Parkinson's Disease and other Movement Disorders Flashcards
Define Parkinson’s disease
Progressive neurodegenerative condition caused by a degeneration of dopaminergic neurones in the substantia nigra
Parkinson’s disease pathophysiology
Basal ganglia coordinates habitual movements
Part of basal ganglia called substantia nigra produces dopamine
Dopamine essential for functioning of basal ganglia
In PD there is progressive decline in dopamine production
Risk factors for Parkinson’s disease
Increasing age
Family history (in younger-onset disease)
Mutation in gene encoding glucocerebrosidase
Clinical features of Parkinson’s disease
Bradykinesia, tremor, rigidity
Asymmetrical
Typically man >70
“Cogwheel rigidity”
Characteristics of Parkinson’s tremor
“Pill rolling” (fingertips + thumb)
Pronounced when resting
Improves on movement
Worse when distracted
Signs of bradykinesia in Parkinson’s
Handwriting smaller and smaller
Shuffling gait
Difficulty initiating movement
Difficulty turning around
Reduced facial movements/expressions (hypotonia)
Differentiating Parkinson’s and essential tremor
Essential tremor is:
Symmetrical
Improved at rest
Worse on movement
Improves with alcohol
Management of Parkinson’s disease
Levodopa
Dopamine agonists if symptoms not affecting QOL
Side effects of L-dopa
Hypotension
Restlessness
GI upset
Acute psychosis (rare)
Becomes less effective with time (end-of-dose effect)
How long does it typically take to develop complete loss of response to L-dopa?
2-5 years
What is “parkinsonism”?
A group of conditions that has symptoms similar to those of Parkinson’s disease
What are “movement disorders”?
A group of neurological conditions that cause abnormal increased movements, which may be voluntary or involuntary
May also cause reduced or slow movements
What is ‘ataxia’?
Affects part of the brain that controls coordinated movement (cerebellum)
May cause uncoordinated or clumsy balance, speech or limb movements, and other symptoms
What is ‘cervical dystonia’?
Causes long-lasting contractions (spasms) or intermittent contractions of the neck muscles, causing the neck to turn in different ways
What is ‘chorea’?
Repetitive, brief, irregular, somewhat rapid, involuntary movements that typically involve the face, mouth, trunk and limbs
What is ‘dystonia’?
Sustained involuntary muscle contractions with twisting, repetitive movements
May affect entire body (generalised dystonia) or one part of body (focal dystonia)
What is ‘Huntington’s disease’?
Inherited progressive, neurodegenerative disorder that causes uncontrolled movements (chorea), impaired cognitive abilities and psychiatric conditions
What is ‘multiple system atrophy’?
Uncommon, progressive, affects many brain systems
Causes a movement disorder, such as ataxia or parkinsonism
Can also cause low blood pressure and impaired bladder function
What is ‘myoclonus’?
Causes lightning-quick jerks of a muscle or a group of muscles
What is ‘progressive supranuclear palsy’?
Rare neurological disorder that causes problems with walking, balance and eye movements
What is ‘restless legs syndrome’
Causes unpleasant, abnormal feelings in the legs while relaxing or lying down, often relieved by movement
What is ‘tardive dyskinesia’?
Caused by long-term use of certain drugs used to treat psychiatric conditions (neuroleptic drugs)
Causes repetitive and involuntary movements such as grimacing, eye blinking and other movements
What is ‘Tourette syndrome’?
Starts between childhood and teenage years and is associated with repetitive movements (motor tics) and vocal sounds (vocal tics)
What is ‘Wilson’s disease’?
Rare inherited disorder that causes excessive amounts of copper to build up in the body, causing neurological problems
