Movement Disorders + Parkinson Flashcards
Dyskinesia vs Bradykinesia vs Akinesia
- Dyskinesia = abnormal, uncontrolled, involuntary movement.
- Bradykinesia = slowness of movement. Difficulty initiating movement.
- Akinesia = absence of movement
Tremor
- Involuntary periodic oscillation of a body part
- Continuous and rhythmical
- Differentials: Parkinson’s disease, Lewy body dementia, physiological tremor, Hypoglycaemia, Thyrotoxicosis, Alcohol withdrawal, Drug-induced tremor (e.g. beta agonists)
What are the types of tremor?
- resting = present in a body part that is supported and relaxed eg parkinsonian
- postural = appears when a body part is maintained in a posture eg essential (benign tremor)
- intention = occurs during a movement which is goal directed eg cerebellar
What is dystonia?
- abnormal contraction of a body part due to sustained contraction of agonist and antagonist muscles
- 1ary or 2ary (stroke, brain injury, encephalitis and Parkinson’s disease)
What is chorea?
- Involuntary dance like movements
- can occur with athetosis, which adds twisting and writhing movements. (a/w CP)
- Huntington’s
- Sydenham’s chorea (complication of rheumatic fever)
- pregnancy (chorea gravidarum)
What is myoclonus?
- Involuntary quick jerk like movement
- benign or 2ary: infection, hyperosmolar hyperglycemic state, head or spinal cord injury, stroke, stress, brain tumors, kidney or liver failure etc.
Ballistic movements (hemiballismus)
- Involuntary large amplitude proximal limb movements
- causes: stroke (basal ganglia), traumatic brain injury, ALS, neoplasm etc.
Motor tics
- semi-voluntary semi-purposeful movements,
can be suppressed for a short while - chronic motor tic disorder (either motor or vocal)
- tourette syndrome (both motor and vocal)
Parkinson’s - definition
- Chronic progressive neurological disorder characterised by motor symptoms of resting tremor, rigidity, bradykinesia, and postural instability.
- Insidious, often asymmetrical onset.
- Associated with numerous, often disabling non-motor symptoms
Genes in Parkinson’s
- SNCA (alpha-synuclein)
- Parkin
- PINK-1
- DJ-1
- LRRK2
- GBA (glucocerebrosidase)
Parkinson’s - risk factors
increasing age
history of familial PD in younger-onset disease
mutation in GBA gene
1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) exposure (lab neurotoxin)
Parkinson’s - clinical features
bradykinesia = Slowness of movements, delay in initiating movements, and freezing of gait, fixed facial expression, slow soft speech, reduced blinking
resting tremor = asymmetrical onset. Chin tremor may occur. May reoccur when arms are outstretched and is abolished by action
rigidity: leadpipe (resist throughout whole range of movement, no fluctuations) or cogwheel (stiff + tremor)
postural instability = Imbalance or falling, retropulsion, stoop and gait shuffling, reduced arm swing
non-motor: pain, depression, constipation, dementia, sleep disorder, hallucinations
Parkinson’s - investigations
- Clinical Dx
- dopaminergic agent trial can confirm Dx (positive response to L-dopa or other dopaminergic agent)
- if uncertain can do DaT scan: identifies the dopamine transporter (asymmetrical in Parkinson)
Parkinson’s - management
- MDT approach: physio, OT, speech therapy
- if symptoms affect daily life = levodopa (co-prescribed with carbidopa)
- adjuvant = dopamine agonist (ropinirole) or MAO-B inhibitor (rasagiline), or COMT inhibitor
- alternative: amantidine
- physical activity (improves functional performance on motor tasks)
What 2 medications can be given for benign essential tremor?
- propanolol
- primidone (anticonvulsant of the barbiturate class)
