Seminar on Movement

Disorder

Presenter :Balamurugan E
Moderator:Mam.MeenaAggarwal
 Today's Topic
• Tremors
• Dystonia
• Tardive dyskinesia
• Chorea (Huntington’s Diseases)
 Tremors
• A tremor is an involuntary, somewhat
rhythmic, muscle contraction and relaxation
involving to-and-fro movements
(oscillations or twitching) of one or more
body parts.
• ( Hands, arms, eyes, face, head, vocal cords,
trunk, and legs)
 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)
 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
 Etiology

• An autosominal
dominant inheritance in
60 % of People.
• Associated with variety
of CNS pathologies.
 Assessment of tremor
• Tremor onset
• Family history
• Tremor response to alcohol
• Functional tremors
• Body part involved
• Tremor at rest or action
• Frequency low(<4Hz) medium(4-7Hz)
high(>7 Hz)
 Symptoms
• Rhythmic tremor (4–12 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
 Diagnostic evaluation
• Only history and clinical examination
 Management
• AAN Evidence based guideline
• Primidone, propanalol,alprazolam for limb
tremor,
• Propanalol for head tremor
• Botulinum injection for refractory cases
 Surgical management
• Thalamotomy
• Deep brain stimulation
 Dystonia
• It is a disorder of sustained or intermittent
contraction that results in abnormal posture
and movent of the affected part.
• Dystonic movement are
• Repitive
• Patterned
• Triggered by voluntary movement
• Often lessened by sensory tricks.
• 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.
 Classification
• According to body part involved
• focal dystonia
• Segmental dystonia
• Multifocal dystonia
• Hemidystonia
• Generalized dystonia
 Focal dystonia
Name
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).
 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.
 Etiology
• Primary
• Secondary
• Dystonia plus
• Heredo degenrative dystonia
 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.
 Diagnostic testing
• Routine diagnostic testing
• Genetic screening in early onset dystonia
with positive family history.
 Treatment
• Goals
• To alleviate symptoms
• Avert contractures
• Improve function
• Enhance quality of life.
 3 principle approach
• Oral medication
• Boutulinum toxin injection
• Surgery
 Oral medication

• Anticholonergic(trihexyphenidyl),
• Benzodiazepines
• Skeletal muscle relaxant
• Dopaminergic agents.

• Botulinum toxin injection

 Surgical management
• Thalamotomy
• Pallidotomy
• Myectomies
• Rhizotomy
• DBS(Deep Brain Stimulation)
 Tardive dyskinesia
• Tardive mean in french late
• Tardive dyskinesia comprises a cluster of
iatrogenic movement disorder
 Risk factors
• Older adult
• Woman
• Greater total drug exposure
• Pre existing drug induced parkinsonism
• Alcoholoism
• Smoking
 Causes

• Exposure to dopamine recptor blocking

agent
• Haloperidol
• Resperidone
• Olanzipine
• Aripiprazole
• Prochlorperzine
• Metaclopromide
 Clinical Feature
• Oral facial movements often reprsents a
combination of licking,smaking,and
chewing
• Limb and truncal rocking movements
• Respiratory-erratic ,gasping breathing.
 Categories

• Classic tardive dykinesia-stereotypes

• Tardive dystonia-face and neck
• Tardive akathesia-sense of inner
restlessness,tension,emotional unease, and
aversion to remain still.
 Treatment

• Presynaptic dopamine depleting agents

• Reserpine
• Tetrabenzine
• Anticholinergic
• Botulinum injection
• DBS
 Chorea
• It is a motor phenomena that consist of non
rhythmic rapid irregular, unpredictable,
brief, jerky movements that flow from one
part of the body to another part in a random
fashion.
• Variants include athetosis and ballism
 Huntington's diseases
• Huntington's disease, chorea,
or disorder (HD), is a
progressive neurodegenerative geneti
disorder, which affects muscle coordination
and leads to cognitive decline and dementia.
 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
Causes
 Causes
• Abnormal gene in short arm of
chromosome 4
• The gene called IT-15 and protein product
is called huntingtin
 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
 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 difficulties
chewing, swallowing and speaking
• Seizures
• Memory disturbances
•  neuropsychiatric manifestations
are anxiety, depression, a reduced display of
emotions (blunted
affect), egocentrism, aggression,
and compulsive behavior,
• Other abnormalities include muscle
atrophy, cardiac failure, impaired glucose
tolerance, weight
loss, osteoporosis and testicular atrophy.
 Diagnostic test
• Genetic testing
• CT and MRI
 Treatment
• Dopamine receptor blockers
• Dopamine depleting agents
• Amantadine
• Antispasmodics
• Benzodiazipines
• Antidepressants
• Anticonvulsants
• Cholinesterse inhibitors
Nursing management
Conclusion