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38 Cards in this Set

  • Front
  • Back
Common Movement Disorders
Parkinson's
Tourette's
Essential Tremor
Restless Leg Syndrome
Drug-induced MD's
(this lecture blows)
Dx of Tourette's
Motor and Vocal tics for more than a year before age 21 = tourette's
How often is cussing involved in tourette's?
only 10-40%
when do tourette's sx's normally show up?
by 7 years old
Tourette's Pathogenesis
Inherited
Developmental Disorder of synaptic neurotransmission involving basal ganglia pathways and an excess of dopamine
Genetic linkage in Tourette's?
Sometimes linked to Chromosome 4 and 8
do all tourette's sufferers need drugs?
no. 20% do NOT!
which drugs are most effective for tics?
Neuroleptics
SE's of neuroleptics
parkinsonism
tremors
rigidity
sedation
depression
wt gain
hepatotoxicity
Other drugs for tics
Clonazepam
clonidine (ADHD)
pergolide
weed
nicotine
botox
What is RLS?
restless leg syndrome is a desire to move limbs with or w/o parestesias
When are sx's of RLS worse?
at rest or inactivity
in the evening or at night
What relieves sx's of RLS?
movement
What is the most troublesome Sx of RLS?
Sleep-related Sx's!
Prevalence of RLS?
3-15%
Mean age of RLS onset?
34, but often due to late Dx. Onset often in adolescence
What often accompanies RLS?
Periodic Limb Movements of Sleep (90% of RLS has PLMS)
when does PLMS occur?
only when you're alseep
What causes Primary RLS?
Majority Hereditary
Many Idiopathic
Causes of Secondary RLS?
Iron Deficiency
Renal Failur
Preggers
PD
Neuropathy
Meds
Management of RLS?
NONPHARM:
mental alerting activities
check current meds
Iron replacement
abstain from caffeine, etc

PHARM:
1st line: dopamine agonists
Alt: gabapentin, opioids
SE's of Levodopa in RLS?
Augmentation

Rebound
Essential Tremor vs PD
1. Location of tremor
ET: hands, head, voice
PD: Hands, Legs, Mouth
Essential Tremor vs PD
2. Associated Signs
ET: absent
PD: present
Essential Tremor vs PD
3. Duration
ET: many years
PD: shorter
Essential Tremor vs PD
Family History
ET: 60-75%
PD: 15-20%
Essential Tremor vs PD
Response to alcohol
ET: +++
PD: +
Essential Tremor vs PD
Tremor Type
ET: Postural, Kinetic
PD: Resting>Postural
Essential Tremor vs PD
Response to Levodopa
ET: -
PD: +++
Essential Tremor vs PD
Response to Propanolol
ET: +++
PD: +
3 drugs that can worsen ET
Inhalers
Theophylline
Steroids
Prevalence of ET's vs. PD
ET's are 10 times more common than PD
how long does booze help for ET's
1-2 hours
ET Rx
MEDS:
Propanolol
BDZ's
Botoulinum Toxin
SURGERY!
stimulate or ablate thalamus (VIM)
SE of Thalamic Stimulation for ET?
speech and balance difficulties (50%)
Potential Causes of PD
1. Genes:
alpha-synuclein
parkin
2. Pathogenic
protein aggregation
Mito dysfxn
oxidative stress
etc
3. Environment
pesticides
rural living
What do you have to watch out for with dopamine agonists?
IMPULSIVE BEHAVIOR
Common Drug-induced MD's
Tardive Dyskinesia
Parkinsonism w/ neuroleptics
REGLAN (metoclopramide)