Moving fast or moving slow: an overview of Movement Disorders

Transcription

1 Moving fast or moving slow: an overview of Movement Disorders Mini Medical School October 25, 2018 Heather Rigby, MD, FRCPC 2014 MFMER slide-1

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3 Basal Ganglia Dysfunction - Movement Disorders Hypokinetic Parkinson s Disease Dystonia Hyperkinetic Huntington s disease Tremor 2014 MFMER slide-3

4 Prevalence of Movement Disorders Disorder Estimated Prevalence Essential Tremor /100,000 Parkinson s Disease /100,000 Dystonia 30-50/100,000 Tic Disorders 40-50/100,000 Huntington Disease 4-8/ MFMER slide-4

5 James Parkinson ( ) Involuntary with a propensity the tremulousness in and senses to pass to and bend with from intellects the lessened a parts walking trunk being not forwards muscular to a action uninjured running and power pace even when supported 2014 MFMER slide-5

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7 Who gets Parkinson s disease? 1-2% of population > 50 years old Median age is 60 years Males and females All races Cause is unknown Directly inherited in a minority of cases (5-10%) Risk factor genes Weak links with rural living, exposure to well water, pesticides, wood pulp mills, etc MFMER slide-7

8 Motor Symptoms Tremor Stiff Weak Slowed down Clumsy molasses Handwriting changes 2014 MFMER slide-8

9 Motor Symptoms Poor balance Shuffling Dragging leg Decreased arm swing Speech quieter Less facial animation 2014 MFMER slide-9

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12 Cardinal Motor Signs 1. Rest Tremor 2. Rigidity (stiffness) 3. Bradykinesia (slowness of movement) 2014 MFMER slide-12

13 Disease(Onset( Diagnosis( Increase( Nonmotor( Symptoms( Motor(( Symptoms( Decrease( Dopamine( Neurons( Premotor(Phase( Motor(Phase( Time((y)( 2014 MFMER slide-20

14 Pre-motor symptoms 2014 MFMER slide-21

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16 As the disease progresses Depression/Anxiety Urinary dysfunction Daytime sleepiness Swallowing difficulty Cognitive impairment Hallucinations Falls 2014 MFMER slide-23

17 Exercise Benefits supported by research Components Stretching Aerobic activity Resistance training / strengthening Examples Walking, biking, Tai Chi, Yoga, Pilates, dance, swimming 2014 MFMER slide-24

18 Medications Replace Dopamine Levodopa Dopamine Agonists Block Degredation of Dopamine MAOB Inhibitors (Rasagline and Selegiline) COMT Inhibitor (Entacapone) 2014 MFMER slide-25

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23 Major ICDs 1. Gambling 2. Buying 3. Hypersexuality 4. Eating 2014 MFMER slide-33

24 Deep Brain Stimulation 2014 MFMER slide-34

25 DUODOPA Intestinal Infusion System 2014 MFMER slide-35

26 Carrying Accessories 2014 MFMER slide-36

27 Caudate Atrophy 2014 MFMER slide-38

28 Clinical Features Movement Disorder Psychiatric Disturbance Cognitive Decline 2014 MFMER slide-39

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31 Essential Tremor Bilateral postural and kinetic tremor of the hands; can have head and voice tremor Generally no other neurologic signs Alcohol responsive Positive family history is common (30-60%) 2014 MFMER slide-43

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33 Cervical Dystonia 2014 MFMER slide-45

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35 What are other types of primary focal dystonia? Blepharospasm Jaw-opening / jaw-closing dystonia Musician dystonia Spasmodic dysphonia 2014 MFMER slide-49

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37 Botulinum Toxin (Botox, Xeomin) 2014 MFMER slide-51

38 Botulinum Toxin Neurotoxin produced by the bacterium Clostridium botulinum 2014 MFMER slide-52

39 Natural History of Clinical Response Kick-in 3-10 days Peak effect 2-4 weeks Duration of benefit weeks 2014 MFMER slide-53

40 Basal Ganglia Dysfunction - Movement Disorders Hypokinetic Parkinson s Disease Dystonia Hyperkinetic Huntington s disease Tremor 2014 MFMER slide-54