W4L1 - Brain Body Connection Failure Flashcards
1.) Describe the basis for the following motor control disorders: Apraxia Ataxia Parkinson’s Disease Polio Myasentheia Gravis Anarchic hand 2.) Appreciate how patients with movement disorders may present to psychology clinics: Tourette Sydrome, Psychogeneic movement disorders
Apraxia: Symptoms and Types
Apraxia
Symptoms:
- “Without Action” but not paralysed
- Inability to imitate or perform actions to vocal instructions
Types:
- Limbs
- Kicking, etc.
- Oral (Speech/Muscle)
- Facial muscles and vocalization
- Constructional agraphia (rare)
- Imitating a picture/ Legos
- Apraxic agraphia (rare)
- Can spell word (understand) but cannot write
Apraxia: Causes and Treatment
Causes
- Parietal Lobe
- Limb: Left frontal and parietal
- Constructional: Right parietal
Treatment
- Physical/occupational/speech therapy
Ataxia: Symptoms
Symptoms
- “Without coordination”
- Poor coordination, speech change, unsteady walking, difficulty swallowing
Ataxia: Causes
Causes
- Cerebellar damage
- Alcohol abuse
- Stroke
- Tumour
- Multiple Sclerosis
- Hereditary forms
- Virus
Ataxia: Treatment/Management
Ataxia: Treatment
- Treat underlying cause (e.g. alcohol consumption)
- Virus may reverse spontaneously
Ataxia: Management
- Physical/Speech/Occupational therapy
- Devices to aid mobility when untreatable
PD: Symptoms
PD: Symptoms
- Muscle tremor, slow movement, rigidity
- “Freezing gait”
- Cognitive difficultiies (memory loss, depression)
- Loss of oflaction (smell)
PD: Causes
PD: Cause
- Neuronal death in substantia nigra which have dopamine releasing axons to basal ganglia
- Genetics and environmental contributions
PD: What are the 2 pathways of dysfunction? What does it mean for the pathways when there is no DA
1.) Direct
- Overall excitatory
2.) Indirect
- Overall inhibitory
No DA > Both pathways are inhibitied > Everything is dampaned (Inhibitory)
What is freezing gait. Which disease is it related to and how does one avoid it?
Freezing gait in PD:
Involuntary inability to move at unpredictable times (e.g. suddenly stop walking)
Avoiding
- Marching: Stepping rhythamically
- Stepping over an imaginary line
One can cycle but cannot walk
PD: Treatment
PD: Treatment
- Behavioural (Exercise)
- Dopamine Agonists and Mao-B inhibitors (inhibit dopaine breakdown)
- Deep Brain Stimulation (Advanced disease)
Polio: Prevalance and Symptoms
Polio: Viral disease.
Asymptomatic in 90-95% (Common Cold); Symptomatic in 5-10%
Symptoms
- Symptomatic: Flu-like, full recovery
- Non-Paralytic (1%): Headache, pain, full recovery
- Paralytic (0.5%): Muscle paralysis, weakness, not all recover
- Post-polio syndrome (25-50% of all): Weakeness years after
Polio: Causes. What is paralyptic polio
Polio
- Viral infection spread through faeces-mouth.
- Paralytic Polio
- Virus attacks the spinal alpha motor neurons.
Polio: Treatment
Treatment:
- None
- Focus on prevention via vaccination (Booster vaccination recommended if travelling to active areas (Afghanistan, Pakistan, Nigeria))
Myasthenia Gravis: Symptoms and Causes
Symptoms
- Muscle weakness and fatigue, usually starting with head muscles (often eyelids).
Cause
- Bodies own immune system creates antibodies that bind to Acetylcholine receptor.
Myasthenia Gravis: Treatment
Treatment
- Immunosuppressant’s that slow antibody production.
- Acetycholinesterase inhibitors to increase the time that Ach is present in the neuromuscular junction.
Anarchic hand (Alien hand syndrome). Definition and Cause
Definition
Rare disorder of involuntary, yet purposeful, hand movements.
Causes
- Anterior cerebral artery strokes, midline tumors, and neurodegenerative illnesses.
What are the variants of Anarchic hand and what are the brain parts implicated?
Frontal variant:
- Groping movements. SMC, prefrontal cortex, corpus callosum involvement.
Posterior variant:
- Levitating hand, withdrawal. PPC, thalamic, occipital lobe damage.
Tourette Syndrome: Symptoms and What are the simple and complex variants
Tics:
- Rapid, repetitive, “involuntary” muscle movements and vocalisations.
- Commonly associated with OCD and ADHD
Simple
- Motor: eye blink, head jerk, nose twitch, shrugging.
- Vocal: grunts, sniffs, throat clearing, barking noise
Complex
- Motor: jumping, twirling, pulling at clothes
- Vocal: words or phrases, coprolalia, echoalia, palilalia
Tourette Syndrome: Causes
Cause:
Unclear pathophysiology but
- Abnormal activity in the cortico-basal ganglia loops.
- Genetic involvement assumed
Tourette Syndrome: Treatment
Treatment
- Mild: Nothing
- Comorbid conditions (ADHD, OCD, anxiety)
- Problematic: haloperidol, pimozide, deep brain stimulation.
What are psychogenic movement disorders
Abnormal movements not attributable to an organic neurologic disorder.
- Considered to be psychologically mediated (conversion disorder)
- Many patients lack clear psychological distress and don’t believe there is a psychological cause of abnormality.
- CBT can be useful.
