Neurology: Movement Disorders Flashcards
When do most movement disorders disappear during the course of the disease?
During sleep
What is dystonia?
Sustained muscle contraction, rapid or repetitive, focal or generalized.
Where does Idiopathic Torsion Dystonia present with symptoms initially?
Begins with inversion of the foot.
Eventually the whole body is involved and results in distortion of the body.
What is the mental status of patients with Idiopathic Torsion Dystonia?
Normal mental status
How is Idiopathic Torsion Dystonia diagnosed and treated?
H&P diagnosis.
Treat with movement and relaxation meds:
-diazepam, baclofen, carbamazepine
What 4 common causes of Torticollis?
- Hyperthyroidism
- Ocular Imbalance
- Cervical Spine disease
- SCM hypertrophy
What is the best treatment for torticollis?
Botulinum toxin
-most torticollis is a tight muscle etiology
-with all the other causes the treatment is to fix the underlying condition
What is a blepharospasm and how is it treated?
Contraction of the orbicularis oculi muscles leading to increased blinking and facial grimacing.
Treat with Botulinum Toxin
What type of genetic characteristic does Essential Tremor exhibit?
Anticipation
What areas of the body are most effected by an Essential Tremor?
Head and larynx (voicebox)
-tremors are exacerbated by stress
What are 6 treatments for an Essential Tremor?
- Alcohol
- Beta Blockers: propranolol
- Barbiturates: primidone
- BZ: diazepam
- Carbonic Anhydrase Inhibitors: topiramate
- Surgery: pacemakers
What is one side effect common with topirimate?
Kidney Stones
What is Tardive Dyskinesia and what are the most common presenting symptoms?
A medication induced persistent, permanent, and repetitive series of involuntary movements.
Patients present commonly with lower facial muscle movements: chewing, tongue darting, as well as other body regions: piano playing, marching in place
What medication is associated with causing Tardive Dyskinesia?
Typical Antipsychotics: haloperidol
What is the treatment for Tardive Dyskinesia?
Remove the cause
Meds: reserpine or Tetrabenazine
What 3 meds commonly cause drug-induced parkinsonism?
Haloperidol (antipsychotics)
Alpha methyl dopa
Metoclopramide
Treatment involves removing the drug
What is acute Akathisia?
Feeling of restlessness and an inability to sit still.
What is neuroleptic Malignant Syndrome?
Autonomic dysfunction, fever, rigidity, akinesia, and altered mental status resulting from use of antipsychotics.
What are two systemic conditions involved with Neuroleptic Malignant Syndrome and what can they lead to?
- Acidosis: caused by accumulation of CO2 from constant muscle contraction, can lead to anything from hyperventilation to coma.
- Myoglobinuria: can clog the kidney and lead to kidney failure
Name two drugs that can treat Neuroleptic Malignant Syndrome.
- Bromocriptine: DA agonist allows muscles to relax
2. Dantrolene: acts on sarcoplasmic reticulum and ryanodine receptor to relax muscles
What causes Sydenham Chorea (St. Vitus Dance)?
Young patients with an immature BBB become infected with Strep. pyogenes which progresses to rheumatic fever. The Abs made against the strep cross the BBB and target the Subthalamus and caudate nuclei.
Patients present with standard chorea symptoms: dance-like movements, darting tongue, facial grimacing
What are 4 treatments for Sydenham Chorea?
- Sedatives
- Phenothiazines (phenothiazine, tetrabenazine), haloperidol
- Valproic Acid
- IV IgG to shut down immune system
What brain structure most notably atrophies in Huntington Chorea?
Caudate Nucleus
What 3 medications can be used to treat HD?
- Haloperidol
- phenothiazine
- Tetrabenazine
What causes Hemiballism?
Some kind of contralateral subthalamic lesion: vascular, hemorrhage, tumor, iatrogenic
Can be bilateral.
What are 3 drugs used to treat Hemiballism?
- Haloperidol
- Tetrabenazine
- Phenothiazine
(same as the choreas)
What condition makes treating Tics in children difficult?
Attention Deficit Disorder
What is required to diagnose Gilles de la Tourette Syndrome?
- Multiple Tics
- Vocalizations
(these patients also have sexual impulses)
What is the biochemical cause of Tourette Syndrome?
Anti-DNAase B antibodies
-hereditary
Some have dysregulation of DA or an absence of the protein Dynorphin.
What are some medications used to treat Tourette Syndrome?
- clonidine
- haloperidol
- pimozide (treats tics)
- naltrexone
- marinol (marijuana pill)
