Movement Disorders (Exam #4) Flashcards
What type of movement is state of restlessness, “can’t sit still”?
Akathisia
What type of movement is inability to coordinate movements of trunk/limbs?
Ataxia
What type of movement is involuntary writhing limb movements?
Athetosis
What type of movement is flailing, involuntary limb movements?
Ballism (ballistic movements)
- Ex. https://www.youtube.com/watch?v=ci6Rp4Sv9ao
What type of movement is quick, involuntary, dance-like movements?
Chorea
What type of movement is involuntary movements, chorea-like or tic-like?
Dyskinesia
What type of movement is abnormal muscle tone with sustained posture?
Dystonia
What type of movement is involuntary, spasmodic, jerky movements?
Myoclonus
What type of movement is habitual, semi-voluntary, spasmodic, quick, brief movements?
Tics
What type of movement is involuntary, rhythmic, repetitive movement?
Tremor
What is the general progression of Idiopathic Parkinson’s Disease (IPD) (hint: 2 steps)?
- Sxs-free honeymoon for ~3 years
2. Motor comp. after 5-7 years
What are the four cardinal features of Idiopathic Parkinson’s Disease (IPD)?
- Rest tremor
- Rigidity
- Akinesia-Bradykinesia
- Postural Instability (late)
What condition presents with resting tremor, rigidity, akinesia/bradykinesia, postural instability?
Idiopathic Parkinson’s Disease (IPD)
What condition involves apraxia of gait (“feet glued to floor”), cognitive impairment, urinary incontinence, rigidity?
Normal Pressure Hydrocephalus (NPH)
What condition involves symmetric sxs, mild akathisia; NO resting tremor?
Drug-Induced Parkinsonism
What condition involves gait disturbance; UMN sxs (spasticity, hyperreflexia)?
Vascular Disease
What condition involves cognitive disorder; limb apraxia, unilateral limb rigidity?
Corticobasal Degeneration (CBS)
What condition involves supranuclear gaze palsy, early falls, poor L-Dopa response?
Progressive Supranuclear Palsy (PSP)
What condition involves prominent autonomic sxs early, poor L-Dopa response, stridor, NO resting tremor?
Multi-System Atrophy (MSA)
What condition involves hallucinations, cognitive disorder, fewer autonomic sxs
Dementia with Lewy Bodies (DLB)
What is the general dx test used for PD?
MRI of brain
What condition presents with “hot cross bun” sign on MRI?
Multi-System Atrophy (MSA)
What condition presents with “hummingbird” sign on MRI?
Progressive Supranuclear Palsy (PSP)
What condition presents with enlarged ventricles on MRI?
Normal Pressure Hydrocephalus (NPH)
What condition should always be ruled out in any patient <50 years with movement disorder?
R/O Wilson’s Disease
In addition to MRI, what other test should be ordered in a patient with cognitive sxs?
Neuropsychometric testing
In addition to MRI, what other test should be ordered in a patient with tremor?
Thyroid studies
In addition to MRI, what other test should be ordered in a patient with suspected PD?
Vitamin D levels
In addition to MRI, what other test should be ordered in a patient with dysphagia?
Swallow study
In addition to MRI, what other test should be ordered in a patient with voice change?
SLP eval
In addition to MRI, what other test should be ordered in a patient with MIXED tremor?
SPECT/DaTSCAN
What medication is prescribed for tx of ALL PD patients?
Carbidopa/Levodopa (Sinemet)
What is a long-term AE of Carbidopa/Levodopa (Sinemet)?
Motor fluctuations
What class of medications might be considered in a PD patient that is <70 years?
DA Agonists
- Pramipexole
- Ropinirole
- Rotigotine
If surgery is warranted for the tx of PD, what surgery is typically considered?
Under what two conditions would this be considered?
Deep Brain Stimulation (DBS)
- Severe disability
- Motor fluctuations (NO cognitive)
What two body parts are often affected by an Essential Tremor (ET)?
- UEs
- Head/chin
What improves an Essential Tremor (ET)? What exacerbates it?
- Improves with EtOH
- Worse with caffeine
What are the three possible med tx for Essential Tremor (ET)?
- Propranolol
- Primidone
- Gabapentin
What condition involves abnormal sensations with urge to move legs at rest? What time of day are sxs often worst?
Restless Leg Syndrome (RLS)
- Sxs worse at night
What class of medications are used to tx Restless Leg Syndrome (RLS)? What other med tx may be considered?
DA Agonists
- Also, Fe replacement
What condition involves the sxs TRIAD of motor, cognitive and psychiatric? What are three examples of motor dysfunction?
Huntington’s Disease (HD)
- Motor = chorea, dystonia, bradykinesia
What is the TRIAD associated with Huntington’s Disease (HD)?
- Motor dysfunction
- Cognitive dysfunction
- Psych dysfunction
What are the three classes of drugs used to tx Huntington’s Disease (HD)?
- Anti-DA drugs
- Benzos
- Anti-depressants
What med is used to tx General Tics? What other two classes of drugs might be considered?
Clonidine
- Neuroleptics
- Benzos
How do you dx Tourette’s Syndrome (3)?
- 2+ motor tics AND - 1+ phonic tics for 1+ years AND - Onset before age 18 years
What are the two types of Primary Dystonia? Describe each.
- General
- Focal
What is the age onset and etiology of General Primary Dystonia?
- Childhood onset
- Idiopathic
What is the recommended tx for General Primary Dystonia?
BOTOX (@Megan @Paige)
What is the most common etiology of Hemifacial Spasm (HFS)?
CN VII compression
What condition involves involuntary, intermittent spasms of half of face?
What part of the face is often initially affected?
Hemifacial Spasm (HFS) - Periorbital muscles initially
How is Hemifacial Spasm (HFS) diagnosed (2)?
- Clinical
- MRI (check for compression of CN VII)
What is the recommended tx for Hemifacial Spasm (HFS)?
BOTOX (@Megan @Paige)
What group of conditions often involves tremor, dystonia and myoclonus?
Functional/Psychogenic Movement Disorders
What three sxs often present with Functional/Psychogenic Movement Disorders?
- Tremor
- Dystonia
- Myoclonus
What group of conditions often involves abrupt onset, bizarre movements, exaggerated efforts, suggestible/trainable, inconsistent?
Functional/Psychogenic Movement Disorders
What is the recommended tx for Functional/Psychogenic Movement Disorders?
Multidisciplinary approach
- Psychiatry, psychology (CBT), PT, OT, ST
