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Phenomenology of Movement Disorders

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Phenomenology of Movement Disorders Phenomenology of Movement Disorders Raja Mehanna MD International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Anatomical reasoning International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Anatomical reasoning International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Phenomenological reasoning Abnormal movement Hypokinetic Hyperkinetic Ataxia International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Video 1 International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] But there is a tremor! UK Parkinson’s Disease Society Brain Bank’s clinical criteria for the diagnosis of probable Parkinson disease International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Hughes et al., 1992; Hughes et al., 1992; Fahn et al., 2011. Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Parkinsonism • PD • MSA • PSP • CBS • DLB • Vascular parkinsonism • Drug induced • With FTD or AD International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Hyperkinetic movement disorders • Tremor (non parkinsonian) • Dystonia • Chorea • Myoclonus • Tics • RLS, PMLS, PLMT… International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Questions to ask • Immediate impressions – Rhythmic or arrhythmic ? – Sustained or non-sustained ? – Paroxysmal or continuous? • More prolonged observations – At rest or with action? – Patterned or non patterned? InternationalFahn Parkinson et al., and2011 Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Rhythmic versus arrhythmic Rhythmic -regular Rhgytmic-Irregular Arrhythmic Akathitic movements Athetosis Ballism Tremor Chorea resting Dystonia postural action Hemifacial spasm intention Hyperekplexia Cortical myoclonus Minipolymyoclonus Segmental Myoclonus Myoclonus Dystonic tremor Oscillatory Myoclonus Moving toes/fingers Stereotypy Myorhythmia Periodic movements in sleep Tardive stereotypy (Dystonic tremor) Tics InternationalFahn Parkinson et al., and2011 Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Sustained contractions or postures Neuro- Dystonia Torticollis SPS myotonia Dystonic Pseudo- Oculogyric Orthop Congenital tics dystonias crisis edic International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Paroxysmal Paroxysm Episodic Hyper- Stereo- Tics Akathitic al ataxias eplexia typies movements dyskinesia International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] At rest only (disappears with action) 1.Akathitic movements 2.Paradoxical dystonia 3.Resting tremor, but can reemerge with posture holding 4.Restless legs 5.Orthostatic tremor (only on standing) With action only 1.Ataxia 2.Action dystonia 3.Action myoclonus 4.Tremor: postural, action, intention 5.Task-specific tremor 6.Task-specific dystonia FahnInternational et al., Parkinson 2011 and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Patterned Myo- Dystonia Stereo- Tremor Myo- Moving Segm kymia typies toes myoclonus rhythmia Tardive Hemi- stereotypy facial spasm International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Video 2 International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Tremor • Alternating contraction of antagonist muscles • Regular • Sinusoidal/oscillatory • Rest and/or action International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Video 3 International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Twisting=Dystonia • Co-contraction of antagonist muscles • Abnormal posturing • Can cause tremor • Stereotyped and predictable International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Video 4 International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Dancing= Chorea • Irregular • Unpredictable • Seems to flow from one body part to another • No volitional control • Can try to mask it initially (parakinesias???) International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Athethosis and ballismus Chorea Athetosis: Ballism: Slow Very large amplitude Writhing Proximal limbs Continuous International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Video 5 International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Jerking= Myoclonus • Literally: “a quick movement of muscle.” • active muscle contractions = positive myoclonus • lapses of muscle contraction in active postural muscles = negative myoclonus or asterixis • Irregular International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Myoclonus Spontaneous Action Reflex Focal/segmental Repetitive Axial Rhythmic or not Multifocal Regular or not Generalized International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Video 6 International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] Tics • Can be clonic, dystonic • Stereotyped, but can change over years • Key – Premonitory feeling – Voluntary control (with rebound) – Relief after completion • Pitfalls: – Fluctuate – Can disappear completely when focused International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] References • Fernandez HH, Rodriguez RL, Skidmore FM, Okun MS. A practical approach to movement disorders. Diagnosis and surgical and medical management. Demos Medical Pusblishing, NY, 2007. • Fahn S, Jankovic J, Hallet M. Principles and practice of movement disorders, 2nd edition. Elsevier Saunders, NY, 2011 • Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: A clinico- pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55:181–184 • Hughes AJ, Ben-Shlomo Y, Daniel SE, Lees AJ: What features improve the accuracy of clinical diagnosis in Parkinson’s disease: A clinical pathological study. Neurology 1992;42:1142–1146. International Parkinson and Movement Disorder Society | 555 East Wells Street, Suite 1100, Milwaukee WI 53202-3823 USA Tel: +1 414-276-2145 | www.movementdisorders.org | [email protected] .
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