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38 Cards in this Set
- Front
- Back
Common Movement Disorders
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Parkinson's
Tourette's Essential Tremor Restless Leg Syndrome Drug-induced MD's |
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(this lecture blows)
Dx of Tourette's |
Motor and Vocal tics for more than a year before age 21 = tourette's
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How often is cussing involved in tourette's?
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only 10-40%
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when do tourette's sx's normally show up?
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by 7 years old
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Tourette's Pathogenesis
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Inherited
Developmental Disorder of synaptic neurotransmission involving basal ganglia pathways and an excess of dopamine |
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Genetic linkage in Tourette's?
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Sometimes linked to Chromosome 4 and 8
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do all tourette's sufferers need drugs?
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no. 20% do NOT!
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which drugs are most effective for tics?
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Neuroleptics
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SE's of neuroleptics
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parkinsonism
tremors rigidity sedation depression wt gain hepatotoxicity |
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Other drugs for tics
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Clonazepam
clonidine (ADHD) pergolide weed nicotine botox |
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What is RLS?
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restless leg syndrome is a desire to move limbs with or w/o parestesias
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When are sx's of RLS worse?
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at rest or inactivity
in the evening or at night |
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What relieves sx's of RLS?
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movement
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What is the most troublesome Sx of RLS?
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Sleep-related Sx's!
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Prevalence of RLS?
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3-15%
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Mean age of RLS onset?
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34, but often due to late Dx. Onset often in adolescence
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What often accompanies RLS?
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Periodic Limb Movements of Sleep (90% of RLS has PLMS)
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when does PLMS occur?
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only when you're alseep
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What causes Primary RLS?
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Majority Hereditary
Many Idiopathic |
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Causes of Secondary RLS?
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Iron Deficiency
Renal Failur Preggers PD Neuropathy Meds |
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Management of RLS?
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NONPHARM:
mental alerting activities check current meds Iron replacement abstain from caffeine, etc PHARM: 1st line: dopamine agonists Alt: gabapentin, opioids |
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SE's of Levodopa in RLS?
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Augmentation
Rebound |
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Essential Tremor vs PD
1. Location of tremor |
ET: hands, head, voice
PD: Hands, Legs, Mouth |
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Essential Tremor vs PD
2. Associated Signs |
ET: absent
PD: present |
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Essential Tremor vs PD
3. Duration |
ET: many years
PD: shorter |
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Essential Tremor vs PD
Family History |
ET: 60-75%
PD: 15-20% |
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Essential Tremor vs PD
Response to alcohol |
ET: +++
PD: + |
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Essential Tremor vs PD
Tremor Type |
ET: Postural, Kinetic
PD: Resting>Postural |
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Essential Tremor vs PD
Response to Levodopa |
ET: -
PD: +++ |
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Essential Tremor vs PD
Response to Propanolol |
ET: +++
PD: + |
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3 drugs that can worsen ET
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Inhalers
Theophylline Steroids |
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Prevalence of ET's vs. PD
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ET's are 10 times more common than PD
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how long does booze help for ET's
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1-2 hours
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ET Rx
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MEDS:
Propanolol BDZ's Botoulinum Toxin SURGERY! stimulate or ablate thalamus (VIM) |
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SE of Thalamic Stimulation for ET?
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speech and balance difficulties (50%)
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Potential Causes of PD
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1. Genes:
alpha-synuclein parkin 2. Pathogenic protein aggregation Mito dysfxn oxidative stress etc 3. Environment pesticides rural living |
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What do you have to watch out for with dopamine agonists?
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IMPULSIVE BEHAVIOR
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Common Drug-induced MD's
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Tardive Dyskinesia
Parkinsonism w/ neuroleptics REGLAN (metoclopramide) |