Movement Disorders Flashcards
describe an essential tremor?
postural or action tremor
(rather than resting tremor seen in parkinsons)
essential tremor is a trait gained throigh which pattern of inheritance?
autosomal dominant
what can imrpove essential tremor?
often improves after alcohol
can be helped by B blockers (propanolol)
lesions in the cerebellum or its pathways can cause which tremor?
intention tremor
other than intention tremor what other cerebellar pathway tremor is there?
Holmes (rubral) tremor
describe holmes tremor?
tripartite tremor incorporating tremor at rest, postural tremor and intention tremor
what common movement disorder is characterised by involuntary muscle spasms leading to abnormal postures of affected body part?
dystonia
what are the possible treatment for dystonia?
anticholinergics
botulinum toxin (used first line if focal dystonia)
surgery
describe chorea?
continuous spontaneous jerky movements, irregularly timed and randomly distributed
what pattern of inheritance is seen in Huntingtons?
autosomal dominant
mutation in which gene causes huntingtons?
HTT gene
the HTT mutation invloved which segment of DNA?
CAG segment
usually repeats 10-30 times, mutation result in 30 to >120 repeats
what are early signs of Huntingtons?
personality changes
depression
apathy
dysarthria
progression of huntigntons will lead to what?
chorea
rigidity
dementia
what neurotransmoitters are affected in Huntington’s?
decreased GABA
decreased ACh
increased dopamine
what drug can be of use in Huntongton’s?
tetrabenazine (anti-choreic)
works by inhibiting vesicular monoamine transporter (VMAT)- limits dopamine vesicle packing and release
what is Sydenhams chorea?
manifestation of rheumatic fever
occurs n children 5-15yrs old
what is seen in sydenhams chorea?
widespread chorea
behvaioural disturbance
OCD symtpoms
how is Sydenhams chorea treated?
self limiting and usually resolves within 6 months
describe tics
brief rapid intermittent stereotyped involuntary movements or sounds
(can be simple/complex)
what is seen in Gilles de la Tourette syndromewhat ?
multiple motor tics and one or more phonic/ vocal tics
what is the maximum age of onset of tourettes syndrome?
18 years
what is the most common first tic?
blinking
most tics usally begin in head and face
what are simple vocal tics and complex vocal tics?
simple: sniffing, throat clearing, snorting, coughing
complex: barking, animal noises, inappropriate voice intonations
what percentage of those with tourettes have a psychiatric co-morbidity?
90%
most common is ADHD followed by OCD
what is the preferred treatment if mild tourettes?
counselling
behavioural/ psychosocial interventions
habit reversal training
if medicaiton is to be used in tourettes what is considered best option for tic control?
risperidone
if tourettes with co-existing ADHD what is the treatment of choice?
clonidine (wiht or without risperidone)
what movement disorder if characterised by a sudden brief, shock-like movement caused by muscular contraction or inhibition?
myoclonus
myoclonus can be a symtpom of which neurodegenerative disease?
wilsons
huntingtons
multiple system atrophy
severe hypoxia (lance adams)
what is hemiballism?
wild flinging/throwing of one arm or leg
usually result of cerebrovascular lesion to subthalamic nucleus
restless leg syndrome is classically seen at what time?
night time
also occurs when tryign to relax when sitting or lying down during the day
what can instantly relieve restless leg syndrome?
getting up and wlakign about
iron deficiency, uraemia and pregnancy are assoc w what movement disorder?
restless leg syndrome
restless leg syndrome has a positive response to which drug?
dopamine agonists
(pramipexole)
