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37 Cards in this Set
- Front
- Back
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TWO MAIN TYPES OF MOVEMENT
DISORDERS: |
1. Hypokinetic
2. Hyperkinetic |
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MOVEMENT DISORDERS:
MAJOR CATEGORIES ____ Parkinson’s disease Parkinson’s plus syndromes |
Hypokinetic
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MOVEMENT DISORDERS:
MAJOR CATEGORIES _____ Dystonia & Dyskinesias Tremor Abnormal tone Myoclonus |
Hyperkinetic
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____ MOVEMENT DISORDERS:
MAJOR CAUSES Parkinson’s Disease Diffuse Lewy Body Disease Multiple Systems Atrophy (+/- Ataxia) Progressive Supranuclear Palsy Corticobasal Degeneration Vascular Parkinsonism Post Traumatic Parkinsonism Secondary (Toxin, Medication, Metabolic) |
HYPOKINETIC
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PARKINSONISMS
________ Usually Asymmetric Cardinal Signs Tremor Rigidity Bradykinesia Levodopa Responsive Later Findings Postural Instability Levodopa-unresponsive gait disorder Non Motor Features |
IDIOPATHIC PARKINSON’S DISEASE
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PARKINSONISMS
_____ Unlike PD, Lewy Bodies rapidly spready throughout the brain, including the cerebral cortex Levodopa Responsive Parkinsonism Rapidly Progressive Dementia Hallucinations |
DIFFUSE LEWY BODY DISEASE
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PARKINSONISMS
______ Early Postural Instability and Falls Parkinsonism Unresponsive to Levodopa “Stone Face” Dementia Ocular Signs |
PROGRESSIVE SUPRANUCLEAR PALSY:
PSP |
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PARKINSONISMS
_________ Asymmetric Parkinsonism with Poor Response to Levodopa Apraxia and Alien Limb Spasticity, Rigidity, Dystonia Gait and Balance Problems Dementia always occurs, but may be a late feature |
CORTICOBASAL DEGENERATION:
CBGB |
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PARKINSONISMS
_____ Cardinal Findings Parkinsonism Unresponsive to Levodopa Autonomic Failure Types Striato-Nigral Type Parkinsonism First Shy-Drager Syndrome Low Blood Pressure Cerebellar Signs Corticospinal Tract Signs Spasticity Autonomic Failure First Olivo-pontocerebellar Type OPCA Ataxia First |
MULTIPLE SYSTEMS ATROPHY:
MSA |
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PARKINSONISM
_____ Haldol and other antipsychotic medications cause symmetric findings that are indistinguishable at times from Idiopathic Parkinson’s Disease Reglan is a dopamine blocker and is an important cause of Parkinsonism in elderly patients Anti-nausea medication |
DRUG RELATED PARKINSONISM
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HYPERKINESIAS
HYPERKINESIAS AND DYSKINESIAS Dystonia Tremor Chorea & Ballismus Myoclonus Ataxia and Dysmetria Tics Akathisia Restless Legs |
bleh
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HYPERKINESIAS
definition of Dystonia |
“A neurologic syndrome characterized by
involuntary, sustained, patterned, and often repetitive muscle contractions of opposing muscles causing twisting movements and abnormal postures.” |
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HYPERKINESIAS
______ Characteristics Sustained, patterned muscle contractions Agonists and Antagonists Cli i l Fi di Types Focal Face Blepharospasm Meige Syndrome Neck Clinical Findings Repetitive Twisting or Squeezing Movements Fixed Postures Cervical Dystonia Limbs Task Specific Dystonias – writing, musicians Generalized |
DYSTONIA
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HYPERKINESIAS
CAUSES OF ____ Idiopathic (Most Cases) DRUG RELATED Antipsychotics and Reglan Genetic (DYT-1 Gene) Structural Trauma Stroke Multiple Rare Diseases |
DYSTONIA
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HYPERKINESIAS
TREATMENT FOR ____ Artane, Valium, occasionally Baclofen Botulinum Toxin Injection Deep Brain Stimulation (Globus Pallidus Interna) |
DYSTONIA
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HYPERKINETIC DISORDERS:
definition of ____ Involuntary, rhythmic oscillatory movement |
TREMOR
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HYPERKINETIC DISORDERS:
TYPES OF TREMOR Resting Tremor Parkinsonism Essential Tremor Limbs, Head, Voice Midbrain Outflow Tremors Cerebellar Tremor Rubral Tremor MS Drug-induced Exaggerated Physiologic Tremor Caffeine, Medication Withdrawal |
woo!
