MOVEMENT DISORDERS

MOVEMENT DISORDERS

DYSTONIA:
Paroxysmal, unprovoked, painful contraction of agonist & antagonist muscles around joint, affecting limbs or trunk.
Causes: - genetic
-drug induced
-task specific: ex WRITER CRAMP
Treatment:
Anticholinergics
Botulinum toxin
Deep Brain Stimulation

SPASM:

Painful, Sudden contraction of muscle or group of muscles. (Muscle cramp)
usually provoked by strenuous exercise.

MYOCLONUS

Sudden, shock like jerky movement of a limb or part of body,
Spontaneous or stimulus induced.


CLONUS
Is repetitive, rhythmic, involuntary contractions & relaxations (3-8)Hz around a joint.
Seen in UMNS with DTR examination & in epilepsy.

TREMOR

Rhythmic oscillatory movement, that is best classified :
Rest tremor when occurs in limb in rest.
Action tremor: Postural tremor
Intention Tremor.

ATHETOSIS:

Abnormal, slow, sinusoidal, writhing distal movements.
Usually results from basal ganglial lesion.

CHOREA

Rapid, irregular, involuntary, proximal movements that may affect different body parts.
Involuntary movements are often superimposed by voluntary ones.
Lesion in basal gabglia (caudate).

BALLISMUS

Unilateral, violent (ballistic), choreaic, proximal movements.
Lesion usually subthalamic vascular in nature.


PARKINSON DISEASE
Ideopathic, neurodegenerative disorder affecting the basal ganglia characterized by dopaminergic loss & imbalance between dopaminergic & cholinergic systems.
Prevalence: 1-2/1000, M=F, WITH INCREASNG AGE.
Clinical Presentation:

NMS Non Motor Symtoms:

Precede the onset of motor symptoms by years:
Weight loss
anxiety & depression.
REM sleep behavioural disorder
Become increasing disabling as PD progress.

Motor Symtoms:

BradyKinesia: (hallmark)
Slow movements, reduction in automatic movements.
Mask face, slow monotonus speech (hypophonia), drooling saliva.
Difficult shoelace tying & buttoning.
.Micrographia

Tremor

Rest tremor (pill rolling) or Counting tremor.
4-6 Hz increases at times of emotional stress & improve during voluntary movements..


Rigidity
Increased muscle tone of lead pipe quality in limbs & when mixed with te tremor Cog wheel Rigidity.
Flexed posture.

Postural instability & abnormal gait:

Slow, shuffling, narrow based gait. Loss of arm swing
Difficulty in getting up from bed.
Difficulty in initiation & stoppage (Festinations)
Difficulty on turning.

INVESTIGATIONS

Diagnosis is clinical.
Neuroimaging is NORMAL & rarely helpfyl
Functional CT or MRI

TREATMENT:

I- Physiotherapy & Education

II- Drug therapy: (symptomatic)

a- Dopaminergic Supplementation: (hypokinesia)

Sinemet 1- LEVO DOPA:

Madopar

2- dopa Agosists: Pramipexol

Ropinirol

3- COMT inhibitors: Entacapone

4- MAO-B inhibitors: Selligiline

5-Amantadine

b- Anticholinergics: (tremor & rigidity)

Procyclidine
Trihexphenidyl
Benztropine

III- Surgery:

drug resistant
Thallamotmy & Pallidotomy


IV- DBS deep brain stimulation.