Movement Disorders + Parkinson Flashcards

1
Q

Dyskinesia vs Bradykinesia vs Akinesia

A
  • Dyskinesia = abnormal, uncontrolled, involuntary movement.
  • Bradykinesia = slowness of movement.
  • Akinesia = absence of movement
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2
Q

Tremor

A
  • 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
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3
Q

What are the types of tremor?

A
  • 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
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4
Q

What is dystonia?

A
  • 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)
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5
Q

What is chorea?

A
  • Involuntary dance like movements
  • can occur with athetosis, which adds twisting and writhing movements.
  • Huntington’s
  • Sydenham’s chorea (complication of rheumatic fever)
  • pregnancy (chorea gravidarum)
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6
Q

What is myoclonus?

A
  • 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.
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7
Q

Ballistic movements (hemiballismus)

A
  • Involuntary large amplitude proximal limb movements

- causes: stroke (basal ganglia), traumatic brain injury, ALS, neoplasm etc.

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8
Q

Motor tics

A
  • 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)
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9
Q

Parkinson’s - definition

A
  • 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
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10
Q

Genes in Parkinson’s

A
  • SNCA (alpha-synuclein)
  • Parkin
  • PINK-1
  • DJ-1
  • LRRK2
  • GBA (glucocerebrosidase)
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11
Q

Parkinson’s - risk factors

A

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)

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12
Q

Parkinson’s - clinical features

A

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
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

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13
Q

Parkinson’s - investigations

A
  • Clinical Dx

- dopaminergic agent trial can confirm Dx (positive response to L-dopa or other dopaminergic agent)

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14
Q

Parkinson’s - management

A
  • MDT approach: physio, OT, speech therapy
  • if symptoms affect daily life = levodopa
  • adjuvant = dopamine agonist (ropinirole) or MAO-B inhibitor (rasagiline), or COMT inhibitor
  • alternative: amantidine
  • physical activity (improves functional performance on motor tasks)
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