Movement Disorders & Parkinson's Disease Overview

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Questions and Answers

Which of the following features is not typically associated with primary Parkinsonian disease?

Bradykinesia

Postural instability

Rigidity

Positive Babinski sign (correct)

Which statement about Parkinsonian tremors is incorrect?

They are characterized by 'pill rolling' movements.

They occur at rest and during sleep.

They occur mainly when the hands are in motion. (correct)

They increase with emotional stress.

Among the treatment options for Parkinson's disease, which is considered the definitive curative line?

Anti-cholinergic drugs

Only symptomatic treatment is available (correct)

Dopaminergic drugs

L-dopa

Which non-motor impairment is commonly addressed in physiotherapy for patients with Parkinson's disease?

Muscle and joint stiffness Signup and view all the answers

Which of the following diagnostic tests would most likely be used to confirm Parkinson's disease?

PET scan to assess brain function Signup and view all the answers

Which of the following is not typically included in the differential diagnosis for Parkinson's disease?

Common cold Signup and view all the answers

What is the focus of hormonally induced stem cell therapy in the context of Parkinson's disease?

To induce differentiation into dopaminergic neurons Signup and view all the answers

What type of exercise is generally recommended for improving muscle strength in Parkinson's patients?

Strength training with resistance Signup and view all the answers

What is a common side effect associated with the use of anti-cholinergic drugs?

Increased heart rate Signup and view all the answers

Which type of surgery is specifically aimed at controlling contralateral tremors?

Thalamotomy Signup and view all the answers

Levodopa-induced dyskinesia is categorized into which type of dyskinesia that occurs at peak doses?

Peak Dose Dyskinesia Signup and view all the answers

Which drugs are classified as newer dopamine agonists and are noted for being more potent?

Pramipexole and Ropinirole Signup and view all the answers

What is a significant complication associated with deep brain stimulation (DBS)?

Electrode failure Signup and view all the answers

Which combination of drugs is usually prescribed alongside levodopa for enhanced efficacy?

MAO Inhibitors and COMT Inhibitors Signup and view all the answers

What is a potential outcome of gene therapy for treating Parkinson's disease?

Increased production of dopamine Signup and view all the answers

What type of dyskinesia involves abnormal movements at varying times throughout the day?

Biphasic Dyskinesia Signup and view all the answers

What is one of the primary side effects of using dopamine agonists?

Retro-peritoneal fibrosis Signup and view all the answers

Which of the following descriptions best fits the on-off effect experienced by patients on levodopa?

Intermittent fluctuations in mobility and symptoms Signup and view all the answers

Which symptom is characterized by a decrease in facial expression and slowness of voluntary movements in Parkinson's Disease?

Bradykinesia Signup and view all the answers

What is the purpose of using diagnostic imaging like MRI in Parkinson's Disease?

To exclude secondary causes of symptoms Signup and view all the answers

Which non-motor impairment is commonly associated with Parkinson's Disease?

Depression Signup and view all the answers

Which of the following conditions is characterized by rigidity predominantly in the lower limbs and early cognitive impairment?

Vascular parkinsonism Signup and view all the answers

What is the main goal of medical treatment in Parkinson's Disease?

To enhance quality of life and offer symptomatic relief Signup and view all the answers

Which diagnostic test is specifically used to detect dopamine levels in the striatum?

PET or SPECT scans Signup and view all the answers

What is the primary risk factor for young onset Parkinson's Disease?

Genetic mutations in α-synuclein Signup and view all the answers

Which of the following is a common side effect of Levodopa treatment in Parkinson's Disease?

Nausea and vomiting Signup and view all the answers

Which type of motor symptom involves regular, rhythmic oscillatory movements that decrease with voluntary movement?

Tremors Signup and view all the answers

Which of the following is NOT a typical clinical feature of Parkinson's Disease?

Involuntary facial movements Signup and view all the answers

What is the characteristic feature of Lewy Bodies in Parkinson's Disease?

Inclusions with eosinophilic cytoplasm surrounded by a halo Signup and view all the answers

Which treatment strategy for Parkinson's Disease aims to decrease peripheral side effects of dopamine therapy?

Levodopa with a dopa decarboxylase inhibitor Signup and view all the answers

Which of the following non-motor symptoms is associated with REM Behavior Disorder?

Sleep disturbances Signup and view all the answers

Study Notes

Movement Disorders Overview

Movement disorders are a group of neurological conditions causing abnormal involuntary movements.
Parkinson's disease (PD) is a chronic, progressive neurodegenerative disorder.
PD is characterized by a loss of dopaminergic neurons in the substantia nigra pars compacta and locus coeruleus

Parkinson's Disease (PD)

Named after James Parkinson, who published "An Essay on the Shaking Palsy" in 1817.
PD is a chronic progressive neurodegenerative disease affecting movement.
It's characterized by a loss of dopaminergic neurons in the substantia nigra.
PD diagnosis requires a careful neurological examination, blood tests, an MRI scan, and PET/SPECT scans.

