Neurosurgery notes/Functional/Movement disorders

Movement disorders

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Parent item
Functional
Sub-item
Movement disorder symptoms
Dystonia
Tremor
Secondary parkinsonism
Parkinson’s disease
Movement disorder radiology
Hemiballismus
Huntington’s disease
  • Basal ganglia circuitry
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      • Lesion in the subthalamic nucleus causes hemibalismus
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  • Movement disorder classification
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      Hypokinetic disorders

      Disorder
      Description
      Parkinson’s disease/parkinsonism
      Idiopathic, secondary (drugs, toxins, infection, trauma, vascular); bradykinesia, tremor, rigidity, and postural instability
      Progressive supranuclear palsy
      Vertical gaze dysfunction, extrapyramidal symptoms, and frontal lobe dysfunction
      Multiple system atrophy
      Parkinsonism, cerebellar, and autonomic dysfunction; rapidly progressive
      Stiff person syndrome
      Progressive rigidity and stiffness of truncal muscles associated with spasms

      Hyperkinetic disorders

      Disorder
      Description
      Restless legs syndrome
      Irresistible urge to move limbs secondary to unpleasant sensations
      Essential tremor
      Action/postural tremor; autosomal dominant
      Tics/Tourette’s syndrome
      Sudden, repetitive, non-rhythmic movements (motor) or utterances (vocal) involving muscle groups
      Dystonia
      Sustained muscle contractions causing twisting/repetitive movements or abnormal postures
      Hemifacial spasm
      Involuntary movement of one side of the face
      Huntington’s disease/Chorea
      Cognitive, movement, and psychiatric disorders
      Torticollis
      Dystonia leading to asymmetrical position of head/neck
      Blepharospasm
      Abnormal contraction of both eyelids
      Writer’s cramp
      Task-specific (e.g., writing) focal hand dystonia

      Difference between essential tremor and dystonia

      Disease
      Presentation
      Treatment
      Essential tremor or familial/idiopathic tremor
      - Most common movement disorder
      - Tremor ONLY with movement (action/postural)
      - Usually upper extremities/head/neck/oropharynx
      - Present only when awake
      1. Beta-blockers (propranolol, nadolol, timolol)
      2. Antiepileptics (topiramate, gabapentin, levetiracetam)/benzodiazepines, alcohol
      3. Avoid stress/caffeine
      4. Deep brain stimulation (VIM)
      Dystonia
      - Slow sustained repetitive posture
      - Several forms (generalized, focal, multifocal, segmental, hemidystonia)
      - Cervical dystonia, blepharospasm common
      1. Botulinum injection (3–6 months relief; repeat)
      2. Medications (anticholinergics, benzodiazepines, carbidopa or levodopa)
      3. Selective neurotomy (for cervical dystonia)
      4. Deep brain stimulation (GP)