43 Movement Disorders
Huntingtons
![](https://photos.thisispiggy.com/file/wikiFiles/HQha00k.jpg)
- know lateral ventricle large
![](https://photos.thisispiggy.com/file/wikiFiles/DMJvBuY.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/58XyWs5.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/afcCXAp.jpg)
![](https://i.imgur.com/pAnwxzh.jpg)
- Loss of caudate, loss of GABA, no inhibition = breakthrough of movement. Indirect pathway
![](https://photos.thisispiggy.com/file/wikiFiles/8deM9zl.jpg)
- each generation passes on more repeats to later generation = worse symptoms
- anticipation: earlier symptoms with each gen
- excitotoxicity mechanism
- NMDA binding to glutamate toxicity
![](https://photos.thisispiggy.com/file/wikiFiles/dWxz79z.jpg)
- usually adopted because most people know about it before have kids
- chorea: dance like abnormal movements
Treatment
![](https://photos.thisispiggy.com/file/wikiFiles/LMdhoVb.jpg)
Hemiballism
- No subthalamic nucleus. No inhibitory of thalamus = movement breakthrough
- once stroke affects IC = hemiplegia
![](https://photos.thisispiggy.com/file/wikiFiles/t20gR0r.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/WkxYlD0.jpg)
![](https://i.imgur.com/BF1klfG.jpg)
Wilson's
![](https://photos.thisispiggy.com/file/wikiFiles/LTP4hSr.jpg)
- deposit in liver (cirrhosis)
- elbows beat like wings of bird
- Mood disorders at very young age
- dysarthria: difficult to get words out, slow irregular speech
![](https://photos.thisispiggy.com/file/wikiFiles/ODKxett.jpg)
Tardive dyskinesia
![](https://photos.thisispiggy.com/file/wikiFiles/TtDBs9T.jpg)
![](https://i.imgur.com/Fkkqk45.jpg)
- face secondary to medications
- antipsychotic/antiemetic blocks D2, increase D2 sensitivity, hyperkinesia via D2 endogenous
- hypersensitivity of D2 receptors
L- DOPA Dyskinesia
![](https://photos.thisispiggy.com/file/wikiFiles/7QMUVke.jpg)
- D2 preferentially bound = blocked inhibitory pathway = dyskinesia
Hypokinetic Disorders
Parkinson
![](https://i.imgur.com/jqpOQob.jpg)
- Dopamine naturally broken down by MAO
- MAO sits on outer membrane of mitochondria
- result: Parkinson
![](https://i.imgur.com/DOJN9og.jpg)
- pt cannot initiate movement
![](https://photos.thisispiggy.com/file/wikiFiles/lEOHC3Z.jpg)
![](https://i.imgur.com/7YDlC9T.jpg)
- Loss of D1, no disinhibition, less movement
![](https://i.imgur.com/uKVyUNu.jpg)
![](https://i.imgur.com/NzTXUfi.jpg)
- no movement in stopping/ending
- initiation is difficult; once initiated, cannot be stopped = festination
![](https://photos.thisispiggy.com/file/wikiFiles/lEOHC3Z.jpg)
![](https://i.imgur.com/7YDlC9T.jpg)
- Loss of D1, no disinhibition, less movement
![](https://i.imgur.com/IQocHi6.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/JQVZbBa.jpg)
- parts of brain becomes pale because lose melanin containing dopaminergic neuron
![](https://photos.thisispiggy.com/file/wikiFiles/UViuCxn.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/7oQ15Nh.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/fykUj8V.jpg)
- now used to induce parkinson's in lab rats
![](https://photos.thisispiggy.com/file/wikiFiles/s9IdlCj.jpg)
- shuffling: shuffles feet
- cogwheel: moving arms stutters as if stopping on stops of cogwheel
Tremor
![](https://i.imgur.com/2BaoDwB.jpg)
Rigidity
![](https://i.imgur.com/CQ48qAV.jpg)
- simultaneous activation of flexors/extensors
Treatment
![](https://photos.thisispiggy.com/file/wikiFiles/XegnBtt.jpg)
- propanolol for central tremor
![](https://photos.thisispiggy.com/file/wikiFiles/LWux3tf.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/dYd16Yg.jpg)
- initially usually tremor symptoms
- once develops bradykinesia/rigidity, add more drugs
- L dopa last
![](https://photos.thisispiggy.com/file/wikiFiles/cpwao9z.jpg)
L- Dopa
![](https://photos.thisispiggy.com/file/wikiFiles/Cbcq90Z.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/KO7mrOt.jpg)
- vit B6 promotes conversion of L-dopa to dopamine in periphery
![](https://photos.thisispiggy.com/file/wikiFiles/s9M7aI7.jpg)
- off so severe akinesia: no movement, frozen
- dyskinesia: involuntary
Entacapone
![](https://photos.thisispiggy.com/file/wikiFiles/r3bRawg.jpg)
Seleginine
![](https://photos.thisispiggy.com/file/wikiFiles/qd6vm1N.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/3Y4MyxW.jpg)
- SSRI raises serotonin; selegiline blocks breakdown = very high serotonin
Other Movement Disorders
![](https://photos.thisispiggy.com/file/wikiFiles/VHGZkSo.jpg)
- myoclonus: sudden contraction once
- dystonia: sustained contraction
- writer's cramp: after writing for so long, arms spasm
- blepharospasm: twitching of eye muscles (blinking)
![](https://photos.thisispiggy.com/file/wikiFiles/QtxzYcj.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/3bbpv9P.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/1IjikTI.jpg)
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