Post on 29-May-2018
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Seminar on MovementSeminar on MovementDisorderDisorder
Presenter :Presenter :BalamuruganBalamurugan EE
Moderator:Mam.MeenaAggarwalModerator:Mam.MeenaAggarwal
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Today's
Topic
Today's
Topic
Tremors
Dystonia Tardive dyskinesia
Chorea (Huntingtons Diseases)
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Tremors A tremoris an involuntary, somewhat
rhythmic, muscle contraction and
relaxation involving to-and-fromovements (oscillations or twitching) of
one or more body parts.
( Hands, arms, eyes, face, head, vocalcords, trunk, and legs)
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Classification
Rest tremor- occurs at rest Action tremor-during voluntary action
Types of action tremor
Postural Physiologic and enhanced physiologic
Kinetic
Primary orthostatic tremors
Isometric
Task and Position specific(primary
writing tremors)
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Essential tremors
Most common tremor disorder
Slowly progressive postural and kinetic
tremor (5-10 Hz)
The hands and forearm are affected in
90%of cases.
Head ,vocal cord , jaw, face,and trunk.
Also called benign. Respond to alcohol
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Etiology
An autosominal
dominant inheritance in
60 % of People. Associated with variety
ofCNS pathologies.
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Assessment of tremor Tremor onset
Family history
Tremor response to alcohol
Functional tremors
Body part involved Tremor at rest or action
Frequency low(7 Hz)
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Symptoms Rhythmic tremor (412 Hz) that is present
only when the affected muscle is exerting
effort
Fatigue, strong emotions, low blood sugar,
cold, caffeine, lithium salts,
some antidepressants or other factors Do not occur in sleep
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Diagnostic evaluation Only history and clinical examination
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Management AANEvidence based guideline
Primidone, propanalol,alprazolam for
limb tremor,
Propanalol for head tremor
Botulinum injection for refractory cases
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Surgical management
Thalamotomy
Deep brain stimulation
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Dystonia
It is a disorder of sustained or
intermittent contraction that results in
abnormal posture and movent of theaffected part.
Dystonic movement are
Repitive Patterned
Triggered by voluntary movement
Often lessened by sensory tricks.
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Dystonia can involve any muscle group
it may be of face ,larynx, neck, trunk ,
limbs, hands, or feet.
Aggravated by stress and abate during
sleep.
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Classification
According to body part involved
focal dystonia
Segmental dystonia
Multifocal dystonia
Hemidystonia Generalized dystonia
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Focal dystoniaName
Cervical dystonia (spasmodic torticollis)
Blepharospasm
Oculogyric crisis
Oromandibular dystonia
Spasmodic dysphonia/Laryngeal dystonia
Focal hand dystonia (also known as musician's or
writer's cramp).
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Others Segmental dystonias affect two
adjoining parts of the body
Hemidystonia affects an arm and a leg
on one side of the body.
Multifocal dystonia affects many
different parts of the body.
Generalized dystonia affects most of the
body, frequently involving the legs and
back.
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Etiology
Primary
Secondary
Dystonia plus
Heredo degenrative dystonia
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Clinical manifestation
Abnormal posturing,
Continuous pain,
Cramping and relentless muscle
spasms
Mirror effect
Stress, anxiety, lack of sleep, sustained
use and cold temperatures can worsen
symptoms.
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Diagnostic testing Routine diagnostic testing
Genetic screening in early onset
dystonia with positive family history.
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Treatment Goals
To alleviate symptoms
Avert contractures
Improve function
E
nhance quality of life.
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3principle approach
Oral medication
Boutulinum toxin injection
Surgery
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Oral medication
Anticholonergic(trihexyphenidyl),
Benzodiazepines
Skeletal muscle relaxant
Dopaminergic agents.
Botulinum toxin injection
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Surgical management Thalamotomy
Pallidotomy
Myectomies
Rhizotomy
DBS(Deep Brain Stimulation)
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Tardive dyskinesia Tardive mean in french late
Tardive dyskinesia comprises a cluster
of iatrogenic movement disorder
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Risk factors Older adult
Woman
Greater total drug exposure
Pre existing drug induced parkinsonism
Alcoholoism Smoking
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Causes
Exposure to dopamine recptor blocking
agent
Haloperidol
Resperidone
Olanzipine
Aripiprazole
Prochlorperzine
Metaclopromide
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Clinical Feature
Oral facial movements often reprsents
a combination of licking,smaking,and
chewing
Limb and truncal rocking movements
Respiratory-erratic ,gasping breathing.
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Categories
Classic tardive dykinesia-stereotypes
Tardive dystonia-face and neck
Tardive akathesia-sense of inner
restlessness,tension,emotional unease,
and aversion to remain still.
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Treatment
Presynaptic dopamine depleting agents
Reserpine
Tetrabenzine
Anticholinergic
Botulinum injection DBS
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Chorea
It is a motor phenomena that consist of
non rhythmic rapid irregular,
unpredictable, brief, jerky movementsthat flow from one part of the body to
another part in a random fashion.
Variants include athetosis and ballism
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Huntington's diseases Huntington's disease, chorea,
ordisorder(HD), is a
progressive neurodegenerative genetidisorder, which affects muscle
coordination and leads to
cognitive decline and dementia.
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Epidemiology
The worldwide prevalence of HD is 5-
10 cases per 100,000 persons,
Highest in peoples of Western
European descent
Men and women equal
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Causes
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Causes
Abnormal gene in short arm of
chromosome 4
The gene called IT-15 and protein
product is called huntingtin
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Pathophysiology the genetic mutation causes loss of
neurons in specific regions of brain
The most affected part is basal ganglia
and frontal lobes of cerebral cortex
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Clinical manifestaion
Subtle changes in personality, cognition,
or physical skills
physical symptoms are jerky, random, and
uncontrollable movements called chorea
physical instability, abnormal facial
expression, and difficultieschewing, swallowing and speaking
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Seizures
Memory disturbances
neuropsychiatric manifestations
are anxiety, depression, a reduced
display of emotions (blunted
affect), egocentrism, aggression,and compulsive behavior,
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Other abnormalities include muscle
atrophy, cardiac failure, impaired
glucose tolerance, weightloss, osteoporosis and testicular
atrophy.
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Diagnostic test Genetic testing
CT and MRI
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Treatment Dopamine receptor blockers
Dopamine depleting agents
Amantadine
Antispasmodics
Benzodiazipines
Antidepressants
Anticonvulsants
C
holinesterse inhibitors
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Nursing management
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Conclusion