movement disorders

Question 1

Two types of movement disorders:

Answer 1

1. Hyperkinesias: Moving too much

2. Hypokinesias: Moving too little

Question 2

tremor is a

Answer 2

rhythmic oscillatory movement produced by alternating or synchronous contraction of antagonist muscles.

Question 3

important things to note about tremors in patients

Answer 3

1. Position when it happens the most? Resting, action (intentional), postural?
2. Frequency? Slow or fast PD tremor 6 Hz
3. Regular or jerky?

Question 4

Atheotosis –

Answer 4

slow, distal twisting movement

Question 5

myoclonus

Answer 5

sudden, brief, shock-like movement

Question 6

ataxia

Answer 6

poorly coordinated, clumsy movement

Question 7

essential tremor nature of movement

Answer 7

1. Intention tremor: tremor with posture and action
2. Affects UE > LE & head
3. Insidious onset, progresses with age

Question 8

essential tremor can cause

Answer 8

degeneration

Question 9

causes of essential tremor

Answer 9

1. familial and idiopathic
2. unknown pathogenesis
   a. oscillator in thalamus
   b. some role of cerebellum

Question 10

ET first line treatment

Answer 10

1. Primidone – anti-epileptic
2. Propranolol
3. Topamax – anti-epileptic
4. thalamic deep brain stim

Question 11

Postural Tremor: nature of movement

Answer 11

Emergent postural tremor: tremor kicks in after 30sec or more

Question 12

Postural Tremor: associated with

Answer 12

PD

Question 13

Cause of Postural Tremor

Answer 13

Loss of dopaminergic neurons in the direct and indirect pathways

Question 14

Treatment of Postural Tremor

Answer 14

1. Sinemet (L-DOPA + Carbidopa)
2. Dopamine receptor agonists
3. Amantidine
4. Anticholinergic Drugs
5. MAO/COMT Inhibitors
6. Deep brain stim

Question 15

Chin Tremor: Nature of Movement

Answer 15

invariable facial expression

Question 16

Chin Tremor is associated with

Answer 16

PD

Question 17

Cause of Chin Tremor

Answer 17

Loss of dopaminergic neurons in the direct and indirect pathways

Question 18

treatment of Chin Tremor

Answer 18

1. Sinemet (L-DOPA + Carbidopa)
2. Dopamine receptor agonists
3. Amantidine
4. Anticholinergic Drugs
5. MAO/COMT Inhibitors
6. Deep brain stim

Question 19

List Hyperkinesias

Answer 19

1. ET
2. PT
3. CT
4. “flapping tremor” asterixis
5. tics
6. chorea
7. dystonia
8. tourettes