Duke PA Movement Disorders
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| the three constituents of the central motor system | pyramidal, extrapyramidal, and cerebellar
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| the major outflow from the motor cortex to the spinal cord | pyramidal system
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| lesions of the pyramidal system cause | motor weakness (paresis), spasticity, and hyperreflexia
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| movement disorders are caused by __ dysfunction | extrapyramidal and cerebellar function
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| what neurobehavioral symptom is associated with Huntington's disease | dementia
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| what neurobehavioral symptom is associated with Tourette's disorder | obsessive-compulsive, and attention deficit
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| what neurobehavioral symptom is associated with Parkinson's disease | depression
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| increased muscular tone throughout the range of motion | rigidity
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| the superimposition of tremor on underlying rigidity | cogwheel rigidity
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| velocity-dependant resistance to passive movement. resistance increases as the speed of passive limb displacement increases | paratonic rigidity
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| inability to fully relax a limb for passive rang of motion testing | gegenhalten
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| tendency to help out as the examiner attempts to move the limb passively | mitgehen
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| true rigidity always implies __ on the contralateral side | basal ganglia dysfunction
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| most likely cause of resting tremor in an older patient with rigidity and bradykinesia | Parkinson's disese
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| most likely cause of action tremor in a patient without rigidity or bradykinesia | essential tremor
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| disorders of proprioceptive function may result in __ caused by impairment of the spinocerebellar inputs | sensory ataxia
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| transitory loss of motor tone resulting in rapid movement of a joint | asterixis
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| slow writhing movement | athetosis
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| flailing movement | ballism
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| irregular flicking, dancelike movement | chorea
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| the combination of chorea and athetosis | choreoathetosis
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| the combination of irregular flicking, dancelike movement and slow writhing movement | choreoathetosis
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| sustained contortion resulting from excess muscular activity across a joint | dystonia
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| nonspecific term for hyperkinesia | dyskinesia
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| rapid jerking muscular movement | myoclonus
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| semi-suppressible motor or vocal gestural movement | tic
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| rhythmic oscillating movement | tremor
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| diagnostic criteria for Parkinson's disease | tremor, bradykinesia, postural instability, and rigidity
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| leading cause of neurologic disease in individuals older than 65 | Parkinson's disease
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| Lewy bodies are found in what disease | Parkinson's disease
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| mainstay of treatment for advanced Parkinson's disease | carbidopa-levodopa (Sinemet)
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| __ delays the need for levodopa treatment in patients with early Parkinson's disease | selegiline
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| one surgical treatment for Parkinson's disease is deep brain stimulation of the __ | subthalamic nuclei
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| the most common cause of drug-induced parkinsonism is treatment with __ | neuroleptic medication
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| poorly coordinated, broad-based, lurching gate | ataxia
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| abnormal modulation of speech velocity and volume | ataxic dysarthria
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| irregular placement of voluntary limb or ocular movement | dysmetria
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| movement falling short of the intended target | hypometria
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| movement overshooting the intended target | hypermetria
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| breakdown in precision and completeness of rapid alternating movements | dysdiadochokinesis
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| irregularity of the rhythm of rapid alternating movements or planned movement sequences | dysrhythmokinesis
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| inability to perform movement as a coordinated temporal sequence | dyssynergia
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| decreased resistance to passive muscular extension (seen immediately after injury to the lateral cerebellum) | hypotonia
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| tremor orthogonal to the direction of intended movement (tends to increase in amplitude as the target is approached) | intention tremor
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| rhythmic rocking tremor of the trunk and head | titubation
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| medications for Parkinson's disease | anticholinergics, dopamine precursors, dopamine agonists, monoamine oxidase type B, catechol-o-methyltransferase inhibitors
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| drugs causing bradykinesia or rigidity (established) | neuroleptics, metoclopramide, reserpine
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| drugs causing bradykinesia or rigidity (reported) | lithium, phenytoin, ACE inhibitors
