Secondary Movement Disorders

Question 1

Drug induced parkinsonism from neuroleptics

Answer 1

Neuroleptics can induce parkinsonism that is typically reversible within weeks of stopping/reducing doses
Will worsen symptoms in patients with Parkinson’s disease, or unmask latent symptoms

Question 2

Medications associated with drug induced parkinsonism

Answer 2

Typical/first generation antipsychotics (haloperidol)
Atypical antipsychotics (risperidone, etc)
Dopamine depleters (tetrabenazine)
Valproic acid

Question 3

Acute dystonic reaction

Answer 3

Typically occurs shortly (within days) after administration of a neuroleptic (or increase in dose/change to IV admin)
Prodrome of restlessness, fixed stare followed by: torticollis > stridor > oromandibular dystonia > oculogyric crisis > opisthotonus (trunk/neck hyperextension)/retrocollis
Can fluctuate/recur over 48 hours

Question 4

Treatment for acute dystonic reaction

Answer 4

Basic life support (ABCs)
Benztropine (anticholinergic)
Diphenhydramine (Benadryl)
Benzos sometimes used too

Question 5

Neuroleptic malignant syndrome

Answer 5

Tetrad of encephalopathy, rigidity, hyperthermia, and dysautonomia
Idiosyncratic rxn to neuroleptic
Can also occur with abrupt cessation of L-DOPA in patients with PD

Question 6

Malignant HTN

Answer 6

Very similar appearance to neuroleptic malignant syndrome
From use of succinylcholine or halogenated inhaled anesthetics in predisposed person
Only really see it in the OR

Question 7

Serotonin syndrome

Answer 7

Dose dependent spectrum of toxicity from serotonergic agents

Hyperreflexia (big one), inceased tone, encephalopathy, hyperthermia, dysautonomia, mydriasis, nausea/diarrhea

Question 8

Tardive dystonia

Answer 8

Caused by chronic neuroleptic exposure
Classically features axial dystonia with truncal/cervical hyperextension
More common in younger patients

Question 9

Tardive dyskinesia

Answer 9

Caused by chronic neuroleptic exposure
Classically features choreiform oromandibular movements (often does not interfere with speech or feeding)
More common in older patients

Question 10

Asterixis

Answer 10

Negative myoclonus (fall down and catch)
Due to metabolic derangement

Question 11

Acute post anoxic myoclonus

Answer 11

Generalized and synchronous myoclonus
Single generator in the brainstem (whole body)
One of the signs that someone is not going to do well after anoxic arrest

Question 12

Chronic post anoxic myoclonus

Answer 12

Bouncy gait
Occurs when trying to activate
Treat with antiepileptics
Generator is cortical or subcortical