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62 Cards in this Set
- Front
- Back
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What are the two types of movement disorders?
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hypokinetic and hyperkinetic ( Added note for these Flash cards+ Pd= Parkinson's disease, HD = huntington's diseas)
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what are hypokinetic diseases?
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parkinson's, parkinson's plus syndromes, Multiple Systems Atrophy, PSP, Cortico degeneration, vascular parkinsonism, post traumatic Pd, Secondary (Toxin, medication, Metabolic)
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what are parkinson's plus syndromes?
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disorders like parkinsons that don’t respond to levadopa
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what are the hyperkinetic disorders?
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dystonia, dyskinesias, tremor, abnormal tone, myoclonus, hunington's chorea
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what are the hyperkinetic disorders and hypkinetic diseases due to?
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iatrogenic or toxic causes (drugs that we give patients)
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What is diffuse lewy body disease?
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protein change that starts in coronal brain and works back,
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What did muhammad ali have?
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post traumatic parkinisms
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What is idiopathic parkinison disease? Symmetric or asymetric?
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assymetric
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Idiopathic Pd disease? Cardinal signs?
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tremor, ridgity, bradykinesia
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What is Idio PD responsive to?
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levodopa
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What are the later findings of idiopathic Pd?
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postural instability, levodopa unresponsive gait disorder, non motor features
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What emotion are Pd pts usually mistaken for?
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depressed, their faces cant portray facial expressions
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What is characteristic of tremor?
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it has rhythmic oscillation
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Diffuse Lewy body disease is charcterized by what?
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hallucinations, radidly progressive dementia, responsiveness to levadopa
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PSP?
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progressive supranuclear palsy
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What are PSP characterics?
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early instability and falls, unresponsive to levodopa, stone face, dementia, ocular signs
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What are all the Parkinsonisms or parkinson like diseases?
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idiopathic parkinson's disease, diffuse lewy body disease, PSP, cortico degeneration(CBGB), Multiple systems atrophy: MSA, drug-related parkinson's disease
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What is the common cause of mortality in PSP?
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head trauma
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Concerning gait, what do PSP and Pd have in common?
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gait freezing
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What CBGB stand for?
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corticobasal degenration
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Describe CBGB?
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asymetric parkinsonism with poor response to levodopa, apraxia, alien limb, spasticity,, ridgitiy , dystonia, gait and balnce problems, dementia in late stages
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What are the cardinal signs of MSA?
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parkinsonism, unresponsive to levodpa, autonomic failure(Low BP), cerebellar signs, cortico tract signs-(spasticity)
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What are are the different types of MSA?
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strato-nigril type, parkinsonism first, shy-danger syndrome, autonomic failure firsst, olivo-ponto-cerebellar type OPCA, ataxia first
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What are the classic Hyperkinesias and dyskinesias?>
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dystonia, tremor, chorea, ballismus, myoclonus, ataxia, dysmetria, akathesia, restless legs
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What is dystonia?
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asustained, patterned msucle contractions (agonist and antagonists basically arguing with eachother)
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What are the clinical findings of dystonia?
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repetitive twisting or squeezing movements, fixed postures
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What are the types of dystonia?
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Focal- face, neck , limb--- and Generalized
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what are the causes of dystonia?
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most are idiopathic, ----- could also be drug related (antipsychotic and reglan), genetic, structural, trauma, stroke, multiple rare diseases
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Tx's for dystonia?
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artane, valium, baclofen, botox injection, deep brain stim
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what is a tremor?
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involuntary, rhythmic oscillatory movement
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what are the different types of tremor?
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resting tremor, parkinsonism, essestial tremor( limbs, head, voice) midbrain outflow tremor( cerebellar tremor, rubral tremor) MS, drug-induced, exaggerated physiologic tremor, caffeine, medication withdrawl
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What are the tx's for essential tremor?
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primidone, propanolol and other beta blockers, deep brain stim to thalamus, for some patients alcohol (Pat ron, Jim Beam, Jack Daniels, Ginny, Natalie, Mildred, Colt 45
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What do we do to tx the dystonic piano player?
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1) out of task, sterognosis, graphesthesia, , 2) avoid triggers that trigger dystonia 3) mirror image workouts 4) mental rehearsal 5) splints on the involved fingers 6) gradually back to in task
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What is resting tremor associated with?
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parkinsonism
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what is chorea?
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ceaseless rapid, non rhythmical, complex body movements that look well coordinated and purposeful but are in face involuntary
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what is ballismus?
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violent movements of the limbs, as in chorea, sometimes affecting only one side of the body (hemiballismus)
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what are the charcteristics of chorea?
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non-rhythmical, excessive spontaneous movement, irregular, random, brief, abrupt, non-repetitive, flitting randomly from one body part to another, purposeless(may be disguised), facial grimacing and abnormal respiratory sounds
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Causes of chorea?
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medications= haldol, other antipsychotics, reglan (can cause tardive dyskinesia), huntingtons's disease (genetic), hemiballism (stroke, post-infectious (strep infection)
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What is the etiology of huntington's diseasE?
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gene defect, each family of a HD person has a 50% chance of getting the gene
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when does HD start?
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mid life between 30-45
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what is the ealriest and latest HD can start?
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2- late 70s
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What happens if children develop the juvinile disease?
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they rarely live to adult hood
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what is the disposition to HD concerning gender and race?
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no discrimination, HD is an equal oppurtunity employer
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what are the early symptoms of HD?
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cognitive ability, mobility, depression, mood swings, forgetfullness, speech impairment, clumsiness, involuntary twitching and lack of coordination
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What happens with HD as the disease progresses?
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concentration, short term memory diminish, involvuntary head, trunk and limbs increase, walking, speaking, and swallowing abilities deteriorate until the individual becomes totally dependant
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what long is the disease progression and what is the ending?
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10-25 yr period : fatal
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What are the meds for HD?
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neuroleptics- haldol, clozapine: benzos= clonazepam, diazepam: NMDA agonist= amantadine: DA receptor blockers= reserpine, tetrabenazine
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What is myoclonus?
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not a tremor, sudden shock-like muscle contractions, focal, mulitfocal, generalized, unually irregular/jerky, may be regular/rhythmic
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What can trigger myoclonus?
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light, sound, threat, startle
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What is a very common example of myoclonus?
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body jerks just prior to falling asleep
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What is a tic?
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semi-voluntary (eg suppressible), rapid, non-rhythmic movements or sounds, associated compulsions
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how do you tx tics?
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neuroleptics
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what can tics be associated with?
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ocd
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What is restless leg syndrome
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bothersome urge to move legs at night, prevents sleep
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what is RLS treated with?
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carbidopa, levadopa, Requip, mirapex
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What is akathesia?
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motor restlessness with a desire to move
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what is akathesia associated with?
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vocalizations or grunting
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meds for akasthesisa?
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antipsychotics and reglan
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How is tardive dyskinesia prevented?
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dopamine depleting agents, life long botox injections, deep brain stim
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what is the problem with dopamine blocking agents?
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reversible, tremor, parkinsons
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what does deep brain stim do?
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control motor fluxations, manage dyskinesias, control tremors, reduce meds, pain
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what does deep brain stim not help?
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gait, balance, They should not expect any symptoms beyond their best "on" time
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