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Movement disorder
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
doesn´t 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.
12. DISORDER LESION
Chorea Striatum, STN(red neucleus)
Athetosis Diff hypermyelination of corpus striatum &
hypothalamus
Dystonia U.K.(Basal motor neuclei)
Hamiballismus H’age in C/l STN
Rest & postural tremors Mid brain, sup cerebeller pudencle
13. 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
14. 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
15. “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
16. 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
18. Valproic acid is drug of choice
May respond to benzodiazepines e.g.
clonazepam, piracetam, primidone,
lamotrignine
19. 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
20. 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
21. Chorea molles:
Marked hypotonia with very minimal involun move
Causes: rhumatic fever,
encaphalitis
huntington’s dis
pergnency(chorea graviderum)
congenital(rarely)
22. Anoxic brain damage ( post – CPR )
Systemic lupus erythematosis
Hepatic failure
Endocrine - Thyrotoxicosis
- Addisons
Electrolyte - Low Ca, Mg,
- High Na
Polycythemia rubra vera
23. 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
24. Chorea of any cause that begins in
pregnancy
May represent recurrence of Sydenham’s
chorea.
Most commonly associated with anti-
phospholipid syndrome +/- SLE
Usually resolves spontaneously
25. Dopamine receptor blockers
Riluzole: corticostrial glutamate release
inhibitor
Remacemide: glutamate/NMDA receptor
antagonist
Co Q 10: UK mecha, possible behavioural
improvement
Anti convulsant: valproate
26. 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
27. 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).
28. Idiopathic torsion dystonia
(oppenheim’s 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(<26yr)
Affects limbs then progress prox
Trial of L-dopa usually initiated
Level of disability variable
29. DRD or segawa variant (DYT 5)
Affects production of tyrosine hydroxylase
and thereby formation of dopamine
1-12yrs, foot dystonias that interefers with
walking which worsens as day progresses and
disapp during sleep
Excellent response to L-dopa
30. Blepharospasm: involuntary forceful closure of eyes
OMD: mus of lower face, lips, tongues
(MEIG’S syn is combo of bleph &OMD)
Torticollis :Tendency of neck to twist to one side.
spasmodic dystonia: involves vocal cords(choking due to
adductor mus involv)
Limb dystonias: writer’s cramps, musician’s cramp
31. Secondary dystonias: neuroleptics, chronic
levodopa Rx, CO poisioning
Dystonia plus syndromes: as a part of other
neurodegenrative disorder HD, PD, Wilson,
CBGD, PSP etc..
33. Recurrent, sterotyped, seemingly purposeless
abnormal movements
May be suppressed voluntarily or with distraction
Voluntary suppression leads to anxiety and a
build-up of internal unrest.
Worsen under stress
35. Movement disorders are often difficult to define precisely, but
have similar differential diagnoses.
They are often a manifestation of a more widespread neurological
or internal medical problem.
Other than the specific treatments mentioned, most details of
therapy are beyond the scope of this lecture
In some cases treatment includes treatment of underlying cause
e.g. Wilson’s disease
36. Harrison’s priciples of internal med
De jong’s neurology
Yellow oza & Dr S.S. desai
Dr Sheetal D vora
