Movement disorders

REHABILITATION PHYSICAL MEDICINE, PARKINSONISM, ,TYPES OF MOVEMENT DISORDERS,

1. MOVEMENT DISORDERS DR. SUSHIL KUMAR NAYAK JR-3 PM&R NILD, KOLKATA

2. MOVEMENT DISORDERS ARE NEUROLOGIC SYNDROMES CHARACTERIZED BY EITHER AN EXCESS OF MOVEMENT OR A PAUCITY OF VOLUNTARY AND AUTOMATIC MOVEMENTS, UNRELATED TO WEAKNESS OR SPASTICITY

3. HYPERKINETIC HYPOKINETIC

4. HYPERKINETIC RESTLESS LEG SYNDROME TREMOR, DYSTONIA, MYOCLONUS CHOREA, TICS

5. HYPOKINETIC PARKINSON DISEASE PARKINSON PLUS SYNDROMES- PROGRESSIVE SUPRANUCLEAR PALSY MULTIPLE SYSTEM ATROPHY CORTICOBASAL GANGLIONIC DEGENERATION

6. RESTLESS LEG SYNDROME CHARACTERIZED BY A DEEP, ILL-DEFINED DISCOMFORT OR DYSESTHESIA IN THE LEGS THAT ARISES DURING PROLONGED REST OR WHEN THE PATIENT IS DROWSY AND TRYING TO FALL ASLEEP, ESPECIALLY AT NIGHT. PATIENTS EXPERIENCE SENSORY DISTURBANCES IN THE LEGS THAT ARE CHARACTERISTICALLY RELIEVED BY MOVEMENT

7. IRLS STUDY GROUP DIAGNOSTIC CRITERIA The urge to move the legs usually but not always accompanied by or felt to be caused by uncomfortable and unpleasant sensations in the legs. The urge to move the legs and any accompanying unpleasant sensations begin or worsen during periods of rest or inactivity, such as lying down or sitting. The urge to move the legs and any accompanying unpleasant sensations are partially or totally relieved by movement , such as walking or stretching, at least as long as the activity continues. The urge to move the legs and any accompanying unpleasant sensations during rest or inactivity only occur or are worse in the evening or night than during the day. The occurrence of the features listed in points 1 to 4 is not solely accounted for as symptoms primary to another medical or a behavioral condition (e.g., myalgia , venous stasis, leg edema , arthritis, leg cramps, positional discomfort, habitual foot tapping).

8. MANAGEMENT FIRST-LINE TREATMENT- LONG-ACTING DOPAMINERGIC COMPOUNDS AND IRON SUPPLEMENTS, PARTICULARLY IN PATIENTS WITH LOW SERUM FERRITIN (LESS THAN 50 TO 80 MG/L). SECOND-LINE TREATMENT INCLUDES ANTICONVULSANTS, SUCH AS GABAPENTIN, PREGABALIN, OR CARBAMAZEPINE. BENZODIAZEPINES AND OPIOIDS, SUCH AS METHADONE OR OXYCODONE, ARE ALSO USED.

9. TREMOR a rhythmic, oscillatory movement produced by alternating or synchronous contracting of antagonist muscle pairs. Tremors may be described as fast or slow, coarse or fine, uniplanar or biplanar . Resting tremor is usually observed when the body part is at complete rest, as is seen in Parkinson tremor. Postural tremor appears while maintaining a body posture; when the tremor is produced during a movement, it is termed an action tremor. Tremors may involve the limbs, neck,

10. PHYSIOLOGIC TREMOR- TREMOR OCCURS ( MOTOR UNITS AT SUBTETANIC RATES ). PHYSIOLOGIC TREMOR CAN BE EXACERBATED BY ANXIETY, FATIGUE, HYPOGLYCEMIA, THYROTOXICOSIS, ALCOHOL WITHDRAWAL, LITHIUM USE, SYMPATHOMIMETIC DRUGS, METHYLXANTHINES SUCH AS CAFFEINE, AND SODIUM VALPROATE.

