Movement Disorder

Question 1

Involuntary, rhythmic oscillations

Answer 1

Tremor

Question 2

Limb is moving through space

Answer 2

Kinetic tremor

Question 3

Kinetic tremor
vs.
intention tremor

Answer 3

More shaking as approaching intended target

Cerebellar pathology

Question 4

Tremor evaluation

Answer 4

• location + laterality
• frequency (fast/slow)/ amplitude (big / small)
• situations/maneuvers that cause tremor\
• Rest
• Action
  
  • postural
  • kinetic

Question 5

Postural+kinetic

• medium frequency
• bilat (arms)
• also head/lower limbs/face

*MC
Middle age
*may have had slight one as kid
*often w/ dystonia, myoclonus, ataxia, cognitive impairment

Answer 5

Essential tremor

Question 6

Essential tremor

Alcohol

Answer 6

Helps (most)
Many become alchys
Small dose

Question 7

Essential tremor

Prognosis

Answer 7

• slow progression
• no life-span reduction
• can become Parkison’s

Question 8

Essential Tremor

Tx. - behavioral mods

Answer 8

• caffeine/stimulants

- assistive devices

Question 9

Essential tremor

Rx

Answer 9

Propranolol = S.E. HypoTN, bradycardia
Primadone = S.E. sedation

Can combine = synergistic

Question 10

Essential tremor

3rd line Tx

Answer 10

Deep brain stimulation

Thalamotomy

Question 11

• abnormal contraction of muscle
• sustained/intermittent
• focal/segmental/multi-focal/hemi/generalized
• worsened = voluntary (TASK-SPECIFIC)

Answer 11

Dystonia

Question 12

Dystonia

Tx

Answer 12

• chemodenervation (focal) = botox
• oral Rx (lower limb, segmental, generalized) = dopaminergic, antichol, dop depleting, muscle relaxants
• Deep brain stim (severe generalized/segmental)

Question 13

• brief, sterotyped movement / vocalization

* motor/vocal, simple/complex

Answer 13

Tics

Question 14

Tics

Dx

Answer 14

• urge
• relief
• supressible

Question 15

Tics

Who

Answer 15

Childhood, reappear in adult hood

*adult tics abnormal

Question 16

Multiple motor tics + 1 vocal tic starting b/f age 21
*daily/ multiple times per day for AT LEAST 1 year

• Men
• ADHD, OCD, anxiety, depression, phobias

Dx for?

Answer 16

Tics

tourette’s syndrome

Question 17

Tics

Tourette’s

Tx

Answer 17

• Rx - daily
• non-pharm = cognitive behavioral therapy, habit reversal therapy
• Tx comorbidities (psyc specialist) = OCD, ADHD

Question 18

• U = urge to voluntary move limbs (dysesthesia)
• R = Rest induces symptoms
• G = Getting active reduces s/s
• E = Evening + night worsens s/s

Dx

Answer 18

Restless Leg syndrome

Question 19

Restless Leg syndrome

Primary

Answer 19

• middle age

* heredity

Question 20

Restless Leg Syndrome

Secondary

Answer 20

• iron def anemia
• pregnancy

Rxs = caffeine, ADDs, lithium, narc withdrawals, anticonvulsants

Question 21

Restless leg syndrome

Labs

Answer 21

Ferritin 40>

Question 22

Restless Leg Syndrome

Rxs

Answer 22

• 1st line = Dopa ags
• 2nd line = levodopa, gabapentin,
• 3rd = opiates, benzo
• Off-label = topiramate

Alternative = quinine

Question 23

• Involuntary, brief irregular
• Flows from one body part to next
• familial = huntington’s dz
• non-familial = metabolic, others

Answer 23

Chorea

Question 24

Huntington’s dz

Answer 24

• auto-dominant
• 50% chance inherit
• Chrom 4 CAG repeat (>40)
• develop 34-50

Question 25

Huntington's Dz Dx

Answer 25

Clinical pres, family history, GENETIC test

Question 26

Huntington's dzt Tx

Answer 26

Symptomatic/supportive * Chorea = dopa blocker * cognitive = AchE inhibitors, keep routines, other behavior tx * psyc s/s = anti-depressants, anti-psycs * genetic counseling, family support

Question 27

Drug induced involuntary movements

Answer 27

* Tremor * chorea * Parkisonism * mixed-movements SEE SLIDE LIST

Question 28

Tardive Dyskinesias Cause

Answer 28

*Drug-induced involuntary chorieform: (Oral-buccal-lingual movements) = DOPA blockers (anti-psyc meds, metoclopromide)

Question 29

Movement disorder General Path

Answer 29

Disrupted sensorimotor processing: * basal ganglia * cerebellum * thalamus * motor cortex

Question 30

TRIAD: 1) Motor * chorea, poor motor, gait, ESP, etc, 2) Cognitive * exec function loss, dementia 3) Psychiatric * depression, impulsivity, irritability S/s?

Answer 30

Huntington's Dz

Question 31

Tardive Dyskinesia Tx

Answer 31

*Stop/Reduce Rx *add antichol (benzotropine, trihexyphenidyl) *tetrabenzene/Valbenzene BENZes

Question 32

Abnormal movement approach

Answer 32

* ID movement type * Determine onset, trigger, mitigating factor, meds * Make differential