Upload
ainulhawa89
View
10
Download
4
Tags:
Embed Size (px)
DESCRIPTION
kp 3.1 mg3
Citation preview
A. HYPERKINESIA TREMOR Chorea Dystonia Athetosis Tics
B. HYPOKINESIA Parkinsonism Spasticity Drop attack
MOVEMENT DISORDER GENERAL OVERVIEW
TREMOR : rhytmical involuntary oscilations around a fixed point occur at rest
outstretching (postural), during anxiety, caffeine drugs
On action (intention) :Cerebral dysfunctionDrugs (phenitoin)StrokeTrauma
A. HYPERKINESIA
TREMOR
Essential tremor : retlatively benign, embarrasing disorder, familial, sporadic forms, aggravated by stress,excitement
Dystonic tremor : involuntary torsion movement, affected muscle group, movement ussually slow
Resting tremor (Parkinsonism)
Exaggerated physiologic tremor : Small amplitude, high frequency
ESSENTIAL TREMOR
Upper extremity tremor with posture and/or action
Bilateral, usually roughly symmetric
Tremor may produce disability
No clear association with other diseases or disorders
ESSENTIAL TREMOR contd….
TREATMENT
Primodone
Propanolol 10-20 mg/day and other Beta blockers
Tremors of some patients are quite responsive to alcohol, and patients may self-medicate
CHOREA Excessive spontaneous movements , rapid,
arrhytmic movements of muscle group The movement are often incorporated into
deliberate movements by the patient to camouflage their disorder
Irreguler, brief and aburpt non stereotype (non repetitive)
Distal predominance Facial grimacing
A. HYPERKINESIA Tremor
CHOREA Dystonia Athetosis Tics
CHOREA contd….
CAUSES :
Medications Haldol, other antipsychotics Reglan is an important cause of tardive
dyskinesia
Huntington’s disease
Hemibalism
Post-infection
CHOREA
1. Chorea sydenham 2. Huntington disease
1. Chorea sydenham Acute movement Paroxismal Uncoordinated movement Involuntary Emotional disturbances Diminish while sleeping and increase by stress
CHOREA contd….
2. Huntington disease : is a neurodegenerative disease charactized by progresive choreoathetosis, psychological changes
Clinical appearance Choreatic Cognitive dysfunction Gait disorder Clumsiness Speech disorder Bladder and bowel incontinence Sexual dysfunction
CHOREA contd….
TREATMENT
Valproic acid : 15-20 mg/kg/days
Carbamazepine : 10-15 mg/kg/days
Corticosteroid
Dopaminergic blocker : • Halloperidol : 3 -40 mg/days• Primazole
DYSTONIA Dystonia is a slow, purpose, involuntary
movements affecting muscle groups of face, limb, trunk
Agonist and antagonist Clinical findings :
Repetitive twisting and squeezing movements Fixed posture
Caused : Idiopathic (most cases) Drug related :
Antipsychotics and Reglan
A. HYPERKINESIA Tremor ChoreaDYSTONIA Athetosis Tics
ATHETOSIS
A movement charactherized by slow, writhing of groups of muscle
More pronounce in the distal extremities Associated with weakness and rigidity Aggravated by stress Disappears during sleep Athetosis is slower than chorea and may
occur together
A. HYPERKINESIA Tremor Chorea Dystonia ATHETOSIS Tics
TICS Definition : brief, sudden, irresistible,
inapposite, reccurent movement These movements are either isolated or
represent an act for a particular purpose For a time tics can be suppresed or
inhibited Patients often feel actively in performing
a tic Tics can be tiggered by environmental
stimuli, exciting events or life event
A. HYPERKINESIA Tremor Chorea Dystonia Athetosis TICS
PARKINSON’S DISEASE
Parkinson’s disease is a chronic neurodegenerative disease associated with substantial morbidity, increased mortality, and high economic burden
Parkinson’s results from the degeneration of dopamine-producing nerve cells in the brain, specifically in the substantia nigra.
B. HYPOKINESIAPARKINSON Spasticity Drop attack
PARKINSON DISEASE contd….
EPIDEMIOLOGY
The most common movement disorder affecting 1 – 2 % of the general population over the age of 65 years.
Prevalence rate in men are slightly higher than in women
Age onset usually between 50-70 years
Rarely in people less than 30 years old
Incidence is 20 every 100.000 population
PARKINSON DISEASE contd....
RISK FACTORS Age - the most important risk factor Positive family history Male gender Environmental exposure: Herbicide and pesticide
exposure, metals (manganese, iron), well water, farming, rural residence, wood pulp mills; and steel alloy industries
Race Life experiences (trauma, emotional stress,
personality traits such as shyness and depressiveness)?
An inverse correlation between cigarette smoking and caffeine intake in case-control studies
PATHOPHYSIOLOGY
The etiology of parkinson disease is not yet clear
It’s widely believed that genetic and enviromental factor induce neuronal death
The most common pathological feature is degeneration of dopaminergic neurons in pars compacta of substansia nigra
The lost of dopaminergic neuron decreased activity of thalamus,thus reducing excitatory input to motor cortex and initiate ivoluntary movement
The presence of lewy bodies is another classic
pathological finding in parkinson disease
CLINICAL FEATURES
Four cardinal symptoms:
® Resting tremor
® Bradykinesia (generalized slowness of movements)
® Muscle rigidity
® Postural instability
CLINICAL FEATURES contd….
