Movement Disorders & Parkinsons Flashcards
Name the parts of the brain involved in voluntary movement
- pyramidal tracts
- basal ganglia
- cerebellum
What is the word used to describe too little movement?
Hypokinetic
What is the word used to describe too much movement?
Hyperkinetic
State three important factors to include in a history of suspected movement disorder
Birth
Family History
Drug and toxin history
What does the pneumonic TRAP stand for?
Tremor
Rigidity
Akinesia/bradykinesia
Postural disturbances
Describe rigidity
Increased muscle tone that is felt on passive movement, resistance is felt throughout full range of movement
What is the difference between rigidity and spasticity?
No increase with higher mobilising speed, which distinguishes rigidity from spasticity owing to UMN lesions
What is the name for the combination of rigidity and tremor?
Cog wheel felt at the wrist
What maneuver can be used to test for rigidity?
Froment’s - rigidity increases in examined body segment by voluntary movement of other body parts
What is akinesia?
Loss of movement
What is bradykinesia?
Slowed movement
State the features of hyperkinetic disorders
Tremor Dystonia Chorea Ballism Myoclonus Tics
Define camptoconia
Extreme anterior truncal flexion
Define festination
Lots of small steps, change of centre of gravity
What is the test for postural instability?
Pull test
What is a tremor?
Rhythmic sinusoidal oscillation of a body part
Name four types of tremor
- rest
- postural (when arms outstretched)
- kinetic
- cerebellar (when you approach a target)
Describe dystonia
Sustained, intermittent muscle contractions causing abnormal repetitive movements, postures or both
What makes a dystonia worse?
Voluntary action
Describe chorea
Irregular purposeless movement that flit and flaws from one body part to another - restless and fidgety
What causes chorea?
Basal ganglia lesions APLS Huntington's Neuroacanthocytosis Oral contraception
Name a variant of chorea
Ballism - involves proximal joints resulting in large amplitude flinging movements with a hemi-body distribution
What causes ballism?
Contralateral lesion invloving striatum or subthalamic nucleus
Describe myoclonus
Brief electric shock like jerks, hiccups and hypnic jerks
Give an example of negative myoclonus
Asterixis in liver flap
What are tics?
Un-voluntary repetitive stereotyped movements or vocalisations - suppressible by the patient for a short period of time
Describe motor and vocal tics
Motor - eye blinking, jerks, complex sequence
Vocal - sniffing, grunting, snorting, phrases
What disease often has a onset of persistent multiple motor and vocal tics?
Gilles de la Tourette Syndrome
Describe the most common type of tremor
Essential tremor - seen when hands are outstretched, runs in families autosomal dominant slow progression made worse by alcohol
What can cause a tremor?
- Wilson’s disease
- Physiological tremor
- Hepatic encephalopathy
- Titubation (oscillation of the head in anteroposterior/verticle position)
What are the non-motor clinical features of Parkinson’s disease?
Sleep disorders Hallucinations GI dysfunction Depression Cognitive impairment Anosmia
What causes parkinsons disease?
Loss of dopaminergic neurons from the pars compacta region of substantia nigra
What percentage of neurons need to be lost to give parkinsons symptoms?
60%
What staging can be used in Parkinson’s?
Braak - early non-motor symptoms, areas subsequently affected as disease progresses through motor and non-motor phases
State the three sub-types of parkinson’s disease
- tremor dominant (relative absence of other motor symptoms)
- non-tremor dominant (akinetic rigid syndrome, postural instability)
- mixed
Which subtype has the slower progression rate?
Tremor dominant
What are the stages of Parkinson’s disease?
Prodromal phase
Early Stage
Unstable
Advanced and palliative
Describe the prodromal phase of Parkinson’s
Up to 20 years, constipation, psychiatric problems, hyposomia, EDS, RBS
How is Parkinson’s diagnosed?
- Bradykinesia and one or more - resting tremor, rigidity, postural instability
- Presence of parkinsonism with no alternative diagnosis and dopamine responsiveness
What form of imaging can be useful in Parkinson’s?
DatSCAN - radioiodine solution will result in a period shaped
State the factors that increase your risk of Parkinson’s
Pesticides, head injury, rural living, beta blockers, agriculture, well water drinking
State the factors that decrease your risk of Parkinson’s
Tobacco, coffee, NSAIDs, CCB, Alcohol
What are motor flucutations?
Alterations between periods of good motor symptom control and reduced control
What are non-motor flucutations?
Alterations between periods of good and bad non-motor symptoms control
What is dyskinesisa?
Involuntary choreiform or dystonic movements which occur most frequently when levodopa concentrations are at their maximum
Describe the pathophysiology of Parkinson’s
- Lewy body formation in the cells that remain due to accumulation of aggregations
- Reactive gliosis, immune pathways can move in blood to outside of the brain
What drugs are used in the treatment of Parkinson’s?
Levodopa + beserazide = madopar Dopamine agonist - ropinirole MAO-B inhibitors - selegiline COM inhibitors - entacapone Muscarinic ACh receptor antagonist
What drug treats the tremor?
Anticholinergic agents
What drug has the greatest symptomatic benefit?
Levodopa
Name the surgical treatment available for Parkinsons
Deep brain stimulation - targets the subthalamic nucleus and globus pallidus
