Dr Hardik K Parmar Dr Hardik K Parmar Student of Dr S.S.Desai Student of Dr S.S.Desai But expression of a well But expression of a well made man appears not only in his face,it made man appears not only in his face,it is in his limbs and joints also. is in his limbs and joints also. - walt whitman - walt whitman
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Dr Hardik K ParmarDr Hardik K Parmar
Student of Dr S.S.DesaiStudent of Dr S.S.Desai
But expression of a well made man But expression of a well made man appears not only in his face,it is in his limbs and joints also.appears not only in his face,it is in his limbs and joints also.
- walt whitman- walt whitman
Are the movements that you do not control;
you make it so fast that your cerebrum doesn´t receive the information.
Are the movements which we control.
The Nervous System transmits the information of the action to the cerebrum.
Reflex:When you blik, when somebody heats you, you shake.
Voluntary movements: when you walk, you throw a ball, when you eat, …
We blink 20.000 times a day.
Yawns are contagious.
The sneeze is an involuntary movement.
Basal ganglia are group of the neuclei located subcorticallywhich take part in motor movements of body.
Abnormal increment or decrement in its parts causes various movements disorders.
Hyperkinetic hypokinetic
Tremor(MC) PD(2nd MC)
Chorea Apraxia
Dystonia Hypothyroid slowness
Ballism rigidity
Myoclonus
Tics
Ataxia
myokymia
myorrhythmia
Hypnogogic myoclonus
Benign fasciculation without LMN disorder
Physiological tremorLow amp, high freq
DISORDER LESION
Chorea Striatum, STN(red neucleus)
Athetosis Diff hypermyelination of corpus striatum & hypothalamus
Dystonia U.K.(Basal motor neuclei)
Hamiballismus H’age in C/l STN
Rest & postural tremors
Mid brain, sup cerebeller pudencle
RhythmicInvoluntary movementsOf fingers, hand, arms, legs,tongue, or headDue to alternatecontaction and relaxation of oppo mus groups
Sometimes they can be so fine that they cant be easily recognised
Put a paper on dorsum of an out streched hand
MC cause is anxiety OTHERS: Psychogenic,Post traumatic(2-8 Hz), Rx: Propranolol, Primidone, gabapentine, BZD
Athotosis, Ballismus, Chorea & DystoniaShould not be thought as a separate entity but as a different manifestation of same spectrum as they often coexist
Hypotonia + but reflexes are also +nt May be hyperextended joints
In the limbs chorea refers more to distal movements ( as proximal movements usually called ballismus)
Patients often attempt to conceal involuntary movements by superimposing voluntary movements onto them e.g. an involuntary movement of arm towards face may be adapted to look-like an attempt to look at watch
Chorea molles:Marked hypotonia with very minimal involun
antagonist Co Q 10: UK mecha, possible behavioural
improvement Anti convulsant: valproate
Slow, snake-like, writhing, worm-like movements of dynamic in nature starting at fingers and then spreades proximally which causes abduction & int rotation of UL
Increased on voluntary movements Disapp during sleep Can also affect face and tongue Often use term “ choreoathetosis ” due to
overlap between syndromes ( chorea referring to less smooth , more jerky movements)
Causes: CP, hepatic failure
Sustained or repetative involuntary mus contraction freq asso with twisting and assumption of abnormal postures.
Due to co-contraction of agonist and antagonist muscles in part of body
Can be thought of as an athetoid movement that “gets stuck” for a period of time; thus, a patient with choreoathetosis may perform an involuntary movement in which his hand and fingers are twisted behind his head. He may hold this position for a few moments before his hand moves back in front of his body.
The part of the movement when the limb was held, unmoving, in an abnormal position would be considered a dystonia ( may occur alone).
Idiopathic torsion dystonia(oppenheim’s
dystonia) Hereditary and sporadic forms Variable inheritence(AD) DYT 1 gene mutation on Chr-9-protein torsin A High incidence in Ashkenazi Jews Onset may be in childhood / adulthood(<26yr) Affects limbs then progress prox Trial of L-dopa usually initiated Level of disability variable
DRD or segawa variant (DYT 5) Affects production of tyrosine hydroxylase
and thereby formation of dopamine 1-12yrs, foot dystonias that interefers with
walking which worsens as day progresses and disapp during sleep
Excellent response to L-dopa
Blepharospasm: involuntary forceful closure of eyes
OMD: mus of lower face, lips, tongues(MEIG’S syn is combo of bleph &OMD)
Torticollis :Tendency of neck to twist to one side.
spasmodic dystonia: involves vocal cords(choking due to adductor mus involv)
Limb dystonias: writer’s cramps, musician’s cramp
Secondary dystonias: neuroleptics, chronic levodopa Rx, CO poisioning
Dystonia plus syndromes: as a part of other neurodegenrative disorder HD, PD, Wilson, CBGD, PSP etc..