Movement Disorders, Peripheral Neuropathy and Bells Palsy

Question 1

Name some movement disorders:

Answer 1

Parkinsons disease

Essential tremour

Question 2

What is Parkinsons disease?

Answer 2

Parkinsons - degeneration of dopaminergic neurones in the basal ganglia

• increasing incidence with age

Question 3

List the clinical features of parkinsons disease:

Answer 3

Bradykinesia: slowness of movement, slow initiation, reduced range of movement

Rigidity: increased muscle tone

Tremour: low frequency

• mask like face - less facial expression
• shuffling gait and risk of falls
• difficulty with fine motor tasks
• swallowing problems
• may have autonomic dysfunction
• cognitive impairment

Question 4

How is Parkinsons disease treated?

Answer 4

Medical - specialist

• dopaminergic drugs: levedopa, dopamine receptor agonists

Rehabilitation/supporive care

• physiotherapy/occupational therapy
• specialist nurse

Surgical - deep brain stimulation

Question 5

What is an essential tremour?

Answer 5

High frequency tremour:

• often hereditary
• may be unilateral
• worse with action (opposite to PD)
• annoying/embarrassing rather than disabling
• improves with alcohol and beta-blockers

Question 6

What is peripheral neuropathy?

What are the types?

Answer 6

Peripheral neuropathy - loss of peripheral nerve function

• generalised: glove and stocking, mltiple causes i.e. diabetes, drug side effects (post chemo)
• specific nerves/nerve roots: often pressure effect - trauma, tumour etc

Question 7

List some symptoms of peripheral neuropathy in sensory nerves:

Motor nerves:

Autonomic nerves:

Answer 7

Sensory nerves:

• sensory loss or paraesthesia
• sometimes neuropathic pain
• loss of proprioception

Motor nerves:

• muscle weakness, especially hands and feet

Autonomic nerves:

• bowel/bladder dysfunction
• BP control

Question 8

Name a specific type of peripheral neuropathy and which nerve is affected?

How is it currently treated?

Answer 8

Bell’s Palsy

• lower motor neurone palsy of the facial nerve
• thought to be viral
• oral steroids within 72 hours to improve outcome
• eye care - drops and tape closed at night to prevent corneal damage

Question 9

How can you tell the difference between bells palsy and a stroke?

What is the outlook for Bells Palsy?

Answer 9

In bells palsy, the full side of the face will droop, including frontalis muscle, lower lip droops

In stroke - preserved brow and forehead due to dual supply to facial muscles

Most people recover from Bells Palsy within 9 months