Movement Disorders - Hon Flashcards
2 types of movement disorders
Bradykinetic, Hyperkinetic
3 Cardinal signs of Parkinson’s
Resting tremor (fingers, mouth, or chin)
Rigidity to all movement
Bradykinesia (slow movement, difficulty initiating)
Parkinson’s vs. PSP
PSP = loss of voluntary vertical gaze
Parkinson’s vs. MSA
MSA = severe autonomic dysfunction
Parkonson’s vs. Cortical Basal Degeneration
CBD = cortical sensory loss, apraxia, myoclonus, aphasia
Do Parkinson-like diseases respond to anti-PD medications?
Not well
Anti-Parkinson treatments
Dopamine agonists (Bromocriptine) Levodopa (Sinemet) COMT inhibitors (COMTAN) MAO-B inhibitors (Selegiline) Anticholinergics (Benztropine, trihexylphenidyl) Amantadine (anti-viral) Surgery
Chorea
Brief, dance-like movements
Athetosis
Writhing, sinuous movements
Dystonina
Sustained muscle contractions that produce twisting and repetitive movements and abnormal postures
Ballism
Large-amplitude flinging movements (proximal extremity)
Tic
Brief, rapid, repetitive stereotyped actions of 1 or more muscle groups
Children/young people
Unilateral choreiform movements (like restlessness or fidgeting), behavioral changes, previous group A strep infection
Treatment?
Sydenham’s Chorea
Bedrest, antibiotics
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?
Idiopathic Torsion Dystonia
Levodopa, anticholingergics, benzo’s, baclofen, carbamazepine
Idiopathic Torsion dystonia, but seemingly confined to ONE area
Additional medication?
Focal torsion dystonia
BOTOX injection
Childhood or young adult
Tremor, Choreiform movements, Rigidity, Bradykinesia, Dysarthria, dysphagia, Ataxia, Dementia, Psychosis/hallucinations
IOW, bradykinesia PLUS hyperkinesia symptoms
Wilson’s disease
Copper metabolism deficit
Autosomal recessive, Chromosome 3
Diagnosis of Wilson’s disease
Increased copper in urine
Decreased serum cerruloplasmin
Kayser-Fleischer Ring on eye exam
Treatment for Wilson’s disease
Penicillamine, restriction to dietary copper
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?
Gilles De La Tourette’s Syndrome
Clonidine, Haldol, Phenothiazines
Both hands tremor (resting or intention)
Head and voice can be included too
Seen later in life
Alcoholic?
Treatment?
Benign Familial Tremor (Essential Tremor)
Beta blockers (propranolol), Primidone, Benzo’s
