Seminar on Movement Disorder

8/8/2019 Seminar on Movement Disorder

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Seminar on MovementSeminar on MovementDisorderDisorder

Presenter :Presenter :BalamuruganBalamurugan EE

Moderator:Mam.MeenaAggarwalModerator:Mam.MeenaAggarwal


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Today's

Topic

Today's

Topic

Tremors

Dystonia Tardive dyskinesia

Chorea (Huntingtons Diseases)


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Tremors A tremoris an involuntary, somewhat

rhythmic, muscle contraction and

relaxation involving to-and-fromovements (oscillations or twitching) of

one or more body parts.

( Hands, arms, eyes, face, head, vocalcords, trunk, and legs)


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Classification

Rest tremor- occurs at rest Action tremor-during voluntary action

Types of action tremor

Postural Physiologic and enhanced physiologic

Kinetic

Primary orthostatic tremors

Isometric

Task and Position specific(primary

writing tremors)


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Essential tremors

Most common tremor disorder

Slowly progressive postural and kinetic

tremor (5-10 Hz)

The hands and forearm are affected in

90%of cases.

Head ,vocal cord , jaw, face,and trunk.

Also called benign. Respond to alcohol


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Etiology

An autosominal

dominant inheritance in

60 % of People. Associated with variety

ofCNS pathologies.


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Assessment of tremor Tremor onset

Family history

Tremor response to alcohol

Functional tremors

Body part involved Tremor at rest or action

Frequency low(7 Hz)


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Symptoms Rhythmic tremor (412 Hz) that is present

only when the affected muscle is exerting

effort

Fatigue, strong emotions, low blood sugar,

cold, caffeine, lithium salts,

some antidepressants or other factors Do not occur in sleep


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Diagnostic evaluation Only history and clinical examination


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Management AANEvidence based guideline

Primidone, propanalol,alprazolam for

limb tremor,

Propanalol for head tremor

Botulinum injection for refractory cases


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Surgical management

Thalamotomy

Deep brain stimulation


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Dystonia

It is a disorder of sustained or

intermittent contraction that results in

abnormal posture and movent of theaffected part.

Dystonic movement are

Repitive Patterned

Triggered by voluntary movement

Often lessened by sensory tricks.


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Dystonia can involve any muscle group

it may be of face ,larynx, neck, trunk ,

limbs, hands, or feet.

Aggravated by stress and abate during

sleep.


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Classification

According to body part involved

focal dystonia

Segmental dystonia

Multifocal dystonia

Hemidystonia Generalized dystonia


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Focal dystoniaName

Cervical dystonia (spasmodic torticollis)

Blepharospasm

Oculogyric crisis

Oromandibular dystonia

Spasmodic dysphonia/Laryngeal dystonia

Focal hand dystonia (also known as musician's or

writer's cramp).


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Others Segmental dystonias affect two

adjoining parts of the body

Hemidystonia affects an arm and a leg

on one side of the body.

Multifocal dystonia affects many

different parts of the body.

Generalized dystonia affects most of the

body, frequently involving the legs and

back.


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Etiology

Primary

Secondary

Dystonia plus

Heredo degenrative dystonia


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Clinical manifestation

Abnormal posturing,

Continuous pain,

Cramping and relentless muscle

spasms

Mirror effect

Stress, anxiety, lack of sleep, sustained

use and cold temperatures can worsen

symptoms.


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Diagnostic testing Routine diagnostic testing

Genetic screening in early onset

dystonia with positive family history.


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Treatment Goals

To alleviate symptoms

Avert contractures

Improve function

E

nhance quality of life.


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3principle approach

Oral medication

Boutulinum toxin injection

Surgery


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Oral medication

Anticholonergic(trihexyphenidyl),

Benzodiazepines

Skeletal muscle relaxant

Dopaminergic agents.

Botulinum toxin injection


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Surgical management Thalamotomy

Pallidotomy

Myectomies

Rhizotomy

DBS(Deep Brain Stimulation)


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Tardive dyskinesia Tardive mean in french late

Tardive dyskinesia comprises a cluster

of iatrogenic movement disorder


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Risk factors Older adult

Woman

Greater total drug exposure

Pre existing drug induced parkinsonism

Alcoholoism Smoking


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Causes

Exposure to dopamine recptor blocking

agent

Haloperidol

Resperidone

Olanzipine

Aripiprazole

Prochlorperzine

Metaclopromide


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Clinical Feature

Oral facial movements often reprsents

a combination of licking,smaking,and

chewing

Limb and truncal rocking movements

Respiratory-erratic ,gasping breathing.


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Categories

Classic tardive dykinesia-stereotypes

Tardive dystonia-face and neck

Tardive akathesia-sense of inner

restlessness,tension,emotional unease,

and aversion to remain still.


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Treatment

Presynaptic dopamine depleting agents

Reserpine

Tetrabenzine

Anticholinergic

Botulinum injection DBS


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Chorea

It is a motor phenomena that consist of

non rhythmic rapid irregular,

unpredictable, brief, jerky movementsthat flow from one part of the body to

another part in a random fashion.

Variants include athetosis and ballism


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Huntington's diseases Huntington's disease, chorea,

ordisorder(HD), is a

progressive neurodegenerative genetidisorder, which affects muscle

coordination and leads to

cognitive decline and dementia.


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Epidemiology

The worldwide prevalence of HD is 5-

10 cases per 100,000 persons,

Highest in peoples of Western

European descent

Men and women equal


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Causes


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Causes

Abnormal gene in short arm of

chromosome 4

The gene called IT-15 and protein

product is called huntingtin


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Pathophysiology the genetic mutation causes loss of

neurons in specific regions of brain

The most affected part is basal ganglia

and frontal lobes of cerebral cortex


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Clinical manifestaion

Subtle changes in personality, cognition,

or physical skills

physical symptoms are jerky, random, and

uncontrollable movements called chorea

physical instability, abnormal facial

expression, and difficultieschewing, swallowing and speaking


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Seizures

Memory disturbances

neuropsychiatric manifestations

are anxiety, depression, a reduced

display of emotions (blunted

affect), egocentrism, aggression,and compulsive behavior,


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Other abnormalities include muscle

atrophy, cardiac failure, impaired

glucose tolerance, weightloss, osteoporosis and testicular

atrophy.


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Diagnostic test Genetic testing

CT and MRI


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Treatment Dopamine receptor blockers

Dopamine depleting agents

Amantadine

Antispasmodics

Benzodiazipines

Antidepressants

Anticonvulsants

C

holinesterse inhibitors


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Nursing management


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Conclusion

Seminar on Movement Disorder

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