Movement disorders

Movement disorders

Basal ganglia

Cerebellum

Hypokinetic

Hyperkinetic

Ataxia

Range of diseases

Myoclonus Ballismus Tics Chorea Athetosis Dystonia

Movements become

less violent smoother & more sustained

Hypokinetic movements

Hyperkinetic movements

Rigidity TremorChoreaDystoniaBallismusMyoclonusTicsAtaxia

Slow movements Involuntary movements

TremorChoreoathetosis Huntington’s chorea Sydenham’s chorea Wilson disease

HemibalismusMyoclonusDrug induced Dystonia Tardive dyskinasiaParkinson’s diseaseTourette’s syndrome(tics)

Brief description of the followings

Alternating contractions of agonist and antagonist muscles in an oscillating, rhythmic manner

Causes: drugs Thyrotoxicosis cerebellar lesion parkinsonism essential tremor

Tremor

Chorea: irregular, brief , jerky ,unintentional movements , affecting differing parts randomlyAthetosis:slower more writhing movements than choreaThe two often co-exist

Choreoathetosis

Rx of hyperkinetic disodersChoreaDopamine receptor blockersRiluzole :corticostrial glutamate

release inhibitorRemacemide:glutamate/NMDA

receptor antagonistAnti-convulsants:valproate

Huntington’s choreaInherited in autosomal dominant

patternTriad of motor ,cognitive and

psychiatric symptoms

SYDENHAM’S CHOREAMainly in children/adolescentsComplication of previous group A

streptococcal infection resulting in Rheumatic fever

Usually remits spontaneously

WILSON’S DISEASEDegeneration of basal ganglia

accompanied by cirrhosis of the liver.Due to inborn defect in the

metabolism of copper

Asymmetrical variable tremorDystoniaChoreoathetoid movements

Kayser-fleischer ring

Violent form of chorea composed of wild,flinging,large-amplitude movements on

one side of the body

Hemiballismus

Brief,rapid shock-like,jerky movements

consisting of single or repetitive muscle discharges

Myoclonus

Dystonia

Sustained or repetitive involuntary muscle contractions frequently associated with twisting or repetitive movements and abnormal postures.

Rx of hyperkinetic disodersDystonia

Botulinum toxinsDopa depleting agentsDopa antagonistsAnticholinergicsBeclofenAnticonvulsantsSurgical methods

Tardive dyskinesia

Associated with chronic use of neuroleptics

Lingual facial buccal chewing type movements

Rx Tardive DyskinasiaStop the causative drugReduce the dose of causative drugSwitch into alternative therapies ex:

clozapineOther drugs: Benzodiazepines anti-cholinergics suppliments – vitamine E Branched chain amino acids

PARKINSON’S DISEASEPathologyTwo balanced systems are in

place for extra pyramidal control of motor activity at the level of corpus striatum & substantia nigra

Cholinergic Dopaminergic

In parkinson’s disease,there is degeneration of nigrostriatal dopaminergic neurones with depletion of dopamine

Acetyl choline

Dopamine

Normal dopamine level

Low level of dopamine

Basal ganglia

Group of the neuclei located subcortically

Take part in motor movements of body

Substantia Nigra

Unilateral onset, involves both sides of the body as the age advances

BradykinesiaResting Tremor/pill rolling tremorRigidityPosture- instability, falls flexion attitude difficulty initiating or stoppingMasked face

Clinical symptoms & Signs:

Rigidity

Drugs to replenish depleted dopamine

levodopa + dopa decarboxylase inhibitorsCarbidopa(sinemet) & madopar

Drugs to reduce the metabolism of dopamine

COMT inhibitors-entacaponeMAO-B inhibitors-selegiline,rasagiline

Anti-parkinsonian therapies

Dopamine agonistsBromocriptinePergolideRopinirolePramipexoleLisuride

Drugs releasing dopamineAmantidine

Ach receptor antagonistsBenzatropine

TOURETTE’S SYNDROME

Childhood Tic disorderTic: sudden repetitive non rhythmic

movement or vocalization involving discrete muscle groups

Rx of hyperkinetic disodersTics

EducationClonidineGuanafacineAtypical

neuroleptics(resperidone,olanzapine)Typical

neuroleptics(haloperidol,fluphenazine)

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