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Movments D/O

Clinical Medicine II-Spring 2012

How do we diagnose movement disorders after r/o other causes such as drugs, lesions, systemic illnesses
Overall tx of a movement d/o symptomatic
Three classifications of abnl movement Impaired voluntary: paralysis, ataxia, impaired motor planning, abnl muscle tone: spasticity, rigidity, involuntary movements: tremor, chorea/athetosis/dystonia, tics/myoclonus
Dance like movement uncontrolled chorea
Twisting, rotational involuntary movement athetosis
Myoclonic movement falling asleep in class and jolting awake: nl, not nl is involuntary happening frequently
Where is the parkinson’s belt upper Midwest, most per capita is in ND
Pathology of Parkinson’s sustantia nigra: dopamine producing cells→by product is melonin linked to parkinson’s movements?
With someone is having parkinson’s movements, what should we look for skin cancer: melanoma
Cause of parkinson’s both environmental and possibly genetic, not set and stone pathology
At dx, how much damage is happening ~70 at start of of sxs, slow onset, hard to dx sometimes
Core motor features of Parkinson’s resting tremor, bradykinesia, rigidity, posture/balance changes
Pt’s with simultaneous PD, dementia, and hallucinations lewy body dz
Sxs with rididity of trunk, falling, unable to look up/down supranuclear palsy-no tremor
How do we test for PD can’t actually test for it, just r/o other causes, r/I by clinical sxs: give them a PD drug see if +result
What is the tx for PD no tx just treat the symptoms, MC levodopa (dopamine), or dopamine agonists,
SE’s of levodopa nausea, postural hypotension, dyskinesia, motor fluctuations
As dz progresses, what happens to sxs need more meds, cells die, need more dopamine, sxs: tremors/can’t move, take pills, control, dyskinesia,then can’t move again
When do the motor complications of PD start 3-10yrs post start of levodopa: dyskinesias
What does deep brain stimulation do high frequency pulsatile, to “ablate” the overactive nerves, targets the nucleus (subthalamic)
When do we do the DBS to the brain middle dz when drugs aren’t nearly as effective, but before in nursing home
What are some sxs that will precede the motor sxs of parkinsons REM, constipation, loss of smell
Cause of death in pt’s w/ PD pulmonary infx/aspiration, UTI, PE, complications w/ falls and fxs
Classification of Essential tremor Action or postural tremor or kinetic with tasks, can move to rest post action
Two most common places to see E.T. Hands and voice, usually bilaterally
Secondary criteria for identifying E.T long duration to dx, Fhx, beneficial response to EtOH
What can a “neck tremor” be contraction of sternocleidomastoid muscle: torticollis
Cause of E.T and Dx Genetic, Fhx, Dx: clinical hx, movement tremor,
Tx for E.T. none, life modifications, wrist weights, biofeedback, BB’s primidone, benzodiazepines, thalamic DBS
Desire to move in association w/ paresthesias/dysethesias of the limbs Restless legs syndrome
Is jerking while sleeping at night RLS? no it is most likely nocturnal myoclonus
Two types of RLS idiopathic, or secondary RLS d/t renal failure, DB neuropathy, RA, radiculopathy, preggo, iron def,
Pathophysiology of RLS CNS abnormality, dopamine dysfx, endogenous opiate system
Why does iron deficiency cause RLS iron a cofactor for dopamine production
Tx RLS tx underlying dz, remove potential aggravators, ↑sleep hygiene, relaxation techniques, Dopamine agonists 1st line drug
Problem with shorter length drugs Levodopa: sxs will start occurring more and more throughout the day
When would we use opioids for RLS tx usually only when there are other sxs with pain
Neurologic movement d/o w/ sustained muscle contractions that cause twisting or repetitive movements w/abnl sometimes painful, postures or positions Dystonia
What is primary dystonia only sign, no specific pathology, DYT1 mutation inheritation
What is secondary dystonia from drugs, w/ parkinsonism, psychogenic causes
5 types of dystonia focal, segmental, multifocal, generalized, hemidystonia
MC types of focal dystonia laryngeal dystonia
Tx of dystonia botox, inject while in a flexed position, just enough to relax/paralysis the muscle good for focal
How do we dx dystonia r/o other causes
Dry eye syndrome or tics blepharospasm
Subtypes of dystonia Blepharospasm, cervical dystonia, writer’s cramp
What is a sign associated with problems in Upper motor neurons Babinski sign + for spasticity
What signs are associated w/ spasticity muscle shortening, motor weakness, + Babinski, muscle overactivity
Tx of spasticity oral meds, muscle relaxants: careful d/t weakness in muscles can turn into jelly, PT, Denervation, intrathecal drug delivery, botox,
What is poor coordination, examples? ataxia, dysmetria of eye movements, nystagmus, dysarthria, limb dysmetria, gait ataxia
Trouble forming words dysarthria
When does ataxia occur anytime from many causes
Workup of ataxia look for underlying causes and treatable conditions, Brain MRI: detect cerebellar atropy and lesions
DDx of Ataxia toxins, paraneoplastic cerebellar syndrome, sporadic cerebellar degeneration or hereditary
Tx of ataxia supportive, assistive devices
What diz has chorea or involuntary movements, later dystonia, and voluntary motor dyscontrol, cognitive, and emotional d/o Huntinton’s disease
Dx and patho of HD gene test, autosomal dominant, attacks the caudate nucleus and putamen, and secondary atrophy in the brain
When does HD set in age 30-40, survival about 15-20yo
Tx HD none, tx sxs: antipsycotic or dopamine antagonists, therapy: PT, OT, speech, nutrition, social services
What is the genetic testing for HD repeated CAG (poly Q) in the HD gene, blood test
Created by: streetsmarts
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