Movement Disorders - Balaguera Flashcards
what is the basal ganglia?
collection of nuclear masses (clustered of neurons) w/in the cerebral hemisphere
what are the 3 functions of the basal ganglia?
(1) help to control movement
(2) help to regulate emotion
(3) help to regulate cognitive skills
movement d/o’s come the malfunction of the….
basal ganglia
what are the 2 pathways that the basal ganglia controls movement by?
direct and indirect pathways
how does the basal ganglia control movement by the direct pathway?
increases muscle movement by decreased inhibition of the thalamus
how does the basal ganglia control movement by the indirect pathway?
decreases muscle movement via signaling from the thalamus
3 main parts of the basal ganglia?
caudate, nucleus accumbent, striatum
if pathology of the caudate part of the basal ganglia, what occurs?
OCD
if pathology of the nucleus accumbens part of the basal ganglia, what occurs?
depression
what part of the basal ganglia regulate memory of skills and habits like driving a car?
the striatum
if damage to the striatum of the basal ganglia, what occurs? what does this lead to?
people lose the ability for the skills they had in the past
leads to dementia, depression, agitation (40% of pts with PD have dementia)
what is Parkinsonism?
generic terms use to define syndrome that manifests as:
(1) rigidity
(2) resting tremor
(3) bradykinesia
(4) postural inhibition
what is primary Parkinsonism?
parkinson’s disease
what is secondary Parkinsonism?
vascular or drug-induced
Parkinsonism is hypokinetic or hyperkinetic movement?
hypokinetic (very slow)
Huntington’s disease is hypokinetic or hyperkinetic movement?
hyperkinetic (very fast)
what are hyperkinetic movements?
tremor, dystonia, chorea, cerebellar ataxia, myoclonus
what is a tremor?
rhythmic oscillation of a body part
what is dystonia?
sustained contraction of agonist and antagonist muscles
opposition tremor, have jerk movement, not oscillatory or rhythmic
what is chorea? what disease is it seen in?
brief, irregular, EXPLOSIVE non-rhythmical movements
seen in Huntington’s
what is cerebellar ataxia?
impaired initiation and coordination of movements
mainly walking (extremities and gait), also speech
what is myoclonus?
lightning-like jerking movements, fast but not as elaborated or explosive as HD
what are the motor sx’s of PD? what parts of body are most frequently affected?
resting tremors
hands, fingers, forearms and feet most frequently affected
what are the nonmotor sx’s of PD?
hyposmia, speech and voice d/o’s
***dysautonomia, dementia, depression/psychosis
what is dysautonomia?
when HR doesn’t change when the BP changes
seen in PD
HTN laying down and dropping BP so much when standing up that pt passes out (orthostatic hypotension)
what do you NOT treat dysautonomia with?
anti-HTN meds
what is the cardinal motor feature of PD?
bradykinesia
pts with PD must have at least one of the following…
4-6 Hz resting tremor, muscular rigidity, postural instability (late presentation)
in PD there must be absence of a ___
secondary cause
pts with PD must have at least 3 supportive criteria…
- Unilateral onset, progressive, resting tremor w/ persistent asymmetry
- Excellent response to levodopa
- Severe levodopa induced chorea
- Levodopa response for >5 yrs
- Clinical course of >10 yrs
what is the most effective tx for PD?
levodopa + dopa decarboxylase inhibitor
what tx for PD is effective in improving motor fxn and tx of depression?
subthalamic deep-brain stimulation
PD is a loss of?
DA neurons
what is vascular secondary Parkinsonism?
Microvascular changes and small infarcts from atherosclerosis may disrupt the basal ganglia → parkinsonian s/s w/o degeneration of DA neurons
vascular secondary Parkinsonism pts present early with what sx’s?
gait problems or marked postural tremor
what are the vascular Parkinsonism RF’s?
typical vascular RF’s
-HTN, DM, hyperlipidemia, smoking, older age
what is the tx for vascular Parkinsonism?
PT
what is the MAIN drug that causes drug induced Parkinsonism? others?
Haloperidol
others: Thioridazine, Perphenazine, Antiemetics
what sx’s does drug induced Parkinsonism typically produce vs PD?
BILATERAL EQUAL BRADYKINESIA (PD starts unilateral)
is drug induced Parkinsonism reversible or irreversible?
irreversible
how can you tell vascular secondary Parkinsonism from primary PD?
because PD responds to Leva-Dopa whereas vascular dz doesn’t
what is Huntington’s?
Hereditary d/o of the basal ganglia caused by a mutation in one gene in chromosome 4
presentation of HD?
Progressive motor incoordination, abnormal movements, and intellectual decline
***CHOREA - powerful, forceful movements (can get rhabdo)
HD is associated with what disorders? high rates of what with HD?
dementia, depression, OCD
HIGH RATES OF SUICIDES
what is the ONLY FDA approved drug for HD and what is it’s indication and MOA?
Tetrabenazine
Indication: control chorea
MOA: monoamine depleting agent
what can you use in HD to control chorea and behavioral comorbidities?
antidepressants
what other drugs may be used to decrease chorea?
amantadine and nabilone
what are some complications of HD?
dementia
ARF 2/2 rhabdomyolysis - use IVF and early dx to treat
Aspiration PNA
what is the M/C movement d/o?
essential tremor
what is the mean age of onset of essential tremor?
45 y/o
how does the essential tremor usually start?
bilaterally from hands or forearms
essential tremor can be what?
postural (occurring w/outstretched arms) or kinetic (occurring w/initiating movement)
during what actions does essential tremor occur?
- Finger to nose mvmt
- Pouring and drinking water from a cup
- Writing
- Drawing archimedean spirals
what’s the KEY DIFFERENCE b/w essential tremor and tremor in PD?
PD tremor is resting
essential tremor occurs with action
can essential tremor cause cognitive impairments?
NO!!!
is essential tremor related to alcoholism?
NO!!!
what is NOT seen in essential tremor, but is seen in PD?
NO GAIT abnormalities, NO SPEECH abnl (dysarthria), NOT a/w DEPRESSION
what’s the core criteria to dx essential tremor?
- Postural or kinetic tremor of the hands and forearms or at least 1 hand
- Head tremor w/ no signs of dystonia
- Absence of other etiologic factors and neuro signs → meds, ETOH, parkinsonism, dystonia, hyperthyroidism
what’s the additional dx criteria for essential tremor?
- bilateral
- duration >1 year
- severity (interferes w/ ADLs like writing, vocalization)
what is the recommended initial tx for essential tremor?
Propranolol or primidone (alone or in combo)
if essential tremor is refractory, then what’s the tx?
deep brain stimulation of the thalamus and unilateral thalamotomy
