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35 Cards in this Set
- Front
- Back
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This occurs when the affected body part is supported against gravity.
This can be aggravated by mental stress and general movements such as walking. This is diminished by target directed movement (finger to nose test) |
Rest Tremor
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This is produced during voluntary muscle contraction.
There are three types: Postural - Held position Isometric - Against resistance Kinetic - With movement |
Action Tremor
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This will show a visible postural tremor of hands and forearms. May have kinetic component. Most common movement disorder worldwide.
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Essential Tremor
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What are the signs and symptoms of Essential Tremor?
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Initial presentation of postural distal arm tremor
Flexion-extension of wrist Frequency of 4-12 Hz Unilateral, progresses to bilateral Head: Yes-Yes or No-No movement Voice: Vibrato quality |
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What will accentuate and diminish essential tremor?
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Accentuate: Stress, fatigue, central nervous system stimulants (SSRIs, neuroleptics, reglan, depakote), some voluntary movements (holding a fork)
Diminish: Rest, beta blockers, alcohol |
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What medications are usually used in TX of essential tremor?
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Propranolol
Primidone - Only FDA drug for essential tremor Topiramate |
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What is the surgical TX of essential tremor?
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Ventral intermediate nucleus (VIM) of thalamus: deep brain stimulation, radio frequency ablation, gamma knife lesioning
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This is degeneration of the substantia nigra - part of the basal ganglia
Loss of Dopa production Results in Tremor, Muscle Stiffness, Rigidity, Slow Movements, Balance Problems. |
Parkinson's Disease
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What are the cardinal features of Parkinson's Disease?
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Tremor
Rigidity Bradykinesia Postural Instability |
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This will have 4-6Hz, pill rolling in nature, enhanced by emotional stress, reduced with voluntary movements, starts unilateral but progresses to bilateral, insidious slow progression over time.
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Tremor in Parkinson's Disease
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What is associated with the Rigidity and Bradykinesia in Parkinson's Disease?
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Rigidity: An increase in resistance to passive movement. Cog-Wheel Rigidity
Bradykinesia: Slow voluntary movements, reduced automatic movements. |
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Postural instability, decreased olfaction, micrographia and shuffling gait are all associated with what?
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Parkinson's Disease
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What are the dopamine agonists used to TX Parkinson's
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Bromocriptine
Pergolide Pramipexole Ropinirole |
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The dopamine agonists used in the TX of Parkinson's are usually given with what?
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Carbidopa/Levidopa (Sinemet)
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These drugs are used in the TX of Parkinson's and they help to counteract the overproduction of ACh, control of mild to moderate symptoms and is the best to treat tremor and rigidity.
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Anticholinergics:
Benztropine Trihexyphenidyl |
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These drugs are given in TX of Parkinson's. These drugs inhibit COMT from metabolizing levodopa.
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Catecholamine - O - Methyltransferase Inhibitors.
Entacapone Tolcapone |
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MAO-B metabolizes dopamine, dopamine agonists are given in the TX of Parkinson's. What drugs are given to inhibit MAO-B?
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MAO-B inhibitors:
Selegiline Rasagaline |
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This is used to TX mild SX, as well as any flu like symptoms associated with Parkinson's.
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N-methyl-D-aspartate (NMDA)
Amantadine |
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How do you initiate therapy in a person less than 50 years old with Parkinson's?
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Dopamine agonists
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How do you initiate therapy in a person between the ages of 50-70 years old with Parkinson's?
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See how the patient does with Sinamet
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How do you initiate therapy in a patient over 70 years old with Parkinson's?
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Levidopa/Carbidopa - Sinamet
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What drug is best to help the Parkinson's symptoms of tremor or rigidity?
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Anticholinergics
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What drug is best to help the Parkinson's symptoms of motor fluctuations?
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COMT inhibitors
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What drug is best to help the Parkinson's symptoms of fluctuations in response to levodopa/carbidopa?
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MAO B inhibitors
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What drug is best to help the Parkinson's symptoms of Dyskinesia?
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NMDA inhibitors
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This effects 20-40% of Parkinson's patients. Cholinesterase inhibitors (donepezi/Aricept) is effective. This is the same drug given to patients with Alzheimers.
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Dementia
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This is characterized by choreiform movements, dementia or behavioral changes, clearly defined inheritance pattern.
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Huntington Disease
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Huntington disease has what kind of genetic heredity?
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Autosomal dominant pattern of inheritance.
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CAG repeats in Huntington Disease:
1. 10-26 repeats 2. 27-35 repeats 3. 36-41 repeats 4. > 41 repeats Higher repeat number = ? |
1. 10-26 repeats = normal
2. 27-35 repeats = Unaffected but more likely to transmit still larger number of repeats to offspring 3. 36-41 repeats = Incomplete penetrance 4. > 41 repeats = Huntington Disease Higher repeat number = Earlier age of onset. |
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The signs and symptoms of this are subtle but progressive:
Oculomotor dysfunction Small Choreiform Movements Psychiatric Dysfunction Dementia |
Huntington Disease
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What are the diagnostic tests used to find Huntington?
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DNA analysis for CAG trinucleotide repeat expansion
Mutation in the HD gene Refer to clinical genetics for pre/post test counseling CT may show symmetrical atrophy of caudate nucleus. |
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This is a TX for Huntington that depletes central monoamines, reduces chorea but has no effect on other symptoms, assocaited with serious adverse effects - worsening depression and suicide.
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Tetrabenazine
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This is used in the TX of Huntington and blocks dopamine receptors.
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Haloperidol
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This is a TX for Huntington used to help treat chorea.
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Amantadine
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This is used to tx behavioral problems associated with Huntington?
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Clozapine
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