Scribd
Upload
48 views

Disorders of Movement

The document discusses movement disorders and provides guidance on evaluating patients presenting with these conditions. It emphasizes that obtaining a thorough history is important for determining the nature and cause of the movement disorder. It then categorizes movement disorders as either hypokinetic, involving a loss of movement, or hyperkinetic, involving excessive or abnormal movements. Specific movement disorders like Parkinson's disease, essential tremor, chorea, ballism, myoclonus, tics, myokymia, and dystonia are then defined. The document concludes by discussing approaches to diagnosing and treating common movement disorders.

Uploaded by

Naghib Bogere
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
48 views

Disorders of Movement

The document discusses movement disorders and provides guidance on evaluating patients presenting with these conditions. It emphasizes that obtaining a thorough history is important for determining the nature and cause of the movement disorder. It then categorizes movement disorders as either hypokinetic, involving a loss of movement, or hyperkinetic, involving excessive or abnormal movements. Specific movement disorders like Parkinson's disease, essential tremor, chorea, ballism, myoclonus, tics, myokymia, and dystonia are then defined. The document concludes by discussing approaches to diagnosing and treating common movement disorders.

Uploaded by

Naghib Bogere
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 31

Disorders of Movement

MARTIN HARLEY
NEUROLOGY
Educational Objectives

 Improved history taking in patients with movement


disorders.
 Develop a systematic approach to observing and
describing movement disorders.
 Understand the vocabulary used to describe
movement disorders.
 Formulate differential diagnoses based on the
history and examination.
 Begin to consider further investigations and
management.
It’s (almost) all in the history

• Time course
• Functional disability
• Past medical history, including infections and
toxin exposures
• Drug history (current, previous, recreational)
• Alcohol responsiveness
• Family history
• Neuropsychiatric features
• Autonomic symptoms
• Sleep problems
It’s (almost) all in the history

• Do specific actions provoke the movement?


• Do the movements occur during sleep?
• Are there any associated sensory symptoms?
• Can the movements be suppressed?
• Are there aggravating or alleviating factors?
Observation before formal examination

 What is there gait like?


 Any involuntary movement?
 Facial expression
 Spontaneity of movement
 Blink frequency

 BP assessment including
orthostatic change
 Gross cognitive assessment
Movement disorders - categorisation
Movement disorders - categorisation

 Hypokinetic movement disorder - a partial or


complete loss of voluntary muscle movement.
 Hyperkinetic movement disorder - an increase in
muscular activity that can result in excessive
abnormal movements, excessive normal movements,
or a combination of both.
Movement disorders - categorisation

Hypokinetic Movements Hyperkinetic Movements


 Idiopathic Parkinson’s  Essential tremor
 Drug induced  Chorea
Parkinsonisim
 Dystonia
 Multi-system atrophy
 Ballism
 Progressive Supernuclear
Palsy  Myoclonus
 Corticobasal Degeneration  Tics
 Dementia with Lewy  Myokymia
bodies
Parkinsonisim

 Tremor at rest
 Bradykniesia
 Rigidity
 Flexed posture of the
neck, trunk and limbs
 Loss of postural reflexes
 Freezing
Parkinsonisim

 Tremor at rest
 Bradykniesia
 Rigidity
 Flexed posture of the
neck, trunk and limbs
 Loss of postural reflexes
 Freezing
Parkinsonisim

 Tremor at rest
 Bradykniesia
 Rigidity
 Flexed posture of the
neck, trunk and limbs
 Loss of postural reflexes
 Freezing
Parkinsonisim

 Tremor at rest
 Bradykniesia
 Rigidity
 Flexed posture of the
neck, trunk and limbs
 Loss of postural reflexes
 Freezing
Parkinsonisim

 Tremor at rest
 Bradykniesia
 Rigidity
 Flexed posture of the
neck, trunk and limbs
 Loss of postural reflexes
 Freezing
Parkinsonisim

 Tremor at rest
 Bradykniesia
 Rigidity
 Flexed posture of the
neck, trunk and limbs
 Loss of postural reflexes
 Freezing
Parkinsonisim

