Movement Disorders - Cohen Flashcards
parkinsons disease
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
tremor
regular oscillatory movement
usually always present
poor control agonist/antagonist muscles
worse with fatigue, stress, drugs, age
chorea
dance like movement
myoclonus
brief jerk
athetosis
writhing movement
snake/worms
dystonic movement
slow uncomfortable movement
pathologic tremor
disturb normal functioning
resting tremor
parkinsons
often asymmetric
first in hand
-to head, jaw, leg
can be only feature of parkinsons
parkinsons bradykinesia
slow movement
patient like statue when standing - no fidgeting when sitting
drool - hard to swallow
can overcome - under stress - kinesis paradoxica
kinesis paradoxica
in parkinsons bradykinesia
-pt can overcome it
dysequilibrium parkinson
hard to become steady
don’t swing arms well
dangerous sign and least responsive to meds
parkinsons rigidity
later sign
-cramps - shoulders
problem when medication wears off
other symptoms of PD
sleep disorder loss semll autonomic problem cramps, pain depression small handwriting loss of power of voice - monotonous and hurried
pathology of PD
lewy bodys - substantia nigra
loss of dopaminergic neurons
loss of cells in BS, thalamus, cerebarl hemisphers, and basal ganglia
lewy bodies
alpha synuclein
eosinophilic structures in cytoplasm of neurons - especially in substantia nigra
genetics of PD
rare in twins
genes - PARK 1-11
markin protein
epidemiology of PD
age of incidence 55-59yo
older - rapid deterioration
majority men
tx of PD
best tx - L-dopa
dopamine does not cross BBB - but L-dopa does
dopamine synthesis
from tyrosine
rate limiting - tyrosine hydroxylase
carbidopa
inhibit metabolism of L - dopamine in blood
-more L-dopa to brain
sinemet
levodopa/carbidopa
tx - can wear off after 5-10 years
can have dyskinesia - too much movement
also possible psychosis
other dopaminergic drugs
bind DA receptors - especially D2
less wearing off effect
not as effective as sinemet
psychosis may occur
psych problems in PD
dementia - later in disease
depression common
psychosis - troubling, violent/aggression
50% PD patient
die within 15 years