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    Lecture On Movement

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    Hassen Kavi Isse
    Movement disorders involve abnormal movements due to disturbances in voluntary movement or presence of unintended movements. The basal ganglia circuit is important for voluntary movement and consists of striatum, globus pallidus, subthalamic nucleus, and substantia nigra. Hyperkinetic disorders involve excessive spontaneous movements while hypokinetic disorders involve poverty of movement. Parkinsonisms like Parkinson's disease and drug-induced parkinsonism present with tremors, rigidity, and bradykinesia. Other movement disorders include chorea, dystonia, myoclonus, ataxia, tics, and akathisia. Treatment depends on the specific disorder but may include levodopa, dopamine agonists, botulin

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    Lecture On Movement

    Uploaded by

    Hassen Kavi Isse
    47 views29 pages
    Movement disorders involve abnormal movements due to disturbances in voluntary movement or presence of unintended movements. The basal ganglia circuit is important for voluntary movement and consists of striatum, globus pallidus, subthalamic nucleus, and substantia nigra. Hyperkinetic disorders involve excessive spontaneous movements while hypokinetic disorders involve poverty of movement. Parkinsonisms like Parkinson's disease and drug-induced parkinsonism present with tremors, rigidity, and bradykinesia. Other movement disorders include chorea, dystonia, myoclonus, ataxia, tics, and akathisia. Treatment depends on the specific disorder but may include levodopa, dopamine agonists, botulin

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    Movement disorders involve abnormal movements due to disturbances in voluntary movement or presence of unintended movements. The basal ganglia circuit is important for voluntary movement and consists of striatum, globus pallidus, subthalamic nucleus, and substantia nigra. Hyperkinetic disorders involve excessive spontaneous movements while hypokinetic disorders involve poverty of movement. Parkinsonisms like Parkinson's disease and drug-induced parkinsonism present with tremors, rigidity, and bradykinesia. Other movement disorders include chorea, dystonia, myoclonus, ataxia, tics, and akathisia. Treatment depends on the specific disorder but may include levodopa, dopamine agonists, botulin

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    47 views29 pages

    Lecture On Movement

    Uploaded by

    Hassen Kavi Isse
    Movement disorders involve abnormal movements due to disturbances in voluntary movement or presence of unintended movements. The basal ganglia circuit is important for voluntary movement and consists of striatum, globus pallidus, subthalamic nucleus, and substantia nigra. Hyperkinetic disorders involve excessive spontaneous movements while hypokinetic disorders involve poverty of movement. Parkinsonisms like Parkinson's disease and drug-induced parkinsonism present with tremors, rigidity, and bradykinesia. Other movement disorders include chorea, dystonia, myoclonus, ataxia, tics, and akathisia. Treatment depends on the specific disorder but may include levodopa, dopamine agonists, botulin

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 29

    Movement Disorders

    Movement disorders
    Are neurologic syndromes in which
    abnormal movements (or dyskinesias)
    occur due to a disturbance of fluency &
    speed of voluntary movement or the
    presence of unintended extramovements
    Anatomic & physiologic
    consideration
    Basal Ganglion: are paired subcortical gray matter
    structures that are important in voluntary movements & making
    postural adjustment.

    They consist of;


    Striatum (putamen & caudate)
    Globus pallidus (internal & external)
    Subthalamic neuclus
    Substantial nigra (parscompacta & parsreticula)
    BASAL GANGLIA CIRCUITRY
    Symptoms of BG diseases
    Hyperkinetic movement disorders
    an excessive amount of spontaneous motor activity is seen or in which
    abnormal involuntary movements occur

    Hypokinetic movement disorders


    characterized by akenesia or bradykinesia in which purposefull motor
    activity is absent or reduced. “Poverty of movement”
    HYPOKINETIC
    Movement Disorders --
    Parkinsonisms
    Parkinson’s Disease
    Diffuse Lewy Body Disease
    Multiple Systems Atrophy (+/- Ataxia)
    Progressive Supranuclear Palsy
    Corticobasal Degeneration
    Vascular Parkinsonism
    Post Traumatic Parkinsonism
    Secondary (Toxin, Medication, Metabolic)
    PARKINSONISMS
    Idiopathic Parkinson’s Disease
    Usually Asymmetric
    Cardinal Signs
    – Tremor
    – Rigidity
    – Bradykinesia
    Levodopa Responsive
    Later Findings
    – Postural Instability
    – Levodopa-unresponsive gait disorder
    – Non Motor Features (Depression, Sexual Dysfunction,
    Cognitive Dysfunction of Variable Severity)
    Drug Related Parkinsonism
    Antipsychotic medications (typical,
    eg.haloperidol) cause symmetric findings
    that are indistinguishable at times from
    Idiopathic Parkinson’s Disease

