Movement Disorders - Introduction.docx

**Movement Disorders: Introduction** A screenshot of a computer Description automatically generated **Overview of Movement Disorders** **Classification of Movement Disorders** - Movement disorders can be categorized as hyperkinetic or hypokinetic. - Hyperkinetic disorders include tremor...

**Movement Disorders: Introduction** A screenshot of a computer Description automatically generated **Overview of Movement Disorders** **Classification of Movement Disorders** - Movement disorders can be categorized as hyperkinetic or hypokinetic. - Hyperkinetic disorders include tremors, chorea, dystonia, myoclonus, tics, and stereotypical movements. - Patients can exhibit elements of both hyperkinetic and hypokinetic disorders simultaneously. - Examples like Parkinson\'s disease can show a combination of hypokinetic symptoms like shuffling gait and hyperkinetic symptoms like resting tremors. - Understanding the classification of movement disorders is crucial for accurate diagnosis. **Tremors** - Tremors can be classified into different types based on behavior patterns. - Observing tremors during specific actions can provide clues for differential diagnosis. - Types of tremors include resting tremors (e.g., seen in Parkinson\'s disease) and action tremors (e.g., essential tremor). - Action tremors may indicate cerebellar injury or lesion. - Differentiating between types of tremors is essential for proper diagnosis and management.  **Hyperkinetic Movement Disorders** **Chorea** - Involuntary abrupt, irregular movements of the body. - **Pathophysiology**: Involves damage to the basal ganglia, disrupting motor control pathways and leading to the characteristic jerky movements. - Associated Conditions: - **Huntington\'s Disease**: Caused by CAG trinucleotide repeat expansion affecting the basal ganglia, leading to chorea. - **Wilson's Disease**: Involves copper metabolism issues, presenting with chorea due to basal ganglia damage. - **Kayser-Fleischer Ring**: A characteristic observation around the iris indicative of Wilson\'s Disease, a copper transport disorder leading to chorea. - **Drug-Induced**: Neuroleptics, dopaminergic medications. - **Toxins**: Ethanol, carbon monoxide. - **Thyrotoxicosis**: Hyperthyroidism can induce chorea-like movements. - **Immunological Causes**: Systemic lupus erythematosus (SLE), post-streptococcal conditions, pregnancy-related issues, and vascular conditions like lacunar infarcts affecting the basal ganglia. **Dystonia** - Sustained muscle contractions leading to repetitive twisting movements or abnormal postures. - **Pathophysiology**: Involves dysfunction in the basal ganglia and its connections, disrupting motor control and leading to the characteristic dystonic movements. - Types: - **Focal Dystonia**: Affects specific body parts such as blepharospasms (eyelids), spasmodic dysphonia (voice box), or torticollis (neck). - **Segmental Dystonia**: Involves adjacent body regions. - **Generalized Dystonia**: Affects multiple body regions. - Causes: - **Idiopathic Dystonia**: Primary form without identifiable cause, such as torsion dystonia (autosomal dominant inheritance). - **Secondary Dystonia**: Results from underlying conditions damaging the basal ganglia, including: - Neurodegenerative diseases (e.g., Huntington\'s, Parkinson\'s). - Hypoxic brain injury (anoxia). - Stroke. - Drug-induced (e.g., neuroleptics). A screenshot of a computer Description automatically generated **Myoclonus** - Sudden, lightning-like movements produced by abrupt and brief muscle contractions. - Comparison with dystonia: myoclonus is quick in nature but still results in muscle contractions. - Causes of myoclonus include physiological factors, epilepsy, metabolic conditions, and brain injuries. - Management: - Medications like benzodiazepines (e.g., clonazepam) or antiepileptics (e.g., valproate/valproic acid, known as Depakote) are often used. - Treatment aims to slow down the sudden movements and reduce their frequency. **Tics** - Abrupt, stereotypical, coordinated movements or vocalizations. - **Suppression and Anxiety**: - - **Tourette\'s Syndrome**: - - - - **Coprolalia**: - - - **Management**: - - \_\_\_\_\_\_Top of Form A 75-year-old man presents to your clinic complaining of difficulty maintaining his balance while walking. He has a history of type 2 diabetes mellitus, hypertension, and asthma. A physical examination reveals a shuffling pattern of gait. In addition to his gait, which of the following features is also seen in this condition?Bottom of Form - - Resting tremor Which of the following movement disorders presents with an abrupt onset of involuntary and irregular movements that flow randomly from one part of the body to another? - Huntington disease A 45-year-old man with a history of Wilson disease presents to the clinic for a follow-up. The physical examination shows a sustained muscle contraction, repetitive twisting, and abnormal posturing. Which of the following is the most appropriate description of this presentation? - Hyperkinetic, secondary dystonia