MOVEMENT DISORDERS 2

MOVEMENT DISORDERS

DYSTONIA:
Paroxysmal, unprovoked, painful contraction of agonist & antagonist muscles around joint, affecting limbs or trunk.
Causes: - genetic
-drug induced
-task specific

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.

Of cortical or spinal pathology

CLONUS

Is repetitive, rhythmic, jerky, 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 (Semipurposeful).

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 increase the prevalence.

Clinical Presentation

NMS Non Motor Symtoms:

Precede the onset of motor symptoms by years: anxiety & depression.

REM sleep behavioural disorder

Become increasing disabling as PD progress.

• Motor Symtoms:
BradyKinesia: (hallmark)
Slow movements, reduction (hypokinesia) in automatic movements.


Mask face, slow monotonus speech (hypophonia), drooling saliva.
Mayerson sign. Glabellar Tap.

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 the tremor

(Cog wheel Rigidity).

Flexed posture (Camptocormia).

• 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 helpful

Functional CT or MRI

TREATMENT

1-Physiotherapy & Education
Occupational therapy
Speech therapy

• 2-Drug therapy: (symptomatic)

- Dopaminergic Supplementation: (hypokinesia)
C


Sinemet LEVO DOPA:
Madopar

Dopa Agosists: Pramipexol

Ropinirol

COMT inhibitors: Entacapone

MAO-B inhibitors: Selligiline

Amantadine

b- Anticholinergics: (tremor & rigidity)

1
Procyclidine
Trihexphenidyl
Benztropine

3- Surgery:

drug resistant


Thallamotmy &

Pallidotomy

• 4- DBS deep brain stimulation.

drug resistant