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| the most common cause of tremor | essential tremor
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| unlike in Parkinson's disease this is bilateral and is more prominent with action | essential tremor
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| most useful medications for essential tremor | propranolol (Inderal), primidone (Mysoline), and topiramate (Topamax)
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| Parkinson's disease tremor responds better to __ rather than medications used for essential tremor | anticholinergics
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| rare disease that should be in the differential for new-onset hyperkinesia or parkinsonism in the young adult | Wilson's disease
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| inexorably progressive autosomal dominant neurodegenerative disorder affecting motor function, cognition, and behavior | Huntington's disease
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| movement abnormalities associated with Huntington's disease | dystonia, rigidity, postural instability, myoclonus and chorea
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| involuntary contractions of neck musculature resulting in various combinations of twisting, tilting, extension, or flexion | spasmodic torticollis
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| foul language | coprolalia
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| a substantial proportion of children with learning disorders have __ | Tourette's disorder
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| defined as the history of both motor and vocal tics (for more than one year) with onset before the age of 18 | Tourette's disorder
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| __ is not progressive or fatal | Tourette's disorder
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| rhythmic oscillation of a part of the body around a fixed point | tremor
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| most common. arise when attempting to maintain a fixed position | action tremor
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| seen in normal people in movements requiring a high degree of precision or power. Can be caused by fatigue, anxiety, hypoglycemia, hyperthyroidism, drug withdrawal, caffeine, amphetamines, theophylline, lithium, valproate | physiologic action tremor
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| slower frequency than physiologic tremor | essential action tremor
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| first line treatment for essential tremor | beta-blockers (propranolol)
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| effective but sedating treatment for essential tremor | primidone
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| can be used for anxiety induced tremor. | tranquilizers/benzodiazepines (diazepam)
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| absent at rest and at the start of a movement. Increases when fine adjustments are required | ataxic (intention) tremor
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| caused by disease of the cerebellum or its connections | ataxic (intention) tremor
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| treatment for tics (limited by side effects) | haloperidol or pimozide
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| violent flinging movements | hemiballismus
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| usually the result of an infarct in the contralateral subthalamic nucleus of Luys | unilateral hemiballismus
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| shock like contraction of a group of muscles. irregular in rhythm and amplitude. It may involve a restricted group of muscles or be generalized | myoclonus
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| treatment for myoclonus (both have limited efficacy) | clonazepam, valproate
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| may result from anoxic damage, spinal cord injury, uremia, hepatic encephalopathy | myoclonus
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| torticollis, writer's cramp, blepharospasm are examples of | focal dystonias
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| increasingly common and helpful treatment of dystonia | botulinum toxin
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| rest tremor, cogwheeling, rigidity, bradykinesia, difficulty initiating movements, masked facies, stooped posture and shuffling gait, disturbance of postural reflexes | Parkinson's disease
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| pathophysiology of Parkinson's disease | degeneration of the nigrostriatal pathway (connecting the substantia nigra and the striatum). There is a dramatic loss of dopamine containing neurons.
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| side effects of L-dopa/carbidopa | nausea, vomiting, confusion, peak dose dyskinesias and on-off phenomenon
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| act like dopamine at the dopamine receptor. May allow for reduction in the dose of Sinemet required and may decrease on-off problems | dopamine agonists (bromocriptine, pergolide, ropinirole and pramipexole)
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| may increase dopamine release from nerve terminals. weakly effective | amantidine (symmetrel)
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| may be more effective for the treatment of tremor. Side effects include confusion, constipation, dry mouth, urinary retention | anticholinergic drugs
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| autosomal dominant, varying age of onset. Symptoms often begin with psychiatric disorder (immaturity, impulsivity, and depression). Later apathy and dementia. Chorea, athetosis | Huntington's disease
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| __ can be thought of as a dopamine excess state | chorea
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| treatment for Huntington's disease | dopamine receptor blockers such as neuroleptics (haloperidol, chlorpromazine)
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| iatrogenic disorder from long-term treatment with neuroleptics. | tardive dyskinesia
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| signs of __ are abnormal buccal-lingual movements (tongue thrusting and chewing). Head movements including head turning and bobbing can also occur. | tardive dyskinesia
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