2ND LECTURE Movement disorder[involuntary ] and ataxia; extra pyramidal and cerebellar system.

The plan Movement disorder introduction Hypokinesis movement disorder[ ex. Parkinsonism] Hyperkinetic movement disorder Cerebellar disorder and ataxia

Introduction; extra pyramidal system function Regulate reflexes ad maintaining posture tone control is involuntary and subconscious It s indirect activation pathways

Where is the extrapyramidal system located? It is make up of the subcortical nuclei called the BASAL GANGLIA

Basal ganglia Striatum/subthalmic nucleusglobus palidusthalamus and cortexdesired movement is normal situations; tics or involuntary movement when striatum has to much control Extra pyramidal system;- picture Lesions of the basal ganglia cause: 1. Hypokinetic movement disorder[ akinesia]- lack of physical movement when a motor command is given 2. Hyperkinetic movement disorder[ dyskinesia]- excessive involuntary body movement. Hypokinetic movement disorder[ akinesia] Parkinson syndrome o Bradykinesia (slowness of initiation of voluntary movement with progressive reduction in speed and amplitude of repetitive actions) obligatory sign o Muscular rigidity obligatory o 4-6 Hz rest tremor o Postural instability not caused by primary visual,vestibular,cerebella or proprioceptive dysfunction. o Freezing- inability to move muscle in desired direction syndrome- combination of signs and symptoms with common pathogenesis e.g i) subarachnoid hemorrhage- headache, meningeal ii) inflammation- fever, etc

UKs Prkinson disease society brain abn clinical diagnostic criteria Cut section of the midbrain where a portion of the substanstia nigra is visible Diminished sunstantia nigra as seen in Parkinsons disease[>80% symptom are showed] Lack of dopamine produce by substantia nigra decrease basal ganglia activation.

Hyperkinetic movement disorder-involuntary movement that are sometimes suppressible for a period of time 1. Tremor Dystonias Chorea (dancing),Athetosis,Ballism Myoclonus Tics TremorExcessive involuntary rhythmic oscillation of a body part caused by contraction of antagonist muscle groups. o Rest tremor- [Parkinson] o Postural tremor- happen in certain condition o Intention tremor- happen when doing something o Ruberal tremor- 1 extremity Chorearapid, jerky, purposeless movement involving limbs, trunk or face of irregular timing Athetosiswrithing of limbs, most prominent distally Ballismlarge amplitudes flinging of a limb, proximal activation of muscles. Dystonissustained agonistantagonist muscle contractions o Torsion dystonia o Cervical dystonia, torticollis o facial dystonia o Hand/arm dystonia Myoclonusrapid discrete simple jerks of the body part through involuntary activation Ticsinvoluntory simple or complex movement or vocalization

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Cerebellar system Does not initiate motor movements, but help with their coordination Function balance and coordination Brainstem- mendulla oblongat, pons and midbrain.

Ataxia[ witout control] and cerebellar system loss of coordination of voluntary movement

Cerebellar ataxia Postural and/or gait[when stand up] instability Dysmetria undershoot or overshoot of intended movement to a target Dysdiadokinesia inability to perform rhythmic movement.

Type of ataxia Cerebellar ataxia- postural, dysmetria, dysdiadokinesia (coordination) Vestibular ataxia- nausea ,vomiting, vertigo, disequilibrium (dizines) Sensory ataxia- sensation disorder

Different between Extrapyiramidal Moving or at rest Cerebellar problem Only when you try to do something

Categorization of movement disorder

movement disorder

pyramidal syndromes

basal ganglia disorder

cerebellar disorder

spasticity

hyperkinesia

ataxia

hypokinesia

miscellaneous motor-sensory behavior