Pathophysiology of PD

Significant loss of dopamine in the substantia nigra is a key factor.
This leads to an imbalance between dopamine and acetylcholine levels in the basal ganglia.
Various pathways including mitochondrial dysfunction/oxidative stress, impaired ubiquitin-proteasomal system, and aberrant protein accumulation contribute to PD development.
The presence of Lewy bodies, which are eosinophilic cytoplasmic inclusions, is a hallmark of the disease.
α-synuclein aggregation into Lewy bodies is critically involved.

Epidemiology of PD

Incidence increases dramatically with age, with onset typically occurring in the 50-60+ age group.
Overall incidence is reported as 15-25/100,000.
4-10% of individuals develop PD before reaching 40 years of age; this is referred to as young-onset PD.
Juvenile-onset PD is defined by symptom presentation prior to 20 years old.
PD is slightly more common in males.
Environmental factors such as exposure to pesticides, toxins, and well water, and possibly a family history, may contribute as risk factors.

Clinical Picture of PD

Typical PD presents with an insidious onset and a progressive course, starting unilaterally then becoming bilateral.
Key symptoms include bradykinesia, resting tremors, rigidity, and postural instability.
Other features include difficulty with initiating and performing voluntary movements. Loss of postural reflexes and emotional expression may occur. Problems with gait, including shuffling and short steps are also common.

Non-Motor Impairments in PD

PD often involves non-motor impairments, including:
Autonomic dysfunction (e.g., orthostatic hypotension, sweating dysfunction, sphincter dysfunction, and erectile dysfunction)
Cognitive and neurobehavioral abnormalities (e.g., dementia, depression, anxiety, hallucinations)
Sleep disorders (e.g., REM behavior disorder)
Sensory abnormalities (e.g., olfactory dysfunction, paresthesia, akathisia)

Diagnostic Testing for PD

Careful neurological examination is crucial.
Blood tests can exclude other causes of tremors.
MRI brain scans identify any secondary causes.
PET and SPECT scans measure dopamine levels in the striatum differentiating PD from similar conditions.

Differential Diagnosis of Parkinsonism

Parkinsonian tremors: Distinguishing Essential Tremors, Psychogenic Tremors, and other conditions
Secondary parkinsonism: Differentiating vascular parkinsonism (risk factors, predominant rigidity, pyramidal signs, predominantly affects lower limbs), Post-encephalitic parkinsonism (any age, presence of pyramidal signs, mental changes, other neurological deficits) , Post-traumatic parkinsonism (repetitive head trauma), Drug-induced parkinsonism,Wilson disease, or Hydrocephalic parkinsonism.

Management of PD

Drugs: L-dopa and dopamine agonists, MAO inhibitors, and COMT inhibitors
Gene therapy: Potential therapies using viral vectors.
Surgical Interventions: Stereotactic ablative surgery (thalamotomy, pallidotomy, subthalamotomy or deep brain stimulation (DBS)).
Physiotherapy is a supplemental treatment to manage movement, balance, muscle stiffness, and discomfort.

Goals of Medical PD Treatment

There's currently no cure for Parkinson's disease.
Treatment aims to alleviate symptoms rather than stopping the disease's progression.
The aim is to provide symptomatic relief.
Treatment's goal is to temporarily restore function and enhance quality of life.
Individual responses to medications vary. Specific treatments for specific cases can be discussed based on individual needs.

Movement Disorders Classification

Akinetic-rigidity syndrome: conditions associated with impaired movement, rigidity. Parkinson's, post-encephalitic parkinsonism, etc.
Hyperkinetic-hypotonic syndrome: conditions with abnormal involuntary movements. Chorea, Hemiballism, Athetosis, Dystonia, Myoclonus, Tics, etc.

Specific Movement Disorders

Chorea: Irregular, sudden, brief, and unexpected movements. Common causes include medications (tardive dyskinesia), Huntington's Disease, Hemiballism, post-infectious (Streptococcal), and pregnancy, etc.
Sydenham's chorea: particular type of chorea linked with rheumatic fever. Primarily affects children, with onset appearing months after the infection.
Hemiballismus: Violent and sudden, large-amplitude, unilateral movements typically due to a stroke in the subthalamic nucleus.
Athetosis: Slow, continuous, writhing movements primarily affecting the extremities, often associated with damage to the putamen.
Dystonia: Sustained, involuntary muscle contractions leading to abnormal postures and movements potentially occurring in generalized or focal forms (Blepharospasm (eyes), Oromandibular dystonia (face and mouth), Spasmodic dysphonia (voice), Writer's cramp).
Myoclonus: Sudden, shock-like muscle contractions, either focal, multifocal or generalized; may arise from various conditions ranging from epileptic or non-epileptic.
Tics: Intermittent, repetitive, stereotyped movements or sounds. Mostly in children, resolves spontaneously, however, medical intervention may be required for severe or socially impairing cases.

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Description

This quiz explores the key aspects of movement disorders, with a focus on Parkinson's Disease. Learn about the pathophysiology, symptoms, and diagnostic methods of PD, including the neurological changes involved. Test your knowledge about the impact of these disorders on movement and the brain.