Movement disorders Flashcards
Hypokinetic movement disorders
Bradykinesia; PD
Hyperkinetic disorder
Dyskinesia; tremor tics chorea myoclonus dystonia
What is a tremor?
Rhythmic sinusoidal oscillation of a body part
What are the different classifications of a tremor?
Rest; occurs when body at rest (5Hz)
Postural; occurs when the arms are outstretched
Kinetic; occurs during movement of a body part
What is an essential tremor?
Seen in hands at 5Hz when hold arms outstretched Continues through moto execution Familial Slow progression Ameliorated by alcohol intake Asymmetric
Describe a physiological tremor
Symmetrical
Fast
Small amplitude
Describe a wilson’s disease tremor
Early stage postural
Wing beating
Describe a hepatic encephalopathy tremor
Asterixis
Repetitive drops of extended hands
What is chorea?
Brief irregular purposeless movement that flit and flow from one body part to another
Constantly restless or fidgety
Often generalised but can be focal
What can cause chorea?
Drugs/ OCP Basal ganglia lesions Sydenham's chorea Antiphospholipid syndrome HD Neurocanathocytosis
What is myoclonus?
Brief electric shock like jerks
Hiccups o hypnic jerks are common and normal forms of myoclonus
Arises from cortex, subcortical structures, spinal cord or nerve root and plexus
What is a tic?
Unvoluntary repetitive, stereotyped movements of vocalizations
They can be suppressed but there will be a growing feeling of anxiety and discomfort during tic suppression and when allowed to relax there will be a flurry of tics
What is a motor tic?
Eye blinking
Head jerks
Arm/leg jerks
Complex sequence
What is a vocal tic?
Sniffing
Grunting
Snorting
What is gilles de la tourette syndrome?
Typically onset of persistent multiple motor and vocal tics, often with assoc psych disturbance (ADHA, OCD, copropraxia, coprolalia)
What is dystonia?
Movement disorder characterized by sustained or intermittent muscle contractions causing abnormal often repetitive movements or posture
Tend to be patterned, twisting and may be tremulous
Often initiated o worsened by voluntary action and assoc with overflow muscle activation
Motor sy of PD
Tremor
Bradykinesia
Rigidity
Postural and gait impairement
Non motor sy of PD
Depression Dementia Constipation Anosmia Parasomnias
What tremor is assoc with PD?
Pill rolling
3-6 Hz
Tx for dementia in PD?
Acetylcholinesterase inhibitor; rivastigmine
Tx for depression in PD?
Dopamine agonist
SSRI
Tricyclic
Tx for REM sleep behavior disorder in PS?
Benz; clonazepam
Hormone; melatonin
Tx for constipation in PD?
Osmotic laxative
Tx for GI motility in PD?
Domperidone
Tx for orthostatic hypotension in PD?
Domperidone
Fludrocortisone
Tx for sialorrhoea in PD?
Atronic drops
Glycopyrrolate
Botulism
Tx for fatigue in PD?
Modanifil
What encomapsses bradykinesia?
Slowness of movement with progressive loss of amplitude or speed during rapid alternating movements
Hypomimia
Hypophonia
Micrographia
Which rigidity is felt in PD?
Cog wheel
Lead pipe
Positive froment’s maneouvre
How is posture and gait affected in PD?
Stooped Impaired postural reflexes Gait; slow, shuffling Decreased arm swing Slow turning Freezing Festination Pull test
Red flags in PD?
Absence of asymmetry Severe axial or lower limb Frequent falls Fast disease progression Eye movement; supranuclear palsy, dysmetric or slow saccades Tics, myoclonus or choea Pyramidal or cerebellar dysfunction Bulbar or pseudobulbar features Parietal assoc sensory disturbances Apraxia
What is vascular parkinsonism?
Affects lower limbs
Rest tremor uncommon
Other neurological signs; spasticity, hemiparesis, pseudobulbar palsy
Poor levodopa response
What is drug induces parkinsonism?
Symmetrical
Coarse postural tremor
Emergence of symptoms after drug exposure, and subsequent improvement after drug withdrawal
What is the triad of symptoms in multi system atrophy?
Dysautonomia
Cerebellar features
Parkinsonism
What is progressive supranuclear palsy?
Symmetric akinetic rigid syndrome with predominantly axial involvement Gait and balance impairment Vertical gaze supranuclear palsy Pseudobulbar symptoms Retrocollis Continuous frontalis action NO response to levodopa
How is psychosis in PD managed?
Clozapine; beware of idiosyncratic adverse drug reactions and agranulocytosis
