Movement disorders
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The document discusses various movement disorders, classifying them as either hypokinetic-hypertonic (such as Parkinson's disease) or hyperkinetic-hypotonic (including tremors, chorea, dystonia, tics, myoclonus, and ballism). Parkinson's disease is primarily caused by dopamine loss in the basal ganglia. Its treatment involves levodopa drugs and dopamine agonists. Tremors can be essential, physiological, or pathological, and are treated with beta-blockers or anti-epileptics. Dystonia causes abnormal muscle contractions and is treated with medications, botulinum toxin, or surgery. Chorea involves irregular movements and its causes include Huntington's disease and
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Movement disorders
- 3. Functional circuits of the basal ganglia
- 4. Classification of movement disorders • Hypokinetic-hypertonic movement disorders – parkinsonism • Hyperkinetic-hypotonic movement disorders (dyskinesias) – tremor – chorea – dystonia – tics – myoclonus – ballism
- 5. Classification of parkinsonism 1. Primary, idiopathic parkinsonism Parkinson’s disease - 80 % 2. Secondary parkinsonism • drug-induced • toxic • vascular • post-hypoxic • post-encephalitic • post-traumatic 3.Parkinsonism-plus syndromes • Progressive supranuclear palsy • Levy body dementia • Multiple system atrophy • Cortico-basal degeneration
- 7. Pathogenesis of Parkinson’s disease Dopamine loss basal ganglia Neurodegeneration of substantia nigra
- 8. Neurodegeneration in Parkinson’s disease enviromental factors ageing genetic factors oxydative stress excitotoxity lack of protective mechanisms mitochondrial damage loss of nigral cells - loss of dopamine loss of other cell populations - loss of other neurotransmitters APOPTOSIS
- 9. • hypokinesia • rigidity • rest tremor • postural instability Clinical features of parkinsonism
- 11. Diagnostic criteria of Parkinson's disease Hypokynetic-hypertonic syndrome Unilateral beginning of the disease (+) effect of levadopa The absence of postural instability, autonomic symptoms, cognitive disturbances at early stage
- 12. Dopaminergic treatment of Parkinson’s disease COMT catabolism catabolism МАО-В hemato-encephalic barrier L - DOPA decarboxylase inhibitor reuptake dopamine agonists
- 13. Treatment of Parkinson’s disease • Levadopa drugs (nakom, madopar) • Dopamine agonists (mirapex, pronoran) • MAO-B inhibitors (selegiline) • Amantidine (midantan) • COMT – inhibitors • Anticholinergic drugs (ciclodol)
- 17. Surgical treatment of Parkinson's disease • Stereotactic destruction of – thalamus – pallidum • Deep brain stimulation of – thalamus – internal segment of pallidum – subthalamic nucleus • Transplantation of dopamine-producing cells – embrional cells
- 19. Tremor involuntary rhytmic oscillating movements in limbs or the whole body due to alternating contraction of agonist and antagonist muscles
- 20. • Rest (pill-rolling) tremor • Action tremor – postural (occurs during maintenance of a posture ) – kinetic (occurs during voluntary movement ) – intentional (appears in movements and increases near of the aim) Types of tremor
- 21. • Physiological • Pathological: essential tremor Classification of tremor
- 22. • Fatigue • Anxiety • Cold • Hypoglycemia • Hyperthyriodism • Drugs (coffein, steroids) Increased physiological tremor
- 23. Essential tremor • It’s type of postural tremor • Rhythmic, usually symmetric movement in the hands, may involve the head • Autosomal-dominant inheritance • Onset may be in adolescence or early adult years; if it’s develops late – senile tremor • Aggravated by emotional stress, disappears with a small amount of alcohol • Neurological examination is normal except for tremor
- 24. Essential tremor
- 25. • β-adrenoblockers (propranolol) • Anti-epileptic drugs (primidone, clonazepam) Treatment of tremor
- 26. sustained muscle contractions frequently causing twisting and repetitive movement or abnormal postures Dystonia
- 27. Dystonia Focal (affects only one region of the body) Segmental (two adjacent regions) Multifocal (two or more nonadjacent regions) Hemidystonia Generalized
- 28. Dystonia
- 29. Focal dystonia blepharospasm oromandibular dystonia cervical dystonia: torticollis (head rotation), laterocollis (head tilt to one side), anterocollis, posterocollis (flexion or extension of the neck) graphospasm (writer’s cramp) spastic dysphonia toy or foot dystonia Cranial distonia
- 30. • clonazepam • Myorelaxants (baclofen, tizanidin) • Anticholinergic drugs • Botulotoxin (botox, disport) Treatment of dystonia
- 31. is irregular, arrhythmic, unpredictable, jerky movement, which involves the extremities and the face in continuous, random sequence Chorea
- 32. • Hereditary: Huntington disease, Wilson disease • Secondary: Sydenham chorea (rheumatic), infections, encephalitis, systemic lupus erythematosus • Drug-induced chorea: antipsychotic, estrogens, levadopa • Metabolic and endocrine: hyperthyroidism, hyperglycemic non-ketotic encephalopathy • Senile chorea Classification of chorea
- 33. Huntington disease • Autosomal-dominant inheritance • Abnormal irregular rapid jerky movements • Progressive dementia • The gait is unsteady with a tendency to bob and weave • Facial grimacing with involuntary movements of the tongue
- 34. Chorea
- 35. • Psychotic drugs – Haloperidol 3-6 mg daily – sulpiride – sonopax Treatment of chorea
- 36. is involuntary, brief, sudden (till 0,1 sec) muscle contractions producing visible movement Myoclonus
- 37. Essential Symptomatic (Alzheimer disease, Huntington disease, liver disease, paraneoplastic syndromes) Physiological (sleep myoclonus, hiccups) Epileptic Classification of myoclonus
- 38. Myoclonus
- 39. • clonazepam • Valproat acid (depakin) • Carbamazepin, hexamidin • Nootropic drug (pyracetam) in high dosage - 12 g i/v (in posthypoxic myoclonus) Treatment of myoclonus
- 40. - are repetitive, rapid, usually brief involuntary non-rhitmic stereotyped movements, which involve the face, axial muscles and proximal limbs. Tics interrupt normal voluntary motor activity Tics
- 41. • Simple motor (blinking, twitching, shrugging of the shoulders) • Complex motor (handshaking, scratching, kicking, toughing) • Simple vocal (moaning, grunting, hissing, clicking, shouting, throat clearing, sniffing, coughing) • Complex vocal (echolalia, coprolalia) • Generalized (Tourette syndrome) Classification of tics
- 42. Tics
- 43. • Clonazepam, baclofen • Neuroleptics (sonopax, tiaprid) • Haloperidol 0.25-10 mg daily Treatment of tics
- 44. -sudden onset of violent involuntary flinging movements of the limbs. Usually affects only one side of the body (hemiballism). The appearance is similar to a baseball pitcher’s windup. Caused by a lesion of the subthalamic nucleus, usually as a result of stroke Ballism