
1. clinical impression 2. No physiologic tests or blood tests will confirm Dx Neurodiagnostic testing with computerized imaging is almost always unrevealing. 3. The true "gold standard" for diagnosis is neuropathologic examination. 4. It is generally accepted that two out of the three cardinal manifestations 1. tremor, 2. bradykinesia, 3. rigidity must be present in order to make the diagnosis of idiopathic PD.
32
Rating scale: UPDRS (Unified Parkinson’s Disease Rating Scale) Rating scale: UPDRS (Unified Parkinson’s Disease Rating Scale). Describe each step on the scale? I-IV
I. Mentation/Behavior/Mood ll. Activities of Daily Living (Subjective) lll. Motor Examination (Objective) lV. Complications of Therapy
33
Parkinson’s Disease Treatment? 6
1. Levadopa/Carbidopa 2. MAO-B Inhibitors 3. Dopamine Agonists 4. COMT inhibitors 5. Amantadine 6. Acetylcholine-blocking agents
34
Treating complications: 1. Depression? 1 2. Hallucinations? 2 3. Orthostatic hypotension? 2
1. Depression - SSRI’s 2. Hallucinations - Decrease levadopa/dopamine agonists - Zyprexa (Olanzapine) 3. Orthostatic hypotension - TED hose - Slow rising
35
Treating complications: 1. Sexual Disturbances? 1 2. Constipation? 3 3. Freezing/Difficulty Initiating? 2
1. Viagra/Dopamine agonist 2. - Stop offending medication - Bulking agents - NO REGLAN (why?)- dopamine resceptor antagonists. will make symtpoms worst 2. - Tape through a doorway - Mark on floor at turning point
36
After we've maxed out medical therapy what is our treatment for PD?
Deep Brain Stimulation
37
Deep Brain Stimulation 1. What does it do? 2. How often does this need to be replaced? 3. Who are our candidates for this? 4 4. What are the complications in this? 2
1. Uses electric pulse generators to control symptoms attached to STN or thalamus 2. Generators must be replaced every 5 years 3. Candidates are generally - under 70, - who have motor fluctuations, - drug induced dyskinesias, and - no other serious medical or psychiatric conditions. 4. Complications occur in 2-4% Bleeding in the brain and infection
38
When, despite optimal pharmacotherapy, PD patient experiences troubling motor symptoms, such as: 4
1. Frequent motor fluctuations 2. Wearing off periods with severe bradykinesia, rigidity, tremor and/or freezing gait 3. Severe on-dyskinesia 4. Severe, treatment-resistant tremor
39
A practice parameter from the American Academy of Neurology (AAN) issued in 2006 concluded that various physical therapy modalities are probably effective in improving functional outcome for patients with PD. These modalities include: 5
1. Multidisciplinary rehabilitation with standard physical and occupational therapy components 2. Treadmill training with body weight support 3. Balance training and high-intensity resistance training 4. Cued exercises with visual (mirror), auditory (metronome), and tactile feedback 5. Active music therapy
40
``` 1. Restless Leg Syndrome (RLS) is also known as? 2. What is RLS? 3. What brings relief? 4. What is it brought on by? 5. When are symtpoms often worse? ```
1. (Wittmaack-Ekbom's Syndrome) 2. Uncontrollable urges to move limbs in order to stop uncomfortable, painful or odd sensation in the body, most commonly the legs 3. Movement brings brief relief 4. Brought on by inactivity involving sitting or lying 5. Sometimes symptoms are worse in the evening and early in the night
41
Difficult for patient to describe unusual sensations, but some ways are the following? 7
1. Uncomfortable 2. Antsy 3. Electrical 4. Creeping 5. Painful 6. Itching 7. Pins and needles
42
1. Describe the onset of RLS? | 2. Where is the cause probably located in the brain?
1. Onset is usually slow | 2. Something in the substania nigra
43
What has RLS been associated with? | 9
1. pregnancy 2. obesity 3. smoking 4. iron deficiency 5. anemia 6. nerve disease 7. polyneuropathy (which can be associated with hypothyroidism, heavy metal toxicity, toxins, and many other conditions) 8. Diabetes 9. Kidney failure (which can be associated with vitamin and mineral deficiency).
44
What medications might cause RLS? | 6
1. Anti-nausea 2. H2 blockers (Tagamet) 3. Antihistamines 4. TCA’s (Elavil) 5. SSRI’s 6. Antipsychotics
45
What foods might cause RLS? | 2
1. Diet soda - -Aspartame 2. ETOH
46
Tretament for RLS? | 10 (nonpharm)
1. Correct underlying cause i. e. Iron deficiency 2. Take pain relievers – OTC ibuprofen 3. Try baths and massages 4. Apply warm or cool packs, or alternating the two 5. Try relaxation techniques, such as meditation or yoga 6. Establish good sleep hygiene 7. Exercise 8. Avoid caffeine 9. Cut back on alcohol and tobacco. 10. Stay mentally alert in the evening.
47
Pharm Treatment of RLS | Which kind drugs are often used?
Medications for Parkinson's disease
48
Pharm Treatment of RLS drugs | 5
1. Pramipexole (Mirapex) 2. Ropinirole (Requip) 3. Carbidopa/levodopa (Sinemet) 4. Lyrica 5. Gabapentin (Neurontin)

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