Movement disorders

Question 1

What causes parkinson’s disease?

Answer 1

Degeneration of dopaminergic neurons in the substantia nigra pars compacta

Question 2

What are the major clinical features of Parkinson’s?

Answer 2

Pin rolling tremor which is worse at rest

Rigidity and increased tone

Bradkinisia (slow to initiate movement and monotonous hypophoic speech)

Shuffling gait

Question 3

What are some of the non-motor symptoms of Parkinson’s?

Answer 3

Sleep disorders

Hallucinations

Dementia

Depression

Question 4

What is the neurohistological hallmark of parkinson’s disease?

Answer 4

Lewy Bodies

Question 5

What is important to consider in terms of medications when treating GI problems in Parkinson’s disease?

Answer 5

Metoclopromide is contraindicated as it is a dopamine antagonist and therefore exacerbates symptoms

Domperidone can be used instead because it doesn’t cross the BBB

Question 6

What drug can be used for symptomatic management of Parkinson’s disease?

What are its main side effects?

Answer 6

Levodopa

Dyskinisia 
Postural hypotension 
Cardiac arrhythmias 
Red discolouration of urine on standing 
Drug resistance

Question 7

?How should psychosis in parkinson’s disease be treated

Answer 7

Quetiapine

NB drugs like haloperidol are contraindicated because they cause EPSE, one of which is parkinsonism

Question 8

What are the causes of postural tremors, which are absent on rest but present with maintained posture?

Answer 8

Benign essential tremor

Neuropathy

B agonist tremor

Anxiety

Thyrotoxicosis

Question 9

What are the causes of kinetic/ intention tremors?

Answer 9

Cerebellar disease

Wilson’s disease

Question 10

Describe essential tremor

Answer 10

Autosomal dominant condition affecting both upper limbs

tremor is postural (worse if arms are outstretched)

Improves with alcohol and rest

Question 11

What is the treatment for essential tremor?

Answer 11

Propanolol

Question 12

Describe Gilles De La Tourette Syndrome

Answer 12

Autosomal dominant inheritance

Multiple motor tics and one or more vocal tics must be present

Age of onset <18

Affects males more than females

Question 13

What is the name of the condition which presents with chorea and is due to previous rheumatic fever?

Answer 13

Sydenham’s

Question 14

What drugs can be given as symptomatic treatment for chorea?

Answer 14

Terabenazine and dopamine receptor blocking drugs

Question 15

What drugs can be given as symptomatic treatment for Tourettes?

Answer 15

Clonidine and tetrabenazine

Question 16

What are the genetics of Huntington’s disease?

Answer 16

Autosomal dominant

CAG triplet repeat affecting the huntingtin gene on chromosome 4

Genetic anticipation

Question 17

What is myoclonus?

Answer 17

Brief activation of a group of muscles leading to a jerk of the affected body part

Question 18

What is negative myoclonus? Give an example

Answer 18

Negative myoclonus is caused by a temporary cessation of muscle activity

E.g asterisks (liver flap) in patients with liver failure

Question 19

Describe juvenile myoclonic epilepsy

Answer 19

Myoclonic jerks and generalised seizures with onset in the teenage years

Alcohol and sleep deprivation are common triggers

Symptoms tend to be worse in the mornings

Sodium valproate can be used as treatment, an AED is usually required long-term

Question 20

What is dystonia?

Answer 20

Involuntary muscle spasms leads to sustained abnormal posture of a body part

Question 21

Describe primary young onset dystonias

Answer 21

Onset in late childhood/ early teens

Autosomal dominant inheritance

Typically limb onset with spreads of symptoms over a couple of years