Movement Disorders - Cohen Flashcards

1
Q

parkinsons disease

A

4 main features

1 - resting tremor
2 - bradykinesia - slow movement - initiating movement
3 - dysequilibrium - instability of gait and posture
4 - rigidity - later in illness

diagnosis - should have at least 3 of 4

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2
Q

tremor

A

regular oscillatory movement

usually always present

poor control agonist/antagonist muscles

worse with fatigue, stress, drugs, age

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3
Q

chorea

A

dance like movement

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4
Q

myoclonus

A

brief jerk

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5
Q

athetosis

A

writhing movement

snake/worms

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6
Q

dystonic movement

A

slow uncomfortable movement

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7
Q

pathologic tremor

A

disturb normal functioning

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8
Q

resting tremor

A

parkinsons

often asymmetric

first in hand
-to head, jaw, leg

can be only feature of parkinsons

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9
Q

parkinsons bradykinesia

A

slow movement

patient like statue when standing - no fidgeting when sitting

drool - hard to swallow

can overcome - under stress - kinesis paradoxica

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10
Q

kinesis paradoxica

A

in parkinsons bradykinesia

-pt can overcome it

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11
Q

dysequilibrium parkinson

A

hard to become steady

don’t swing arms well

dangerous sign and least responsive to meds

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12
Q

parkinsons rigidity

A

later sign
-cramps - shoulders

problem when medication wears off

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13
Q

other symptoms of PD

A
sleep disorder
loss semll
autonomic problem
cramps, pain
depression
small handwriting
loss of power of voice - monotonous and hurried
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14
Q

pathology of PD

A

lewy bodys - substantia nigra

loss of dopaminergic neurons

loss of cells in BS, thalamus, cerebarl hemisphers, and basal ganglia

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15
Q

lewy bodies

A

alpha synuclein

eosinophilic structures in cytoplasm of neurons - especially in substantia nigra

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16
Q

genetics of PD

A

rare in twins

genes - PARK 1-11

markin protein

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17
Q

epidemiology of PD

A

age of incidence 55-59yo

older - rapid deterioration

majority men

18
Q

tx of PD

A

best tx - L-dopa

dopamine does not cross BBB - but L-dopa does

19
Q

dopamine synthesis

A

from tyrosine

rate limiting - tyrosine hydroxylase

20
Q

carbidopa

A

inhibit metabolism of L - dopamine in blood

-more L-dopa to brain

21
Q

sinemet

A

levodopa/carbidopa

tx - can wear off after 5-10 years

can have dyskinesia - too much movement
also possible psychosis

22
Q

other dopaminergic drugs

A

bind DA receptors - especially D2

less wearing off effect

not as effective as sinemet

psychosis may occur

23
Q

psych problems in PD

A

dementia - later in disease

depression common

psychosis - troubling, violent/aggression

24
Q

50% PD patient

A

die within 15 years

25
surgery for PD
deep brain stimulation - very effective - advanced PD disease also - small strokes in lower basal ganglia - thalamus or subthalamic nucleus
26
drug induced parkinsons
with drugs that block dopamine nausea drugs - phenothiazines and butyrophenones
27
progressive supranuclear palsy
PSP - severe dysequilibrium - falls early - as is choking NO tremors puzzled look on face progressive loss of extraocular movements -cannot move eyes often die - aspiration pneumonia
28
PSP treatment
levodopa works for some | but no known tx
29
essential tremor
4-8 Hz symmetric - arms, head, voice, legs action tremor or familial "Is there when I do things."
30
DDx for essential tremor
hyperthyroid antidepressant drugs cerebellar disease parkinsonian features
31
tx of essential tremor
weight arms and wrists alcohol helps meds - propranolol and primidone
32
tics
mostly disease of kids -quick random simple movements usually head may fade with time never serious pathology
33
tourettes syndrome
motor and vocal tics -start before age 21 minority use obscenities does not fade away with adolescence many also have OCD and depression
34
pathology of tourette
unknown possible dopamine derangement
35
Tx of tourette
haloperidol or other D2 blockers
36
chorea
dance like disorder irregular and variable movement no clear pattern
37
st vitus dance
untreated group A strep infection -syndeham chorea delayed autoAbs for that affect brain
38
huntington disease
inherited disease - auto dom typically begin 40-50yo trinucleotide repeat chromosome 4 -CAG movement disorder - chorea, tremor, jerk cognitive loss - dementia psychiatric - agitation, depression, psychosis often suicidal
39
Tx of huntington
dopamine blockers new drug - tetrabenazine
40
diagnosis of HD
fam hx symptoms in middle age genetic testing available - huntingtin protein
41
restless leg syndrome
cannot stop moving sleep disorder as well bad when get into bed
42
pathology of RLS
reduction of brain iron reduced dopamine activity in BS and basal ganglia tx - dietary iron tyrosine hydroxylase - iron cofactor L-dopa helps best tx - dopamine agonists - pramipexole