Movement disorders Flashcards
The 3 key features of parkinsonism?
Akinesia
Tremor
Rigidity
how do you get cogwheel rigidity in someone with parkinson’s?
the combo of tremor + rigidity = cogwheeling
pathophysiology behind parkinsons?
Neuronal loss + Presence of Lewy bodies
Lewy Bodies target the pars compacta of SUBSTANTIA NIGRA causing a disturbance in the DOPAMINERGIC pathway
Apart from the 3 characteristic features of Parkinson’s, what other symptoms do they show?
Shuffling gait
Masked facial expression
Non-motor symptoms such as depression & dementia
Treatment of Parkinson’s Disease
Levodopa
S/E of levodopa
Hypotension
Nausea
Dyskinesia - rolling of tongue (like jack)
What other types of drugs can be used to treat Parkinson’s?
Monoamine oxidase B inhibitors
Dopamine agonists
Why does inhibiting the work of the enzyme monoamine oxidase B help with Parkinson’s?
The enzyme is responsible for catabolising dopamine to homovanilic acid
Why would you used dopamine agonists in younger patients (>70) instead of using levodopa?
Due to the high risk of dyskinesia
What Parkinson’s drugs cause hypotension and what ones cause hypertension?
Levodopa + Dopamine agonists = HYPOtension
Monoamine oxidase B inhibitors = HYPERtension (when you eat cheese)
What drugs may induce parkinsonism?
Typical anti-psychotics
- Haloperidol
- Chlorpromazine
Mood stabilizer
- Lithium
Anti-epileptics
- Valproic acid
Dopamine receptor antagonist
- Metoclopramide
What drugs can aid in the symptomatic relief of drug induced parkinsonism?
Anticholinergics:
Benzotropine
Procyclidine
If dementia starts more than 6 months after the onset of parkinsonism, it is called Parkinson’s disease dementia - T/F?
FALSE. It is called Lewy Body Dementia
Dementia starting more than 1 YEAR after the onset of parkinsonism is called Parkinson’s disease dementia
What are the 3 core features of Lewy Body dementia?
Progressive disabling cognitive impairment (dementia)
Recurrent VISUAL HALLUCINATIONS
Features of Parkinsonism
What is multiple system atrophy?
Nerve cells in MULTIPLE parts of the brain deteriorate over time.
Parkinsonism symptoms
Autonomic dysfunction (hypotension, ED, urinary urge)
Cerebellar dysfunction
what is an MRI ‘hummingbird’ sign seen on the midbrain characteristic of?
progressive supranuclear palsy
what are the symptoms of progressive supranuclear palsy?
Axial akinesia Rigidity Loss of balance Unexplained falls Forgetfulness Dysarthria Loss of eye movements
what form of imaging can be used to differentiate between vascular parkinsonism and other parkinsonism syndromes?
SPECT (single-photon emission computed tomography)
how does vascular parkinsonism compare to that of other parkinsonism syndromes?
It progresses slower
Poor response to levodopa
what is a MRI hot cross bun appearance at the pons characteristic of?
multiple system atrophy
you get an essential tremor with parkinsonism - T/F?
FALSE. You get a RESTING tremor with parkinsonism
Essential (or ‘action/postural’) tremors are commonly inherited
How to treat essential tremor
Alcohol
Beta-blockers
What are the 2 types of tremor you can get from cerebellar damage
Intention tremor - due to a lesion
Holmes (rubral) tremor - ‘‘triple’’ tremor because you get a tremor at rest, postural/essential tremor AND intention tremor
How do you test for a intention tremor
finger to nose test
what is dystonia?
involuntary muscle spasms leading to abnormal postures of the affected body part
pathophysiology behind dystonia
opposing agonists and antagonist muscles working against each other
blepharospasm (the thing vorrey has!) is an example of a GENERALIZED dystonia - T/F?
F.
It is FOCAL
how to treat dystonia?
anticholinergics botulinum toxin (1st line in focal dystonias)
what conditions can dystonia arise in?
Parkinson’s
MS
Stroke
What is chorea?
continuous spontaneous jerky movements
genetic association of huntington’s
CAG triplet repeat
what is genetic anticipation?
when the genetic mutation increases from generation to generation causing increased severity and earlier onset
early signs of huntingtons?
personality changes depression apathy clumsiness dysarthria dysphagia abnormal eye movements
late signs of huntingtons?
chorea
rigidity
dementia
in huntington’s:
GABA increases - T/F?
ACh increases - T/F?
Dopamine increases - T/F?
F - GABA decreases
F - ACh decreases
T - dopamine increases
mode of action of tetrabenazine
limits dopamine release
what is Sydenham’s chorea
widespread chorea
behavioural disturbance
OCD symptoms
what age group does syndenham chorea often occur in?
Young girls
what condition often precedes syndenham chorea?
rheumatic fever
what are tics
rapid stereotyped intermittent involuntary movements or sounds
difference in tics and chorea
tics occur in similar place
chorea - occurs randomly in various locations
what is Tourette’s syndrome
motor tics + vocal tics lasting longer than a year
e. g. of simple tic
e. g. of complex tic
simple - sniffing/coughing/throat clearing
complex - barking/strings of words
what is the most common psychiatric co-morbidity to tourette’s
ADHD
pharmacological treatment for solo Tourette’s
pharmacological treatment for Tourette’s + ADHD
solo - risperidone (tic control)
**help to remember - risperidone sounds like ‘on my own’ **
combo - clonidine
1st line management of Tourette’s
counselling
behavioural intervention
habit reversal
what is myoclonus?
sudden brief shock like involuntary movement caused by muscle contraction or inhibition
what conditions can myoclonus occur in?
Wilson’s disease
Huntington’s
Multiple system atrophy
Severe hypoxia
what is hemiballism?
the wild flinging/throwing movements of one arm or leg (lady from church !!)
how does hemiballism occur?
cerebrovascular lesion to the subthalamic nucleas
restless leg syndrome is associated with zinc deficiency - T/F?
F
IRON deficiency
it’s also related with uraemia, pregnancy, parkinsons
treatment of restless leg syndrome
dopamine agonists (pramipexole)
pathophysiology of progressive supranuclear palsy?
protein called tau which is naturally occurring in brain
in PSP it isn’t broken down properly so high levels in the brain are harmful
