> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/01-step-1/neurology/43-movement-disorders.md).

# 43 Movement Disorders

## Hyperkinetic Disorders

### Huntingtons

![](https://f001.backblazeb2.com/file/wikiFiles/HQha00k.jpg)

* know lateral ventricle large

![](https://f001.backblazeb2.com/file/wikiFiles/DMJvBuY.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/58XyWs5.jpg)

![](https://f001.backblazeb2.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://f001.backblazeb2.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://f001.backblazeb2.com/file/wikiFiles/dWxz79z.jpg)

* usually adopted because most people know about it before have kids
* chorea: dance like abnormal movements 

### Treatment

![](https://f001.backblazeb2.com/file/wikiFiles/LMdhoVb.jpg)

### Hemiballism

* No subthalamic nucleus. No inhibitory of thalamus = movement breakthrough
* once stroke affects IC = hemiplegia 

![](https://f001.backblazeb2.com/file/wikiFiles/t20gR0r.jpg)

* only half of body

![](https://f001.backblazeb2.com/file/wikiFiles/WkxYlD0.jpg)

![](https://i.imgur.com/BF1klfG.jpg)

### Wilson's

![](https://f001.backblazeb2.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://f001.backblazeb2.com/file/wikiFiles/ODKxett.jpg)

### Tardive dyskinesia

![](https://f001.backblazeb2.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://f001.backblazeb2.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://f001.backblazeb2.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://f001.backblazeb2.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://f001.backblazeb2.com/file/wikiFiles/JQVZbBa.jpg)

* parts of brain becomes pale because lose melanin containing dopaminergic neuron

![](https://f001.backblazeb2.com/file/wikiFiles/UViuCxn.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/7oQ15Nh.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/fykUj8V.jpg)

* now used to induce parkinson's in lab rats

![](https://f001.backblazeb2.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://f001.backblazeb2.com/file/wikiFiles/XegnBtt.jpg)

* propanolol for central tremor

![](https://f001.backblazeb2.com/file/wikiFiles/LWux3tf.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/dYd16Yg.jpg)

* initially usually tremor symptoms
* once develops bradykinesia/rigidity, add more drugs
* L dopa last

![](https://f001.backblazeb2.com/file/wikiFiles/cpwao9z.jpg)

#### L- Dopa

![](https://f001.backblazeb2.com/file/wikiFiles/Cbcq90Z.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/KO7mrOt.jpg)

* vit B6 promotes conversion of L-dopa to dopamine in periphery

![](https://f001.backblazeb2.com/file/wikiFiles/s9M7aI7.jpg)

* off so severe akinesia: no movement, frozen
* dyskinesia: involuntary

#### Entacapone

![](https://f001.backblazeb2.com/file/wikiFiles/r3bRawg.jpg)

#### Seleginine

![](https://f001.backblazeb2.com/file/wikiFiles/qd6vm1N.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/3Y4MyxW.jpg)

* SSRI raises serotonin; selegiline blocks breakdown = very high serotonin

## Other Movement Disorders

![](https://f001.backblazeb2.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://f001.backblazeb2.com/file/wikiFiles/QtxzYcj.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/3bbpv9P.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/1IjikTI.jpg)