Resting tremor: most common first symptom, usually asymmetric and most evident in one hand with the arm at rest.
Shaking or trembling in the hand, arm, leg, face, and it spreads, sometimes affecting only one side of the body.– Worsen when the muscles are relaxed or individual is
stressed– Dissapears during sleep or during intentionally moved
Bradykinesia: spontaneus and automatic movement are lost and all movement becomes extremely slow. Diffiulty with daily activities such as writing, shaving, using a knife and fork and opening buttons
Decreased blinking, masked facies, slowed chewing and swallowing.
CLINICAL FEATURES contd....
Rigidity: muscle tone increased in both flexor and extensor muscles providing a constant resistance to passive movements of the joints
Stooped posture, anteroflexed head, and flexed knees and elbows.
Postural instability: due to loss of postural reflexes. balance and coordination become impaired.
Patients tend to lean forward or backward, and to develop a stooped posture. Walking with quick and small steps.
ADDITIONAL CLINICAL FEATURES
• Dysfunction of the autonomic nervous system: impaired gastrointestinal motility, bladder dysfunction, excessive head and neck sweating, and orthostatic hypotension.
• Depression: mild to moderate depression in 50% of patients.
• Cognitive impairment: mild cognitive decline including impaired visual-spatial perception and attention
Slowness in execution of motor tasks At least 1/3 become demented during the course
of the disease.
OTHER SYMPTOMS
• Difficulty swallowing or chewing• Urinary problems• Constipation• Irregular sleep• Short breathing
NON-MOTOR FEATURES OF PD :
Include :mental health problems
• depression• psychotic symptoms• dementia
sleep disturbancefallsautonomic disturbance
PARKINSON DISEASE contd….
DIAGNOSIS
No specific test or marker for PD
Diagnosis is made on clinical ground
Depends on the presence of at least two of the three major signs : tremor at rest, rigidity, and bradykinesia.
Bradykinesia is tested by determining how quickly the person can tap the finger and thumb together.
Clinical criteria for diagnosis (by Hughes)
Possible Alt least one of TRAP symptoms (tremor, rigiditas,
akinesia, postur tak stabil)
Probable Combining 2 major symptoms (including postural
instability) or 1 of 3 asymetrical cardinal signs
Definite Combining 3 of 4 major symptoms or 2 symptoms
with another asymetrical symptom (3 cardinal signs)
TREATMENT
The goal of therapy is to reverse functional disability, abolition of all symtoms and signs is not currently possible even with high dose of medication
Treatment highly individualized
no universal first choice drug therapy
choice of adjuvant drug should take into account
• clinical and lifestyle characteristics• patient preference
TREATMENT contd….
1. Supporting treatment Explanation to the patient, giving
support, and and occupational
counseling
education for the patient, in order
obtain general picture of the disease
Emotional support and professsional
counseling
Training in accordance with their
physical condicions
TREATMENT contd….
2. Medication
• Anticholinergic : benztropine mesylate 1-8 mg/day
thyhexyphenidil 3 -6 mg/ day
• NMDA antagonist : amantadine (symetrel) 100-300mg/day
• Dopaminergic : carbidopa+levodopa 10/100mg, 25/100mg,
25/250 mg
• Dopamine agonist : bromocryptine 5-40mg/day
pramipexole 1,5-4,5 mg/day
ropinirole 0,75-2,4mg/day
• COMT inhibitors : entacapone 200 mg/day
• MAO-B inhibitors : selegiline 5 mg/day
TREATMENT contd….
2. Operative treatment
Deep brain Stimulation
2. Rehabilitation treatment: physic, occupation,
speech, psychotherapy
SUGGESTED ACTIONS
make sure there are enoughphysiotherapistsoccupational therapistsspeech and language therapists
PD patients should have regular access to monitoring and alteration of medication a continuing point of contact a reliable source of information
COMPLICATION OF PARKINSON DISEASE
Complication of long-term levodopa therapy Dyskinesia Freezing Falls Response fluctuations
Behavioral / psychiatric disorder Dementia Depression Psycoses
REFERENCE
1. Waters CH. Diagnosis and maanagement of Parkinson’s disease, second edition. Caddo, Professional Communications nc; 1999: 31-71.
2. Basjiruddin A. Management of late’s Parkinson’s disease. In: Sjahrir H, dkk (eds). Parkinson’s disease and other movement disordres. Medan; 2007: 124-43.
3. Wolter’s EC, Bosboom JLW. Parkinson’s disease. In: Wolters et al (eds). Parkinsonism and related disorders. Amsterdam, VU University Press; 2007:143-155.
4. Parkinsons: Clinical features and differential diagnosis. Fahn S, Jankovic J. Principles and practice of movement disorders. Philadelphia, Churchill Livingstone Elsevier; 2007: 79-96.
5. Benazzouz A. Parkinson’s disease and implication of basal ganglia in its pathoophysiology. Egypt, June 2009.
6. NHS National Institu for Health and Clinical Excellence. Parkinson’s disease.June, 2006
7. Jakala P. Parkinson’s disease, finland, 2008