Movement Disorders - Hon

Question 1

2 types of movement disorders

Answer 1

Bradykinetic, Hyperkinetic

Question 2

3 Cardinal signs of Parkinson’s

Answer 2

Resting tremor (fingers, mouth, or chin)
Rigidity to all movement
Bradykinesia (slow movement, difficulty initiating)

Question 3

Parkinson’s vs. PSP

Answer 3

PSP = loss of voluntary vertical gaze

Question 4

Parkinson’s vs. MSA

Answer 4

MSA = severe autonomic dysfunction

Question 5

Parkonson’s vs. Cortical Basal Degeneration

Answer 5

CBD = cortical sensory loss, apraxia, myoclonus, aphasia

Question 6

Do Parkinson-like diseases respond to anti-PD medications?

Answer 6

Not well

Question 7

Anti-Parkinson treatments

Answer 7

Dopamine agonists (Bromocriptine)
Levodopa (Sinemet)
COMT inhibitors (COMTAN)
MAO-B inhibitors (Selegiline)
Anticholinergics (Benztropine, trihexylphenidyl)
Amantadine (anti-viral)
Surgery

Question 8

Chorea

Answer 8

Brief, dance-like movements

Question 9

Athetosis

Answer 9

Writhing, sinuous movements

Question 10

Dystonina

Answer 10

Sustained muscle contractions that produce twisting and repetitive movements and abnormal postures

Question 11

Ballism

Answer 11

Large-amplitude flinging movements (proximal extremity)

Question 12

Tic

Answer 12

Brief, rapid, repetitive stereotyped actions of 1 or more muscle groups

Question 13

Children/young people
Unilateral choreiform movements (like restlessness or fidgeting), behavioral changes, previous group A strep infection

Treatment?

Answer 13

Sydenham’s Chorea

Bedrest, antibiotics

Question 14

Neck twisted to one side (torticollis)
Spontaneous involuntary forceful closure of eyelids
Spasms of mouth muscles
Arm and hand in "waiter's tip" position
Leg in extension, foot in inversion

Treatment?

Answer 14

Idiopathic Torsion Dystonia

Levodopa, anticholingergics, benzo’s, baclofen, carbamazepine

Question 15

Idiopathic Torsion dystonia, but seemingly confined to ONE area

Additional medication?

Answer 15

Focal torsion dystonia

BOTOX injection

Question 16

Childhood or young adult
Tremor, Choreiform movements, Rigidity, Bradykinesia, Dysarthria, dysphagia, Ataxia, Dementia, Psychosis/hallucinations

IOW, bradykinesia PLUS hyperkinesia symptoms

Answer 16

Wilson’s disease

Copper metabolism deficit

Autosomal recessive, Chromosome 3

Question 17

Diagnosis of Wilson’s disease

Answer 17

Increased copper in urine
Decreased serum cerruloplasmin
Kayser-Fleischer Ring on eye exam

Question 18

Treatment for Wilson’s disease

Answer 18

Penicillamine, restriction to dietary copper

Question 19

Chronic multiple motor (face, throat) and vocal (bark, hiss, grunt) tics
Imitation of other people’s movements or speech
Repitition of words or phrases
Child or teenager - MALE

Treatment?

Answer 19

Gilles De La Tourette’s Syndrome

Clonidine, Haldol, Phenothiazines

Question 20

Both hands tremor (resting or intention)
Head and voice can be included too
Seen later in life
Alcoholic?

Treatment?

Answer 20

Benign Familial Tremor (Essential Tremor)

Beta blockers (propranolol), Primidone, Benzo’s