MOVEMENT DISORDERS

DYSTONIA: Paroxysmal, unprovoked, painful contraction of agonist & antagonist muscles around joint, affecting limbs or trunk. Causes: - genetic -drug induced -task specific

Treatment: Anticholinergics Botulinum toxin Deep Brain Stimulation

SPASM: Painful, Sudden contraction of muscle or group of muscles. (Muscle cramp) usually provoked by strenuous exercise.

MYOCLONUS Sudden, shock like jerky movement of a limb or part of body. Spontaneous or stimulus induced. Of cortical or spinal pathology

CLONUS Is repetitive, rhythmic, jerky, involuntary contractions & relaxations (3-8)Hz around a joint. Seen in UMNS with DTR examination & in epilepsy.

TREMOR Rhythmic oscillatory movement, that is best classified : Rest tremor when occurs in limb in rest. Action tremor: Postural tremor Intention Tremor.

ATHETOSIS: Abnormal, slow, sinusoidal, writhing distal movements. Usually results from basal ganglial lesion.

CHOREA Rapid, irregular, involuntary, proximal movements that may affect different body parts. Involuntary movements are often superimposed by voluntary ones (Semipurposeful). Lesion in basal gabglia (caudate).

BALLISMUS Unilateral, violent (ballistic), choreaic, proximal movements. Lesion usually subthalamic vascular in nature.

PARKINSON DISEASE Ideopathic, neurodegenerative disorder affecting the basal ganglia characterized by dopaminergic loss & imbalance between dopaminergic & cholinergic systems.

Prevalence: 1-2/1000, M=F. WITH INCREASNG AGE increase the prevalence.

Clinical Presentation NMS Non Motor Symtoms: Precede the onset of motor symptoms by years: anxiety & depression. REM sleep behavioural disorder Become increasing disabling as PD progress.

Motor Symtoms: BradyKinesia: (hallmark) Slow movements, reduction (hypokinesia) in automatic movements. Mask face, slow monotonus speech (hypophonia), drooling saliva. Mayerson sign. Glabellar Tap. Difficult shoelace tying & buttoning. Micrographia

Tremor Rest tremor (pill rolling) or Counting tremor. 4-6 Hz increases at times of emotional stress & improve during voluntary movements..

Rigidity Increased muscle tone of lead pipe quality in limbs & when mixed with the tremor (Cog wheel Rigidity). Flexed posture (Camptocormia).

Postural instability & abnormal gait: Slow, shuffling, narrow based gait. Loss of arm swing Difficulty in getting up from bed. Difficulty in initiation & stoppage (Festinations) Difficulty on turning.

INVESTIGATIONS Diagnosis is clinical. Neuroimaging is NORMAL & rarely helpful Functional CT or MRI

TREATMENT 1-Physiotherapy & Education Occupational therapy Speech therapy

2-Drug therapy: (symptomatic) - Dopaminergic Supplementation: (hypokinesia) C Sinemet LEVO DOPA: Madopar Dopa Agosists: Pramipexol Ropinirol COMT inhibitors: Entacapone MAO-B inhibitors: Selligiline Amantadine

b- Anticholinergics: (tremor & rigidity) 1 Procyclidine Trihexphenidyl Benztropine

3- Surgery: drug resistant Thallamotmy & Pallidotomy

4- DBS deep brain stimulation. drug resistant