 Tremor at rest
 Bradykniesia
 Rigidity
 Flexed posture of the
neck, trunk and limbs
 Loss of postural reflexes
 Freezing
Idiopathic Parkinson’s Disease
- Making a diagnosis

 To make a diagnosis of Parkinson’s disease the


patient must demonstrate:
 Bradykinesia and at least one of the following:
 Muscular rigidity
 4-6 Hz rest tremor
 Postural instability not caused by primary visual, vestibular,
cerebellar or proprioceptive dysfunction
Idiopathic Parkinson’s Disease
- Making a diagnosis

 The following are all features suggestive of IPD:


 Unilateral onset

 Rest tremor present

 Progressive disorder

 Persistent asymmetry affecting side of onset most

 Excellent response to levodopa in inital stage

 Severe levodopa-induced chorea

 Levodopa response for 5 years or more

 Clinical course of 10 years or more


Idiopathic Parkinson’s Disease
- Making a diagnosis

 Any of the following would suggest a diagnosis other than IPD :


 History of repeated head injury
 History of repeated strokes with stepwise progression
 History of definite encephalitis
 Oculogyric crises
 Neuroleptic treatment at onset of symptoms
 More than 1 affected relative
 Sustained remission
 Strictly unilateral features after 3 years
 Supranuclear gaze palsy
 Cerebellar signs
 Early severe autonomic involvement
 Early severe dementia with disturbances of memory, language, and praxis
 Babinski sign
 Presence of cerebral tumor or communication hydrocephalus on imaging
study
 Negative response to large doses of levodopa in absence of malabsorption
Not Idiopathic Parkinson’s?
Idiopathic Parkinson’s Disease
– not just a motor problem
Treatment of IPD
Levodopa Induced Dyskinesia
Essential Tremor

 Moderate amplitude
tremor
 Can have significant
impact on ADL
 Often have a long and
insidious history
 Tends to run in families
 Can be eased with
alcohol
 Propranolol is first
choice for treatment
Chorea

• Involuntary, irregular,
purposeless, nonrthymic,
abrupt, rapid, unsustained
movements that seem to
flow from one body part to
another
• Characteristically
unpredictable in timing,
direction and distribution
• Can be partially
suppressed or
camouflaged into semi-
purposeful voluntary
movements
• Prototypical example is
Huntington’s disease
Ballism

• Large amplitude
choreic
movements of the
proximal parts of
the limbs
• Flailing or flinging
movements
• Most common
cause of hemi-
ballism is stroke
Myoclonus

• Sudden, shock-like
involuntary
movements caused by
muscular contractions
or inhibitions
• Can occur at rest or
during activity (action
myoclonus)
• Can be both
arrhythmic or
rhythmic
Tic dissorders

• Consist of abnormal
movements and
abnormal sounds
• Vary in severity over
time
• Usually preceded by
uncomfortable feeling
or sensory urge that is
relieved by carrying out
the movement
• May be simple or
complex
• Often suppressible
Myokymia

• Unilateral facial muscle


contractions
• Continual, rapid, brief,
repetitive spasms
• Can evolve into
sustained tonic spasms
• Can often be brought
out when patient
voluntarily and
forcefully contracts the
facial muscles
Dystonia

• Refers to twisting
movements that tend
to be sustained at the
peak of the
movement, are
frequently repetitive
and often progress to
prolonged abnormal
postures
• Tend to be patterned
(in the same muscles)
Dystonia

• Focal
• When a single body part is affected
• Segmental
• Involvement of 2 or more contiguous regions of
the body are affected
• Multifocal
• Involves 2 or more regions, not conforming to
segmental or generalized dystonia
• Generalized
• Movements of one or both of the legs, trunk and
some other part of the body
Thank you

 Any questions?

 If you want to know more :


 Youtube - Springer Video Atlas of Movement Disorders

 Parkinsons.org.uk – learning module for junior doctors


coming January

You might also like