Movement disorder

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  • 1. Dr Hardik K ParmarDr Hardik K Parmar Student of Dr S.S.DesaiStudent of Dr S.S.Desai But expression of a well made manBut expression of a well made man appears not only in his face,it is in his limbs and joints also.appears not only in his face,it is in his limbs and joints also. - walt whitman- walt whitman

2. Are the movements that you do not control; you make it so fast that your cerebrum doesnt receive the information. 3. Are the movements which we control. The Nervous System transmits the information of the action to the cerebrum. 4. Reflex:When you blik, when somebody heats you, you shake. Voluntary movements: when you walk, you throw a ball, when you eat, 5. We blink 20.000 times a day. Yawns are contagious. The sneeze is an involuntary movement. 6. Basal ganglia are group of the neuclei located subcorticallywhich take part in motor movements of body. Abnormal increment or decrement in its parts causes various movements disorders. 7. Hyperkinetic hypokinetic Tremor(MC) PD(2nd MC) Chorea Apraxia Dystonia Hypothyroid slowness Ballism rigidity Myoclonus Tics Ataxia myokymia myorrhythmia 8. Hypnogogic myoclonus Benign fasciculation without LMN disorder Physiological tremor Low amp, high freq 9. DISORDER LESION Chorea Striatum, STN(red neucleus) Athetosis Diff hypermyelination of corpus striatum & hypothalamus Dystonia U.K.(Basal motor neuclei) Hamiballismus Hage in C/l STN Rest & postural tremors Mid brain, sup cerebeller pudencle 10. Rhythmic Involuntary movements Of fingers, hand, arms, legs,tongue, or head Due to alternatecontaction and relaxation of oppo mus groups Sometimes they can be so fine that they cant be easily recognised Put a paper on dorsum of an out streched hand MC cause is anxiety OTHERS: Psychogenic,Post traumatic(2- 8 Hz), Rx: Propranolol, Primidone, gabapentine, BZD 11. Athotosis, Ballismus, Chorea & Dystonia Should not be thought as a separate entity but as a different manifestation of same spectrum as they often coexist Tics:cant be suppresed by voluncontrol 12. rapid, brief, shock-like, jerky, involuntary movements May be caused by active muscle contraction - positive myoclonus May be caused by inhibition of ongoing muscle activity - negative myoclonus ( eg. Asterixis ) Generalised - widespread throughout body Focal / segmental restricted to particular part of body Hypnogogic: occurs during sleep 13. Action myoclonous: asso with voluntary movements Reflex/startle: In response to external stimulus Reversible: Renal failure, hypocalcemia D/D from tics: interfere with normal movements & not suppressible 14. Symptomatic i.e secondary to disease process - Neurodegenerative eg. Wilsons disease - Infectious e.g CJD, Viral encephalitis - Toxic e.g. penicillin, antidepressants - Metabolic - anoxic brain damage - hypoglycemia - hepatic failure ( asterixis ) - renal failure - hyponatremia.. And others 15. Valproic acid is drug of choice May respond to benzodiazepines e.g. clonazepam, piracetam, primidone, lamotrignine 16. Rapid, flinging, rotatory, Violent movement of larger amplitude of axial or prox parts of limb, irreguler, U/l, disapp during sleep Almost always unilateral and therefore known as HEMIBALLISMUS Patient may hurt himself Can lead to exhaustion 17. Semi purposive, darting, jerky, short-lasting, centrifugal, affecting limbs (face & tongue sos) Hypotonia + but reflexes are also +nt May be hyperextended joints In the limbs chorea refers more to distal movements ( as proximal movements usually called ballismus) Patients often attempt to conceal involuntary movements by superimposing voluntary movements onto them e.g. an involuntary movement of arm towards face may be adapted to look-like an attempt to look at watch 18. Chorea molles: Marked hypotonia with very minimal involun move Causes: rhumatic fever, encaphalitis huntingtons dis pergnency(chorea graviderum) congenital(rarely) 19. Anoxic brain damage ( post CPR ) Systemic lupus erythematosis Hepatic failure Endocrine - Thyrotoxicosis - Addisons Electrolyte - Low Ca, Mg, - High Na Polycythemia rubra vera 20. Mainly children / adolescents Complication of previous group A streptococcal infection Usually no recent history of infection Acute / subacute onset May have behavioural problems Usually remits spontaneously 21. Chorea of any cause that begins in pregnancy May represent recurrence of Sydenhams chorea. Most commonly associated with anti- phospholipid syndrome +/- SLE Usually resolves spontaneously 22. Dopamine receptor blockers Riluzole: corticostrial glutamate release inhibitor Remacemide: glutamate/NMDA receptor antagonist Co Q 10: UK mecha, possible behavioural improvement Anti convulsant: valproate 23. Slow, snake-like, writhing, worm-like movements of dynamic in nature starting at fingers and then spreades proximally which causes abduction & int rotation of UL Increased on voluntary movements Disapp during sleep Can also affect face and tongue Often use term choreoathetosis due to overlap between syndromes ( chorea referring to less smooth , more jerky movements) Causes: CP, hepatic failure 24. Sustained or repetative involuntary mus contraction freq asso with twisting and assumption of abnormal postures. Due to co-contraction of agonist and antagonist muscles in part of body Can be thought of as an athetoid movement that gets stuck for a period of time; thus, a patient with choreoathetosis may perform an involuntary movement in which his hand and fingers are twisted behind his head. He may hold this position for a few moments before his hand moves back in front of his body. The part of the movement when the limb was held, unmoving, in an abnormal position would be considered a dystonia ( may occur alone). 25. Idiopathic torsion dystonia (oppenheims dystonia) Hereditary and sporadic forms Variable inheritence(AD) DYT 1 gene mutation on Chr-9-protein torsin A High incidence in Ashkenazi Jews Onset may be in childhood / adulthood(