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HYPERKINETIC DISORDERS:
______ TREMOR Very Common - Idiopathic UE Tremor with Posture and/or Action Bilateral, usually roughly symmetric Typically of Long-Standing Duration Other Areas May Be Involved Head or Jaw Voice Lower Extremities Tremor may produce disability, but often doesn’t No clear association with other diseases or disorders |
ESSENTIAL
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TREATMENT OF ___
TREMOR Primidone Propanolol and other Beta Blockers Deep Brain Stimulation (Thalamus) Tremors of some patients are quite responsive to alcohol, and patients may self-medicate |
ESSENTIAL
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HYPERKINETIC DISORDERS:
CHOREA & BALLISMUS _____ Ceaseless rapid, non-rhythmical, complex body movements that look well coordinated and purposeful but are, in fact, involuntary. |
Chorea
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HYPERKINETIC DISORDERS:
CHOREA & BALLISMUS _____ Violent movements of the limbs, as in chorea, sometimes affecting only one side of the body (hemiballismus). |
Ballismus
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HYPERKINETIC DISORDERS:
CHARACTERISTICS OF ____ Non-rhythmical Excessive Spontaneous Movements Irregular, Random, Brief and Abrupt Non-repetitive Flitting randomly from one body part to another Purposeless, but may be disguised Facial grimacing and abnormal respiratory sounds |
CHOREA
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HYPERKINETIC DISORDERS:
CHOREA -- CAUSES MEDICATIONS (e.g. ___ dyskinesia) Haldol, other antipsychotics Reglan is an important cause of tardive dyskinesia Huntington’s Disease (Genetic) Hemiballism (Stroke) Post-Infectious (Strep Infection) |
tardive
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HYPERKINETIC DISORDERS:
______ Etiology: Gene defect (CAG trinucleotide repeat) on chr 4- “anticipation” Each child of a person with Huntington's Disease has a 50% chance of inheriting the HD disease causing gene. |
HUNTINGTON’S DISEASE
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HYPERKINETIC DISORDERS:
_____ Epidemiology: Typically begins in mid-life, between the ages of 30 and 45, though onset may occur as early as the age of two or as late as the 70s. Children who develop the juvenile form of the disease rarely live to adulthood. HD affects males and females equally and affects all ethnic and racial groups. |
HUNTINGTON’S DISEASE
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HYPERKINETIC DISORDERS:
_____– PROGRESSION Early symptoms: cognitive ability,mobility, depression, mood swings, forgetfulness, speech impairment, clumsiness, involuntary twitching and lack of coordination. As the disease progresses, concentration and short term memory diminish and involuntary movements of the head, trunk and limbs increase. Walking, speaking and swallowing abilities deteriorate until the individual becomes totally dependent. usually progresses over a 10-25 year period; fatal. |
HUNTINGTON’S DISEASE
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_____- MEDICATIONS
Neuroleptics - Haloperidol, fluphenazine, risperidone, thiothixene, thioridazine, clozapine, quetiapine Benzodiazepines - Clonazepam, Diazepam NMDA agonist - Amantadine DA receptor blockers - Reserpine, tetrabenazine |
CHOREA
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HYPERKINETIC DISORDERS:
_____ Not a Tremor Sudden, shock-like muscle contractions Focal, Multifocal, or Generalized Usually irregular and jerky But may be regular and rhythmic Can be triggered by light, sound, threat, startle Example: body jerks just prior to falling asleep |
MYOCLONUS
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HYPERKINETIC DISORDERS:
_____ Semi-voluntary (e.g. suppressible), rapid,nonrythmic movements or sounds Background of normal activity Associated Compulsions May be associated with OCD Occasionally tics are disabling, but the OCD is usually the more disabling condition, if it exists Treat with neuroleptics |
TICS
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Motor restlessness with a “desire to move” Difficult for patients to describe “I feel like I’m always crawling out of my skin” Often with associated vocalizations and grunting Often very disabling Cause: MEDICATIONS – antipsychotics and Metoclopromide (Reglan) |
AKATHISIA
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Bothersome urge to move legs at night Prevents sleep Medications carbidopa-levodopa, opioids ,Benzodiazapenes, Neurontin The FDA recently approved Ropinorole (Requip) and Pramipexole (Mirapex). |
RESTLESS LEGS
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(POST DOPAMINE-BLOCKADE) MOVEMENT DISORDERS PREVENTION Dopamine Depleting Agents Difficult now to Obtain in the U.S. Life Long Botulinum Toxin Injections Deep Brain Stimulation |
TARDIVE DYSKINESIA
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COMPLICATIONS OF ____
BLOCKING AGENTS Reversible? Sequelae Include Tremor Parkinsonism Permanent and Difficult to Treat Sequelae Include Tardive Dyskinesia (Chorea-like syndrome) Tardive Akathisia Tardive Dystonia (Long Term Botox, may need DBS) |
DOPAMINE
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APPLICATIONS PD Dystonia Essential Tremor Tourette’s and Severe OCD Cluster HA’s Intractable pain Side effect: lowered BP *Clinical trials: Epilepsy & Depression *Other psychiatric disorders (Europe) |
DEEP BRAIN STIMULATION
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Helps to: Control motor fluxuations Manage dyskinesias Control tremors Reduce medications Pain Does not help: gait and balance PD patients should not expect DBS to improve any symptoms beyond their best “on” time |
DEEP BRAIN STIMULATION (DBS)
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MOVEMENT DISORDERS SUMMARY
PD Parkinson's Plus syndromes Iatrogenic Toxic |
Hypokinetic
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MOVEMENT DISORDERS SUMMARY
Akathisia - restlessness Athetosis - writhing Ballismus - Lightning-like Chorea - dancing, non-rhythmic Dystonia - co-contractions Myoclonus - sudden jerks Tics - Compulsive, repetitive Tremors - shaking, rhythmic |
Hyperkinetic
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