Movement disorders Flashcards by Rachel Gordon

The 3 key features of parkinsonism?

Akinesia
Tremor
Rigidity

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how do you get cogwheel rigidity in someone with parkinson’s?

the combo of tremor + rigidity = cogwheeling

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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

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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

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Treatment of Parkinson’s Disease

Levodopa

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S/E of levodopa

Hypotension
Nausea
Dyskinesia - rolling of tongue (like jack)

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What other types of drugs can be used to treat Parkinson’s?

Monoamine oxidase B inhibitors

Dopamine agonists

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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

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Why would you used dopamine agonists in younger patients (>70) instead of using levodopa?

Due to the high risk of dyskinesia

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What Parkinson’s drugs cause hypotension and what ones cause hypertension?

Levodopa + Dopamine agonists = HYPOtension

Monoamine oxidase B inhibitors = HYPERtension (when you eat cheese)

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What drugs may induce parkinsonism?

Typical anti-psychotics

Haloperidol
Chlorpromazine

Mood stabilizer
- Lithium

Anti-epileptics
- Valproic acid

Dopamine receptor antagonist
- Metoclopramide

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What drugs can aid in the symptomatic relief of drug induced parkinsonism?

Anticholinergics:
Benzotropine
Procyclidine

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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

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What are the 3 core features of Lewy Body dementia?

Progressive disabling cognitive impairment (dementia)
Recurrent VISUAL HALLUCINATIONS
Features of Parkinsonism

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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

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what is an MRI ‘hummingbird’ sign seen on the midbrain characteristic of?

progressive supranuclear palsy

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what are the symptoms of progressive supranuclear palsy?

Axial akinesia 
Rigidity 
Loss of balance 
Unexplained falls 
Forgetfulness
Dysarthria 
Loss of eye movements

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what form of imaging can be used to differentiate between vascular parkinsonism and other parkinsonism syndromes?

SPECT (single-photon emission computed tomography)

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how does vascular parkinsonism compare to that of other parkinsonism syndromes?

It progresses slower

Poor response to levodopa

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what is a MRI hot cross bun appearance at the pons characteristic of?

multiple system atrophy

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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

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How to treat essential tremor

Study These Flashcards

Alcohol

Beta-blockers

What are the 2 types of tremor you can get from cerebellar damage

Study These Flashcards

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

Study These Flashcards

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

Movement disorders Flashcards

(53 cards)