11. THE MOST COMMON MOVEMENT DISORDER IS ESSENTIAL TREMOR (ET) A TYPE OF POSTURAL TREMOR BUT MAY BE ACCENTUATED BY GOAL-DIRECTED ACTIVITIES. ET IS TYPICALLY UNIPLANAR WITH FLEXION-EXTENSION MOVEMENT OF THE HAND. CONSUMPTION OF SMALL QUANTITIES OF ALCOHOL IMPROVES ET IN MOST CASES, AND ALCOHOL INGESTION IS AN OFTEN-USED CLINICAL CHALLENGE TO AID DIAGNOSIS. HOWEVER, CARE SHOULD BE TAKEN BY THE CLINICIAN TO NOT IMPLY TO THE PATIENT THAT ALCOHOL USE IS A RECOMMENDED TREATMENT.

12. DYSTONIA IS DEFINED AS AN ABNORMAL MOVEMENT CHARACTERIZED BY SUSTAINED MUSCLE CONTRACTIONS, FREQUENTLY CAUSING TWISTING AND REPETITIVE MOVEMENTS, WHICH MAY PROGRESS TO PROLONGED ABNORMAL POSTURES. DYSTONIA IS AUTOSOMAL DOMINANT IN INHERITANCE.

13. FOCAL DYSTONIA: ONE PART OF THE BODY IS INVOLVED, SUCH AS BLEPHAROSPASM, OROMANDIBULAR DYSTONIA, AND CERVICAL DYSTONIA. SEGMENTAL DYSTONIA: TWO OR MORE CONTIGUOUS PARTS INVOLVED, SUCH AS MEIGE SYNDROME. MULTIFOCAL DYSTONIA: TWO OR MORE NONCONTIGUOUS PARTS ARE INVOLVED. HEMIDYSTONIA: ONE SIDE OF THE BODY IS AFFECTED. GENERALIZED DYSTONIA .

14. DYSTONIA MAY BE TASK-SPECIFIC, SUCH AS WRITER’S CRAMP OR MUSICIAN’S CRAMP. IT IS RELIEVED BY REST OR SLEEP. ONE OF THE PECULIAR AND UNIQUE FEATURES IS THAT SOME PATIENTS HAVE THE ABILITY TO RELIEVE THE DYSTONIC MOVEMENT BY SENSORY TRICKS, USUALLY TACTILE STIMULI.

15. MYOCLONUS IS DEFINED AS SUDDEN, SHOCKLIKE MOVEMENTS THAT ARE USUALLY RANDOM AND RANGE IN SEVERITY FROM MILD TO SEVERE ENOUGH TO MOVE THE WHOLE BODY. IT CAN BE PHYSIOLOGIC AND CAN BE SEEN AFTER EXERCISE, EXCESSIVE FATIGUE, OR SOMETIMES WHEN THE INDIVIDUAL IS FALLING ASLEEP, SUCH AS HYPNAGOGIC JERKS.

16. SPINAL MYOCLONUS PALATAL MYOCLONUS. ASTERIXIS (NEGATIVE MYOCLONUS)

17. The word chorea is derived from the Greek word khoreia , which means dance. CHOREA IS DEFINED BY THE IRREGULAR, UNPREDICTABLE, BRIEF JERKY MOVEMENTS THAT ARE USUALLY OF LOW AMPLITUDE movements are usually distal and range in severity.

18. CHOREA RESULTS FROM PATHOLOGIC CHANGES IN THE BASAL GANGLIA. MILD CHOREA MAY RESEMBLE FIDGETINESS IN CHILDREN, SEVERE CHOREA MAY INTERFERE WITH SPEECH, SWALLOWING, ABILITY TO MAINTAIN POSTURE, OR ABILITY TO AMBULATE. HUNTINGTON DISEASE, BENIGN HEREDITARY CHOREA, AND WILSON DISEASE

19. TICS ARE DEFINED AS ABNORMAL MOVEMENTS (MOTOR TICS) OR ABNORMAL SOUNDS (PHONIC TICS) THAT ARE BRIEF, INVOLUNTARY, RAPID, AND NONRHYTHMIC. THERE IS OFTEN AN IRRESISTIBLE URGE TO MOVE BEFORE THE TIC, RESULTING IN A TENSION THAT BUILDS AND IS SUBSEQUENTLY RELIEVED BY EXECUTION OF THE TIC.

20. SIMPLE MOTOR TICS- brief, isolated movement as an eye blink, facial grimace, shoulder shrug, or head jerk. slower and sustained. COMPLEX MOTOR TIC- stereotyped facial expressions or patterned coordinated movements