We're going to talk now about drugs used to treat
other movement disorders or what we call
non Parkinsonian movement disorders.
We're going to start off first with tremor.
Now, you're going to cover tremor in much more detail
in your neurology lectures,
I'm only going to talk about the medications.
Propranolol is a beta blocker.
Other beta blockers can be used as well.
Propranolol is a very effective agent in postural tremor.
It seems to respond well to beta blockade,
we're not exactly sure why that happens. Gabapentine,
primidone and topiramate are also anti-epileptic drugs
that may also work in postural tremor.
Huntington's disease is a complex choreiform type of
movement. It's inherited. It's passed on.
It affects the GABA function. So, by giving medications
to affect GABA function, we can reduce Huntington's disease.
So, drugs like reserpine and tetrabenazine
deplets the levels of amines.
We really are not sure how it works entirely, which is why my
lectures are a little bit sparse in terms of mechanism of action.
We think that it corrects brain neurotransmitter imbalances.
We are not sure though.
Gabapentin, primidone and topiramate are anti-epileptic
drugs that may also work in this disease.
Haloperidol, also known as haldol,
is a dopamine receptor antagonist,
and for some reason it works although
we're not really sure what the mechanism is.
Tourette's syndrome is a harder one to treat.
We look at D2 receptor antagonism.
So, haloperidol and pimodize are D2 receptor antagonists and
carbamezapine is an anti-seizure medication.
It has been described as being less useful
but it is something that we can try.
And on one of my patients, it has actually worked quite well
where haloperidol didn't work at all.
Once again, we're not sure how it works. Other agents that we
have used are benzodiazepine. They tend to be less useful.
And clonidine which is the very first treatment we used in
Tourette's syndrome. It's an alpha blocker
that works centrally in the brain.
It is less useful as well.
Wilson's disease. Now, Wilson's disease
is generally thought that it was liver disease.
The classical finding in Wilson's disease is a
Kayser-Fleischer ring that's seen in the eye on eye exams.
You can see a little bit of a brown haze on the edges
of the iris. This is a disorder of copper metabolism.
Why am I talking about it here?
Because it does result in neurological damage.
Myasthenia can occur. And mild movement disorders that
are very nonspecific can occur in Wilson's disease.
This is why, just as a clinical pearl, always do a good eye
exam in your patients and take a close look at their iris
cause you may actually pick up Wilson's disease.
I've done it a couple of times in my own patients.
The treatment is penicillamine.
Now, penicillamine chelates copper out of the blood.
So, if you can give them penicillamine early enough, you can
actually treat the movement disorder associated with Wilson's disease.
Restless leg syndrome is a particular problem
we don't really know why it occurs
and we think that it might be dopamine related pathways. Pramipexole
is probably the most commonly used treatment of restless leg syndrome
We also have used carbamezepine or Tegretol
for treatment of it.
Drug induced dyskinesias, I've mentioned them before in the
psychosis lecture, benztropine is the antidote.
Acute dystonia is often caused by antipsychotics.
We administer benztropine as quickly as possible.
Tardive dyskinesia is another type of drug induced dyskinesia.
It may be due to a D2 receptor malfunction or damage to the
D2 recptor, we're not sure. We know of course that fetal
alcohol syndrome may develop tardive dyskinesia
just after one dose of the antipsychotic agent.
I mentioned this already in the psychosis lecture previously.
It's hard to treat. No specific treatment. And once again,
we can use clonazepam, clozapine and other drugs.
So there you have it. These are the non Parkinsonian movement
disorders. I'm sure you'll do very well on your exams.