1. MOVEMENT DISORDERS

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

3. Treatment:
Anticholinergics
Botulinum toxin
Deep Brain Stimulation

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

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

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

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

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

9. 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).

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

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

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

13. 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.

14. 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

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

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

17. 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.

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

19. TREATMENT 1-Physiotherapy & Education Occupational therapy
Speech therapy

20. 2-Drug therapy: (symptomatic)
- Dopaminergic Supplementation: (hypokinesia) C
Sinemet LEVO DOPA:
Madopar
Dopa Agosists: Pramipexol
Ropinirol
COMT inhibitors: Entacapone
MAO-B inhibitors: Selligiline
Amantadine

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

22. 3- Surgery:
drug resistant
Thallamotmy &
Pallidotomy

23. 4- DBS deep brain stimulation.
drug resistant