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Movement disorders Dr. Zana A. Mohammed M.B.Ch.B., F.I.B.M.S. University of Sulaimaniah School of medicine.

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Presentation on theme: "Movement disorders Dr. Zana A. Mohammed M.B.Ch.B., F.I.B.M.S. University of Sulaimaniah School of medicine."— Presentation transcript:

1 Movement disorders Dr. Zana A. Mohammed M.B.Ch.B., F.I.B.M.S. University of Sulaimaniah School of medicine

2 What is a Movement disorder? “A disorder which impairs the regulation of voluntary motor activity without directly affecting strength, sensation or cerebellarfunction ” Sometimes also known as “ extrapyramidal disorders”

3 It is a disorder of basal ganglia which are group of the neuclei located subcortically which take part in motor movements of body. Abnormal increment or decrement in its parts causes various movements disorders.

4 Basal ganglia Corpus striatum Caudate NLenticuler NPutamen Globus pallidus Other subcortical neuclei STNSNSNcSNr

5

6 classification

7 Hyperkinetic Movements Tremor (ET-Most common) Tremor (ET-Most common) Chorea/ Athetosis DystoniaBallismMyoclonusTics Hypokinetic Movements Parkinsonism (2nd most common) Apraxia Hypothyroid slowness Rigidity

8 Hyperkinetic Movements

9 Tremor  Rhythmic  Involuntary movements of fingers, hand, arms, legs, tongue, or head  Due to alternate contraction and relaxation of agonist and antagonist muscle groups  Sometimes they can be so fine that they cant be easily recognized –Put a paper on dorsum of an out streched hand May be coarse May be coarse

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11 Common Causes of Tremor Postural Tremor 1.Enhanced physiologic tremor 2.Essential tremor 3.Drugs ( coffee, salbutamol) 4.thyrotoxicosis Rest Tremor 1.Parkinson disease 2.Drug-induced parkinsonism 3.Vascular parkinsonism Kinetic Tremor 1.Cerebellar disease 2.Wilson disease 3.Psychogenic (functional)

12 Ballismus, Chorea, Athotosis and Dystonia These should NOT be thought of as separate entities amenable to specific definition but rather as a SPECTRUM of movements that blend into one-another WHY?

13 Because…….. They often co-exist They often co-exist They often ( with some notable exceptions ) have the same significance in terms of aetiology. They often ( with some notable exceptions ) have the same significance in terms of aetiology.

14 The spectrum BallismusDystoniaChoreaAthetosis Movements become - Less violent / explosive / jerky - Smoother and more flowing - More sustained They differ from tics in that they cannot be suppressed by voluntary control

15 Ballismus Violent “flinging” movement of entirelimb Violent “flinging” movement of entirelimb Almost always unilateral and therefore use term “ HEMIBALLISMUS” Almost always unilateral and therefore use term “ HEMIBALLISMUS” Involves proximal musculature and is sometimes thought of as a “ proximal unilateral chorea ” Involves proximal musculature and is sometimes thought of as a “ proximal unilateral chorea ” Usually due to a stroke in contralateral subthalamic nucleus Usually due to a stroke in contralateral subthalamic nucleus

16 Chorea ( “dance” in Greek) Rapid irregular muscle jerks Rapid irregular muscle jerks May affect limbs, head, face and tongue May affect limbs, head, face and tongue In the limbs chorea refers more to distal movements ( as proximal movements usually called ballismus) 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 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

17 Athetosis “ changeable” in Greek Slow, flowing, often twisting movements Slow, flowing, often twisting movements Occurs mainly distally ( hands, fingers) Occurs mainly distally ( hands, fingers) Can also affect face and tongue Can also affect face and tongue Often use term “ choreoathetosis ” due to overlap between syndromes ( chorea referring to less smooth, more jerky movements) Often use term “ choreoathetosis ” due to overlap between syndromes ( chorea referring to less smooth, more jerky movements)

18 Dystonia “ condition in which the patient assumes a sustained, abnormal posture or limb position” “ condition in which the patient assumes a sustained, abnormal posture or limb position” Due to co-contraction of agonist and antagonist muscles in part of body Due to co-contraction of agonist and antagonist muscles in part of body The part of the movement when the limb was held, unmoving, in an abnormal position would be considered a dystonia ( may occur alone). The part of the movement when the limb was held, unmoving, in an abnormal position would be considered a dystonia ( may occur alone).

19 Classification: focal (single body part); affect one part of the body such as eyes, neck, arm or vocal cords. focal (single body part); affect one part of the body such as eyes, neck, arm or vocal cords. Usually idiopathic Usually idiopathic Most common type Most common type BlepharospasmTorticollis Writer’s cramp Musician’s cramp

20 Hemidystonia affects an arm and a leg on one side of the body. Hemidystonia affects an arm and a leg on one side of the body. Generalized dystonia affects most of the body, frequently involving the legs and back. Generalized dystonia affects most of the body, frequently involving the legs and back.

21 Causes of Chorea, Dystonia and athetosis Hereditary Hereditary Static Encephalopathy ( Cerebral Palsy ) Static Encephalopathy ( Cerebral Palsy ) Drugs Drugs stroke stroke Secondary to medical disorders Secondary to medical disorders Miscellaneous- Sydenham’s chorea Miscellaneous- Sydenham’s chorea - Chorea Gravidarum - Sporadic idiopathic torsion dystonia

22 Anoxic brain damage ( post – CPR ) Anoxic brain damage ( post – CPR ) Systemic lupus erythematosis Systemic lupus erythematosis Hepatic failure Hepatic failure Endocrine- Thyrotoxicosis Endocrine- Thyrotoxicosis - Addisons Electrolyte- Low Ca, Mg, Electrolyte- Low Ca, Mg, - High Na Polycythemia rubra vera Polycythemia rubra vera Secondary to medical disorders (A SHEEP)

23 Myoclonus Brief, isolated, random, non-purposeful jerks of muscle groups in the limbs, may occur normally at the onset of sleep (hypnic jerks).Brief, isolated, random, non-purposeful jerks of muscle groups in the limbs, may occur normally at the onset of sleep (hypnic jerks). May be caused by active muscle contraction May be caused by active muscle contraction - positive myoclonus May be caused by inhibition of on going muscle activity May be caused by inhibition of on going muscle activity - negative myoclonus ( eg. Asterixis ) Generalised - widespread throughout body Generalised - widespread throughout body Focal / segmental – restricted to particular part of body Focal / segmental – restricted to particular part of body

24 Causes Physiologic- Nocturnal ( usually on falling asleep ) Physiologic- Nocturnal ( usually on falling asleep ) - Hiccups Epileptic- Demonstrable cortical source Epileptic- Demonstrable cortical source Symptomatic hypoglycemia Symptomatic hypoglycemia - hepatic failure ( “ asterixis” ) - renal failure - hyponatremia

25 Tics Recurrent, sterotyped abnormal movements Recurrent, sterotyped abnormal movements May be suppressed voluntarily or with distraction May be suppressed voluntarily or with distraction Voluntary suppression leads to anxiety and a build-up of internal unrest. Voluntary suppression leads to anxiety and a build-up of internal unrest. Worsen under stress Worsen under stress

26 Thanks


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