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Flashcards in Movement disorders Deck (82)
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1

what is the role of the basal ganglia

initiation and modulation of movements

receives input from cerebral cortex and relays it back to the cerebral cortex via the thalamus via direct (enhance outflow of thalamus) or indirect (inhibits thalamus outflow) pathways

2

what are the two types of movement disorders

hypokinetic (too little movement)
hyperkinetic (too much movement)

3

what descending pathway do basal ganglia disorders affect

extra pyramidal

4

what features are seem in pyramidal (corticospinal)/ UMN lesions

pyramidal weakness= arms: extensor weaker than flexor
legs: flexors weaker than extensors

spascticity

5

what are the features of a extrapyramidal/ basal ganglia lesion

hyperkinetic:
-dystonia
-tics
-myoclonus
-chorea
-tremor

hypokinetic:
-parkinsonism

6

what are the motor features of a cerebellar lesion

ataxia- lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes and abnormalities in eye movements

7

what is the most common neurodegenerative disease

alzeheimers, followed by parkinsons

8

what is the pathology of parkinsons

loss of black pigment correlating to the degeneration of dopaminergic neurones in basal ganglia (substantia nigra (pars compacta region) and locus coeruleus)

presence of lewy bodies

9

what causes parkinsons

idiopathic
advancing age
genetic and environmental factors
5% familial

10

what are the clinical features of parkinsons

tremor (resting, slow reemergence of tremor when in posture, often asymmetrical)
bradykinesia
rigidity
postural instability

non motor:
sleep disorders (RBD)
hallucinations
GI dysfunction (constipation)
depression
cognitive impairment
dementia
anosmia

11

what are the three subtypes of parkinsons motor features

1. tremor dominant (with relative absence of other motor symptoms)
2. non tremor dominant (such as akinetic, rigid syndrome, postural instability)
3. mixed

12

which motor subtype of parkinsons has the best prognosis

tremor dominant has slowest progression and less rate of physical disability

13

what are the common pre motor/ prodromal symptoms of PD

constipation, RBD, excessive daytime sleepiness, hyposmia, depression

14

how do you test bradykinesia

finger tapping
will have decrements in amplitude/ speed of movement and fatiguing

15

what are the features of advanced PD

urinary symptoms
orthostatic hypotension
dementia
dysphagia
postural instability
freezing of gait
falls
fluctuations
dyskinesia
psychosis

16

what are the essential features for a PD diagnosis

bradykinesia and one more of the following: resting tremor, rigidity (cog wheel or lead pipe), postural instability).

Additional motor features: stooped, fixed posture, dystonic postures, hypomimia (masked face), shuffling, short stepped gait (+/- festination= running after their centre of gravity).

Additional non motor: late onset hyposmia, depression, anxiety, constipation, bladder problems, pain, subtle mental or cognitive impairment

17

what should patient with suspected PD not present with

early onset bulbar problems (CN 9-12)
dementia
hallucinations
preferential involvement of lower limbs
prominent eye movement disorder (e.g. supranuclear palsy= problems in voluntary upwards and downwards movement)
intrusive early autonomic problems (e.g. bladder control)

18

what imaging can be done for a PD diagnosis

brain imaging
DaTSCAN (nuclear medicine presynaptic dopaminergic imagine- if comma shaped = possible essential tremor. If period shape= possible parkinsons tremor)

19

who gets parkinsons

all ethnicities
men more likely
old age

20

what are the risk factor for parkinsons

old age
family Hx
male
environmental:
-pesticides
-head injury
-rural living
-beta blocker use
-farmer
-well water drinker

21

what decreases you risk of parkinsons

tobacco smoking
coffee drinking
NSAID use
CCB use
alcohol consumption

22

what are the monogenic forms of parkinsons

LRRK2
PARKIN

23

what do symptomatic treatments do in PD

enhance intracerebral dopamine concentrations/ stimulate dopamine receptors

24

what are the symptomic PD drugs

levodopa (best, given >65/70s)
dopamine agonists (if patient young)
monoamine oxydase type B inhibitors (adjuvant/ early disease)
amantadine (NMDA antagonist)

25

when should you start Tx in parkinsons

when symptoms cause disability/ discomfort

26

what in PD responds well to dopaminergic treatment

bradykinesia and rigidity in early phase of disease
tremor is inconsistently responsive

27

what drugs can be effective for tremor

anticholinergics
trihexphenidyl
clozapine

28

what type of drug is levodopa and cardibopa

levo- dopamine precurosor
carbi- carboxylase inhibitor

29

what are the side effects of PD medications

dopamine agonists and levodopa- nausea, daytime somnolence, oedema

dopamine agonists- impulse control disorders (gambling, hypersexuality, binge eating, spending) - avoid in Hx of addiction/ impulsive personality. hallucinations (avoid in elderly with CI)

levodopa best symptomatic benefit but longterm use is associated with motor complications (dyskinesia and motor fluctuations)

30

what are the long term complications of dopamingeric therapies for PD

motor fluctuations- (periods of good and bad motor symptom control)

non motor fluctuations

dyskinesia (involuntary choreiform or dystonic movements)- happens when levodopa is at highest conc

drug induced psychosis- hallucinations