Basal ganglia and cerebellum are involved in movement disorders. Hypokinetic disorders involve slow movements while hyperkinetic disorders involve involuntary movements. Examples include Parkinson's disease, Huntington's disease, Tourette's syndrome, dystonia, chorea, athetosis, ballismus, myoclonus, tics and ataxia. Treatment depends on the specific disorder but may include drugs to replenish dopamine, reduce metabolism of dopamine, use of dopamine agonists or Ach receptor antagonists.

2. Movement
disorders
Basal
ganglia
Cerebellum
Hypokinetic Hyperkinetic Ataxia

3. Range of diseases
Myoclonus Ballismus Tics Chorea Athetosis Dystonia
Movements become
less violent smoother & more
sustained

4. Hypokinetic
movements
Hyperkinetic
movements
Rigidity Tremor
Chorea
Dystonia
Ballismus
Myoclonus
Tics
Ataxia
Slow movements Involuntary movements

5.  Tremor
 Choreoathetosis
Huntington’s chorea
Sydenham’s chorea
Wilson disease
 Hemibalismus
 Myoclonus
 Drug induced
Dystonia
Tardive dyskinasia
 Parkinson’s disease
 Tourette’s syndrome(tics)

6.  Alternating contractions of agonist and
antagonist muscles in an oscillating,
rhythmic manner
 Causes:
drugs
Thyrotoxicosis
cerebellar lesion
parkinsonism
essential tremor

7.  Chorea:
irregular, brief , jerky
,unintentional movements ,
affecting differing parts
randomly
 Athetosis:
slower more writhing
movements than chorea
 The two often co-exist

8.  Chorea
Dopamine receptor blockers
Riluzole :corticostrial glutamate
release inhibitor
Remacemide:glutamate/NMDA
receptor antagonist
Anti-convulsants:valproate

9.  Inherited in autosomal dominant
pattern
 Triad of motor ,cognitive and
psychiatric symptoms

10.  Mainly in children/adolescents
 Complication of previous group A
streptococcal infection resulting in
Rheumatic fever
 Usually remits spontaneously

11.  Degeneration of basal ganglia
accompanied by cirrhosis of the liver.
 Due to inborn defect in the metabolism of
copper
 Asymmetrical variable
tremor
 Dystonia
 Choreoathetoid
movements
Kayser-fleischer ring

12.  Violent form of chorea composed of
wild,flinging,large-amplitude movements
on
one side of the body

13.  Brief,rapid shock-like,jerky
movements
consisting of single or repetitive muscle
discharges

14.  Sustained or repetitive
involuntary muscle
contractions frequently
associated with twisting or
repetitive movements and
abnormal postures.

15.  Dystonia
Botulinum toxins
Dopa depleting agents
Dopa antagonists
Anticholinergics
Beclofen
Anticonvulsants
Surgical methods

16.  Associated
with chronic
use of
neuroleptics
 Lingual
facial buccal
chewing
type
movements

17. Rx Tardive Dyskinasia
 Stop the causative drug
 Reduce the dose of causative drug
 Switch into alternative therapies ex:
clozapine
 Other drugs:
 Benzodiazepines
 anti-cholinergics
 suppliments –
vitamine E
Branched chain amino acids

18. PARKINSON’S DISEASE
 Pathology
Two balanced systems are in place for
extra pyramidal control of motor
activity at the level of corpus striatum
& substantia nigra
Cholinergic Dopaminergic

19.  In parkinson’s disease,there is
degeneration of nigrostriatal
dopaminergic neurones with depletion
of dopamine
Acetyl choline
Dopamine

20. Normal
dopamin
e level
Low level
of
dopamine

21. Basal ganglia
 Group of the neuclei located subcortically
 Take part in motor movements of body

23.  Unilateral onset, involves both sides of the
body as the age advances
 Bradykinesia
 Resting Tremor/pill rolling tremor
 Rigidity
 Posture- instability,
falls
flexion attitude
difficulty initiating or stopping
 Masked face
Rigidity

25.  Drugs to replenish depleted dopamine
 levodopa + dopa decarboxylase inhibitors
Carbidopa(sinemet) & madopar
 Drugs to reduce the metabolism of dopamine
COMT inhibitors-entacapone
MAO-B inhibitors-selegiline,rasagiline

26.  Dopamine agonists
Bromocriptine
Pergolide
Ropinirole
Pramipexole
Lisuride
 Drugs releasing dopamine
Amantidine
 Ach receptor antagonists
Benzatropine

28.  Childhood Tic disorder
 Tic: sudden repetitive non rhythmic
movement or vocalization involving
discrete muscle groups

29.  Tics
Education
Clonidine
Guanafacine
Atypical
neuroleptics(resperidone,olanzapine)
Typical
neuroleptics(haloperidol,fluphenazine)