movement disorders

what is the first step in differential diagnosis

identify if it’s as hypo/hyper kinetic movement disorder

what is the second step in the differential diagnosis

determine the category of the hypo/hyper kinetic MD (broad name)

what are the categories of hypo/hyper MD

parkisons

apraxia

huntingtons

ataxia

myoclonus

dystonia

what is step 3 of the differential diagnosis

describe the symptoms

what is step 4 of the differential diagnosis

describe the possible cause of the disease (neuropathology)

what is step 5 of the differential diagnosis

describe the corse of action (treatment)

what are symptoms of parkinsons

1. tremor at rest

2. bradykinasia

3. rigidity

4. loss of postural reflexes

5. flexed posture

6. freezing

what do these symptoms indicate

1. tremor at rest

2. bradykinasia

3. rigidity

4. loss of postural reflexes

5. flexed posture

6. freezing

parkinsons

how to determine if it is primary parkinsons

excluding all other cause of parkinson’s

what causes drug induced Parkinsonism

from intake of dopamine receptor blocking agents such as antipsychotic

if someone has parkinson’s and had a stoke, has a tumor, or infection what do they have?

secondary parkinson’s arising from a stoke, tumour or infection

what is Parkinsonism plus syndrome

progressive neurodegenerative disorder with Parkinsonism as the main thing but not the only thing

is parkinsons hypo or hyper

hypo

what is juvenile onset parkinson’s

when symptoms start before 21

what is required for a parkinson’s diagnosis

temors at rest or bradykinasia along with 1 or more of

• rigidity

• flexed posture

• loss of postural reflexes

• freezing

how can someone be treated for PD

physical and mental health therapy

medications

surgery

what is the most effective way to treat bradykinesia and rigidity in PD

most responsive to medications

treatment for tremors and loss of postural reflexes in PD

least responsive to treatment

what is the most common medication for PD

L-DOPA

what are the surgical treatments for PD

1. ablative lesions of the GPi/ motor thalamus &/ the STN

2. Deep brain stimulation

3. Brain grafting

what is the proffered surgical treatment for PD

deep brain stimulation

how to know if someone is viable for deep brain stimulation

must be 75 yrs old

dopaminergic responsiveness

troublesome dyskinesia despite optimal mediation

disabling medication resistant tremor

normal MRI

exclude atypical and secondary Parkinsonism

exclude dementia and depression

good medical health

what is Chorea

irregular, flowing, non stereotypical, random involuntary movement

what are the clinal features of chorea

patient can partially or temporary suppress the chorea

parakinesia

motor impersistance

what is parakinesia in chorea

act of camouflaging movement

what are the symptoms of huntingtons disease

chorea

reduced manual dexterity

slowed speech (dysarthria)

swallowing difficulties

balance problems

falls

dystonia

is huntingtons hypo or hyper

hyper

is chorea hypo or hyper

hyper

how to treat huntingtons

you can’t

what is a tic

involuntary

sudden

rapid

repetitive

nonrhythmic

stereotypes moevemnts

vocalization

what are the two classes of tics

simple and complex

what are simple motor tics

typically involve only one muscle group

what are simple vocal tics

do not form words (sounds)

what are complex motor tics

involve a cluster of simple ties or a more coordinated movement

what are complex vocal tics

syllables or phrases

what is echolalia

repetition of other peoples words

what is palilalia

repetitions of ones own words

what is coprolalia

uttering obscene words

what cause tics to happen more

anticipations

emotional upset

fatigue

what tends to cause tics to subside

absorbed in an activity

concentrating

pleases or asleep

what are transient tics

tics present for less than 12 months

what are chronic tics

longer than 12 months

what is Tourette

multiple motor tics and one vocal tic

what is the neuropathology of Tourette

metabolic deragements’s in

• basal ganglia

• orbitofrontal cortex

• dorsolateral prefrontal cortex

• supplementary motor axons

• cingulate cortex

  • sensorimotor cortex

how to treat tics

pharamacolgic

education

behavioural treatments

uscic therapy

what are behavioural treatments for tics

awareness training

relaxation training

conditioning techniques

what is the pharmacological treatment for tics

will aim at decreasing the impairment caused by tics rather than attempting to suppress them

what is myoclonus

uncontrollable jerk

sudden, brief, shock like , involuntary movement

myoclonus with muscle contraction is what

positive myoclonus

myoclonus with muscle inhibition is what

negative myoclonus or asterixis

if the myoclonus is caused by stimulus it is what

reflex myoclonus

if the myoclonus is caused by activity it is what

action mayoclonus

what is physiological myoclonus

occurs in healthy people, like hiccups

what is essential myoclonus

it is isolated