Movement Disorders Flashcards
The balance in Parkinson Disease
Dopaminergic pathway is compromised, and the cholinergic system operates unopposed.
Therefore, goal of tx is to either enhance dopamine’s influence or to inhibit ACh’s influence
Tx of Parkinson Disease
- Carbidopa-Levodopa (Sinemet)
- Dopamine-R agonists (bromocriptine, pramipexole)
- Selegine–it inhibits MAO-B activity
- Amantadine (antiviral)–mild benefit, mostly for. early or mild disease
-
Anticholinergic drugs
- Trihexyphenidyl and benztropine
- Amitriptyline–useful in tx as anticholinergic agent and as antidepressant
- Surgery (DBS)
Parkinsonian sx + autonomic insufficiency
Shy-Drager syndrome
Parkinson disease results from the loss of dopamine-containing neurons which are located: (2)
midbrain:
substantia nigra
locus ceruleus
What is a key neuronal finding in the brains of pts with Parkinson disease
Lewy bodies (hyaline inclusion bodies)
Progressive Supranuclear Palsy (PSP)
Degenerative condition of the brainstem, basal ganglia, and cerebellum, most commonly affecting middle-aged and elderly men
Unlike Parkinson disease, PSP:
does NOT cause tremor
dose cause ophthalmoplegia
Huntington Chorea
Inheritance?
Autosomal Dominant
Huntington Chorea
Cause?
Mutation on chromosome 4 (expanded triplet repeat sequence) – CAG leads to a loss of GABA-producing neurons in the striatum
Huntington Chorea
Dx?
MRI = atrophy of the head of caudate nuclei / DNA = confirm
Common Tremors and Associated Features
Parkinsonism
Characteristic Setting?
Description?
Etiology?
Associated Features?
Improved by?
Parkinsonism
- Characteristic Setting?
- Rest
- Description?
- Pill-rolling
- Etiology?
- Idiopathic or adverse effect of neuroleptic
- Associated Features?
- Rigidity, bradykinesia, shuffling gait
- Improved by?
- Action
Common Tremors and Associated Features
Cerebellar
Characteristic Setting?
Description?
Etiology?
Associated Features?
Improved by?
Cerebellar
- Characteristic Setting?
- With action–“intention tremor”
- Description?
- Coarse
- Etiology?
- Multiple possible etiologies
- Associated Features?
- Ataxia, nystagmus, dysarthria
- Improved by?
- Rest (no tremor at rest)
Essential
Characteristic Setting?
Description?
Etiology?
Associated Features?
Improved by?
Tx?
- Characteristic Setting?
- With certain postures (e.g., arms outstretched) or certain tasks (e.g., handwriting)
- Description?
- Fine
- Etiology?
- Often familiar
- Associated Features?
- Head tremor, vocal tremulousness
- Improved by?
- Alcohol
-
Tx?
- Propanolol
Neurologic diseases with tremor
Parkinson
Cerebellar
Wilson
Tourette Syndrome
Inheritance
Tx
AD
- Clonidine
- Pimozide
- Haloperidol
