Here, we’ll take a look
at movement disorders.
At first, what we will do is under
the category of movement disorder,
we will then organize
our thoughts and
think of it as being either
hyperkinetic or hypokinetic.
tremors, chorea, dystonia,
and stereotypical movement come under
the category of being hyperkinetic.
Now, is it possible if the patient
might be then exhibiting both
hyper and hypokinetic
simultaneously very much so.
an example of a hypokinetic type
of disorder such as Parkinson’s
could show you that
hypokinetic type of disorder,
but then could also
have resting tremors.
Elements of both categories
of movement disorders.
Is that clear?
Our topic continues with discussing
tremors in greater detail.
Under tremors, you would
have different types.
And the different types or
behavior patterns of your tremor
would then clue you in that
a particular diagnosis
should be thought of as being
your high differential.
I want you to think of the motion
or the action or intention
of going after a cup of
coffee or mug of coffee.
Let’s say that the tremors that
exist here which are going to be the
shaking, jerking movement
of let’s say the hands
is taking place prior to
going for the coffee.
So meaning to say that at rest, there
were tremors, taking place of the hand.
You should be thinking about
Parkinson for example.
But when you’re actually going for
the cup at that point intentionally,
the tremors at that point would be, well,
if not halted, then maybe subsided.
You have postural.
A postural type of tremor would
be more or less essential tremor,
being the most common.
Meaning to say that the cause here
would be more less idiopathic.
You have action type of tremor.
An action tremor in which you have
these jerk-like movements of the hand.
Well, at rest, once again you’re going
for that cup or that mug of coffee.
But this time, at rest, your
hand is more or less stable.
And it’s not moving.
But then upon intention or action of
needing to grab that cup of coffee,
it is at that point when you grab the cup
in which maybe the tremors would set in
and you’re having these tremors and perhaps
spilling the fluid all over the place.
There’s a difference between an action
tremor versus a resting tremor.
And when you’re thinking about
an intentional or action tremor,
you then should be thinking
that, “Okay, well,
is there some type of injury or lesion
taking place in the cerebellum?”
Continuing our discussion of
hyperkinetic movement disorder,
we now move on to chorea.
By definition, chorea would
be involuntary, abrupt,
irregular movement of the
body from one to another.
So here, you have this flow-like
movement that’s taking place
from one part of the
body to another.
And here, for example, something that
you might find with Huntington disease.
The causes of chorea,
well, you’ve heard of CAG as being your
trinucleotide expansion and anticipation.
And if you start having damage
taking place with the basoganglia,
then Huntington’s disease
should come into play.
If you have a patient and we’ll
deal with this patient later on
or we will address this patient later on
in which around the iris, you’ll notice
a particular type of observation.
And this is then known as
a Kayser-Fleischer ring,
and here with this patient with such copper
disease or a copper transport disease,
Wilson’s disease may also cause a
movement disorder such as chorea.
Drugs such as neuroleptics or even perhaps
dopaminergic type of medications.
Toxic: Ethanol or alcohol, carbon
monoxide, or thyrotoxicosis
may then bring about
chorea type of movement.
Remember, in involuntary jerky flow-like
movement from one body part to anther.
SLE, maybe post-streptococcal,
pregnancy-related and perhaps even vascular
when you have these penetrating blood
vessels down deep subcortically.
Remember, we talked about this
in terms of lacunar infarcts
in which if the basal ganglia
has been interrupted,
then it may result in
chorea type of movements.
Here, we’ll take a look
at another hyperkinetic
movement disorder and
here we have dystonia.
With dystonia, this would be
sustained muscle contraction
that’s taking place leading to repetitive
twisting movement, abnormal posturing.
and by that we mean blepharospasms,
think about your eyelids,
or it could be torticollis,
those will be more or less focal
versus it being postural.
Segmental or perhaps
The causes of dystonia would be
perhaps idiopathic, symptomatic.
Well, with symptomatic, maybe
being primary versus secondary.
With primary idiopathic is
something called torsion dystonia,
will be an inheritance pattern
of autosomal dominant.
Where is that with your secondary?
Once again, here,
you can have the common suspects
or usual suspects of diseases
that may result in damage taking
place to the basoganglia region.
Once again, Huntington,
maybe anoxia, stroke or
drug-induced type of movement.
At this point,
it is of utmost importance that
you understand the definitions
of these type of
Here, we have myoclonus,
yet another hypokinetic
A sudden lightning-like movement
produced by abrupt and brief
and muscle contraction.
So I need you to compare
myoclonus versus dystonia.
Myoclonus would be extremely quick in nature,
but still would result in a muscle --
like a contraction or clonus.
And myo- referring
to the muscle.
Causes or types of myoclonus include:
It could be physiologic.
And by physiologic, maybe it’s
jerk or even hiccups taking place.
Epileptic, primary generalized epilepsy.
And you’ve heard of
myoclonus type of epilepsy
and that’s something that
we’ve also discussed.
Symptomatic, metabolic encephalopathy,
hypoxic brain injury or Wilson’s disease,
all different causes and type of myoclonus.
For the most part, if you wish to
manage your patient with myoclonus,
you want to slow things down,
you’re thinking about a
benzodiazepines such as clonazepam
or perhaps even
antiepileptic known as
valproate or valproic acid,
you’ve heard of Depakote.
A hyperkinetic disorder
here known as your tics.
Abrupt, stereotypical, coordinated
movement or perhaps even vocalization.
It can be voluntarily suppressed if
the patient has enough awareness
of this particular issues taking place
and suppression causes anxiety.
The tics relieve the anxiety is the
theory that you want to keep in mind
when dealing with tics, a
A hyperkinetic disorder in which we
refer to as being Tourette’s syndrome.
It’s a genetic disorder, must have both
vocal and motor tics for diagnosis.
And what do we mean by a motor tic?
A tic would be a coordinated movement
that’s taking place of the muscle.
So we have motor and both vocal
type of issues taking place.
There’s something called the rare --
but we have something
is rare in Tourette’s.
Associated with obsessive-compulsive
behavior and perhaps even your ADHD.
The management of tics,
here, remember the dopamine
has a number of pathways,
and here, you’re trying
to control the movement,
and so therefore dopamine antagonists seem
to be most effective in management of tics.
Clonidine may be
helpful as well.