    Reglan (metoclopromid) is a dopamine


    blocker and is an important cause of
    Parkinsonism in elderly patients (currently
    used as an anti-nausea medication)
    HYPERKINESIAS
    Hyperkinesias and Dyskinesias
    Tremor
    Chorea
    Dystonia
    Myoclonus
    Ataxia and Dysmetria
    Stereotypies and Tics
    Akathisia
    Myokymia and Synkinesias
    Restless Legs
    Periodic Hypnogogic Movements (PLMS)
    Movement Disorders -- Tremor
    Essential Tremor
    – Limbs, Head, Voice
    Dystonic Tremor
    – Task Specific Tremors
    Midbrain Outflow Tremors
    – Cerebellar Tremor
    – Rubral Tremor
    Rest Tremor (Parkinsonism)
    Orthostatic Tremor
    Exaggerated Physiologic Tremor
    – Caffiene, Medication Withdrawal
    Other (Drug Related Tremor)
    Essential Tremor
    Common
    Upper Extremity Tremor with Posture and/or
    Action
    Bilateral, usually roughly symmetric
    Typically of Long-Standing Duration
    Other Areas May Be Involved
    – Head or Jaw
    – Voice
    – Lower Extremities
    Tremor may produce disability, but often doesn’t
    No clear association with other diseases or
    disorders
    Myoclonus
    Not a Tremor
    Sudden, shock-like muscle contractions
    Focal, Multifocal, or Generalized
    May be regular and rythmic, but usually
    irregular and jerky
    Epileptic or Non-Epileptic
    – Cortical (Epileptic)
    – Brainstem or Spinal Segmental (Non-
    Epileptic)
    Chorea
    Excessive Spontaneous Movements
    Irregular, Random, Brief and Abrupt
    Non-repetitive
    Distal Predominance
    Flitting randomly from one body part to another
    Purposeless, but may be disguised
    (parakinesias)
    Facial grimacing and abnormal respiratory
    sounds
    Chorea -- Causes
    MEDICATIONS (e.g. tardive dyskinesia)
    – Haldol, other antipsychotics
    – Reglan is an important cause of tardive
    dyskinesia
    Huntington’s Disease
    Hemiballism (Stroke)
    Post-Infectious (Strep Infection)
    Pregnancy
    Other Disorders
    Tics
    Semi-voluntary (e.g. suppressible),
    rapid,non-rythmic movements or sounds
    Background of normal activity
    Associated Compulsions
    May be associated with OCD
    Occasionally tics are disabling, but the
    OCD is usually the more disabling
    condition, if it exists
    Dystonia
    Sustained, patterned muscle contractions
    Agonists and Antagonists
    Clinical Findings
    – Repetitive Twisting or Squeezing Movements
    – Fixed Postures
    Localization
    – Focal
    Face (Blepharospasm and Meige Syndrome)
    Neck (Cervical Dystonia)
    Limbs (Task Specific Dystonias)
    – Segmental
    – Generalized
    Causes of Dystonia
    Idiopathic (Most Cases)
    DRUG RELATED
    – Antipsychotics and Reglan
    Genetic (DYT-1 Gene)
    Structural
    – Trauma
    – Stroke
    – Multiple Rare Diseases
    Ataxia
    Symptomatic Interruption of the Cerebellar
    Pathways
    – Dysmetria (Poor targeting of planned movements)
    – Dysdiadochokinesia (Poor sequencing of planned
    movements)
    – Intention Tremor (Past Pointing)
    Gait Abnormalities
    – Wide based gait
    – Poor balance
    “Drunken Sailor’s Walk”
    Causes of Ataxia
    Lesion in the following areas of the brain
    – Cerebellum
    – Pons
    – Midbrain (Red Nucleus)
    – Olivary Nucleus
    – Thalamus (Cerebellar Inflow Nucleus)
    Causes of Ataxia
    Acute intoxication (Alcohol, Dilantin, others)
    Chronic Substance Abuse (including Alcohol)
    Stroke
    Multiple Sclerosis
    Brain Tumors
    Genetic Ataxias
    – Autosomal Dominant Ataxias
    – Autosomal Recessive Ataxias
    Metabolic
    – Vitamin E, Thiamine,
    Multiple Systems Atrophy
    Treatment of Parkinson’s Disease

    Levodopa and Dopamine Agonists

    Amantidine, MAO-B Inhibitors

    Deep Brain Stimulation (Subthalamic


    Nucleus, Globus Pallidus Interna)
    Treatment of Dystonia

    Artane, Valium, occasionally Baclofen

    Botulinum Toxin Injection

    Deep Brain Stimulation (Globus Pallidus


    Interna)
    Treatment of Essential Tremor

    Primidone

    Propanolol and other Beta Blockers

    Deep Brain Stimulation (Thalamus)

    Tremors of some patients are quite responsive


    to alcohol, and patients may self-medicate
    Treatment of Tardive (Post
    Dopamine-Blockade) Movement
    Disorders
    PREVENTION
    Dopamine Depleting Agents (Difficult to Obtain
    in the U.S.)
    Ramp up dopamine blockade (often worsens the
    underlying pathologic process)
    Life Long Botulinum Toxin Injections
    Deep Brain Stimulation
    Complications of Dopamine
    Blocking Agents
    Reversible? Sequelae Include
    – Tremor
    – Parkinsonism
    Permanent and Difficult to Treat Sequelae
    Include
    – Tardive Dyskinesia (Chorea-like syndrome)
    – Tardive Akathisia
    – Tardive Dystonia (Long Term Botox, may need DBS)
    DEEP BRAIN STIMULATION

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