This document provides an overview of hypokinetic movement disorders, specifically focusing on Parkinson's disease. It defines hypokinetic movements as abnormal movements involving initiation, implementation, velocity, frequency or posture. It then discusses Parkinson's disease in more detail, covering its epidemiology, aetiology, clinical presentations, investigations, available treatments, and prognosis. Key points include that Parkinson's disease is the second most common neurodegenerative disorder, involves the loss of dopaminergic neurons, and can be diagnosed clinically. Treatment involves pharmacological therapies like levodopa as well as non-pharmacological options such as deep brain stimulation for advanced cases.
Extrapyramidal symptoms. ... These symptoms include dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), parkinsonism (characteristic symptoms such as rigidity), bradykinesia (slowness of movement), and tremor, and tardive dyskinesia (irregular, jerky movements).
Extrapyramidal symptoms. ... These symptoms include dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), parkinsonism (characteristic symptoms such as rigidity), bradykinesia (slowness of movement), and tremor, and tardive dyskinesia (irregular, jerky movements).
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
-Detailed Introduction, Patho-physiology, Evaluation & Physiotherapy Management of Parkinsonism.
-Clinical classification is discussed.
-Various measures of evaluation and physical therapy is discussed in this.
SSPE, dr. amit vatkar, pediatric neurologistDr Amit Vatkar
Subacute sclerosing pan encephalitis (SSPE) also known as Dawson Disease, Dawson encephalitis, and measles encephalitis is a rare and chronic form of progressive brain inflammation caused by a persistent infection with measles virus.
In this presentaion i will a case a sspe and give u some information regarding daignosis and treatment
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Brief overview of hypokinetic movement disorder
1. Brief Introduction of Hypokinetic
Movement Disorders
Dr Ahmad Shahir Mawardi
Neurologist,
Neurology Department
Hospital Kuala Lumpur
26th April 2021
16. Prevalence of Parkinson’s disease in the Western Pacific
Region (per 100 000 population)
SY Lim et al, Parkinson’s disease in the Western Pacific Region: www.thelancet.com/neurology Published online June 4, 2019
17. History
• James Parkinson (11 April
1755 – 21 December 1824)
was an English surgeon,
apothecary, geologist,
palaeontologist, and political
activist.
• An Essay on the Shaking
Palsy (1817) describe
"paralysis agitans", a condition
that would later be renamed
Parkinson's disease by Jean-
Martin Charcot.
20. • Loss of
dopaminnergic
neuron in substantia
niagra
The main pathologies in
patients with clinical
Parkinson’s
disease and the
pathological progression
21. • Both genetic factors as well as probable
environmental factors contribute to the
risk of developing PD
• However, only 5-10% of patients have Fhx
which is why PD is usually regarded as a
sporadic condition.
What cause Parkinson's Disease?
26. Clinical presentations
• neurodegenerative disease characterized by
slowly progressive symptoms of resting tremor,
rigidity, akinesia/bradykinesia, and postural
instability.
• the second most common neurodegenerative
disease after Alzheimer disease.
• motor and non-motor symptoms
29. Natural History of Parkinsons
Disease
Ist
Symptoms
Loss of
Nigro-
Striatal
cells
Anosmia
3to 5 yrs
Diagnosis
ONSET
Treatment
HONEYMOON
PERIOD
4 to 6 years
MOTOR
COMPLICATIONS
Surgery
2 yrs 5
years
Cognitive
Decline
Death
1 year
6 to 7 years
Presymptomatic
stage
Postural
instability
Non Motor
complications
34. Suggestive Features of Idiopthic PD
• Unilateral onset
• Rest tremor present
• Progressive disorder
• Persistent asymmetry affecting the side of onset
most
• Excellent (70–100%) response to levodopa
• Severe levodopa-induced chorea
• Levodopa response for ≥ 5 years
• Clinical course of ≥ 10 years
35. How to make diagnosis?
• The diagnosis of PD remains clinical to this day.
• no biological marker that confirms the diagnosis
of PD.
• There are other disorders that can mimic PD and
investigations may be needed in some patients.
36.
37. hallucinations are common in PD – particularly visual. sometimes this arise as an
illusory misperception from an object – a coat becomes a person – but can also
be complex, detailed and distressing.
38.
39.
40.
41.
42.
43. Staging and severity
• The severity of PD is based mainly on the
clinical features.
• Hoehn and Yahr staging
• Unified Parkinson’s Disease Rating Scale
(UPDRS)
44.
45.
46. I. Mentation, Behavior and Mood
II. Activities of Daily Living
III. Motor Examination (14 components)
IV. Complications of Therapy
58. Treatment
• Currently no cure (or prevention)
• Motor symptoms (+ some NMS) can often be well
controlled in the earlier stages of the disease.
• Can be divided into:
– Pharmacological (oral,non-oral)
– Non-pharmacological
67. Dispersible Madopar
• Properties and AE: same as Madopar
• Pharmacokinetic : time to peak concentrations
tends to be shorter, less interindividual variability
in absorption parameters
• Administration: to be dispersed in 25-50 ml of
water. The tablets disintegrate completely,
producing a milky-white dispersion
75. Advanced therapy
costs
1. Deep Brain Stimulation (DBS)
RM 120-130K (10 -15 years)
2. Apomorphine infusion (KPK)
RM70-100K per year + consumables.
However company has issues to
register the consumable items.
3. Jejunal L-dopa
infusion
£16K / RM 88K
76. Deep Brain Stimulation
• Main indication : Parkinson's Disease
• Mainly to control : Motor symptoms
(bradykinesia,rigidity, tremor) also reported
to improve some non-motor symptoms
77. Criteria for DBS based on Movement
Disorders Society (MDS)
• PD
• motor complications: –fluctuations–severe
dyskinesias
• tremor
• refractory to optimal medical treatment
• important enough (severity/duration) to
justify surgical risk
• Intolerance to dopaminergic drugs
78. DBS for PD
Inclusion Criteria
1. Diagnosis by UKPDSBB criteria
2. Good Levodopa response (improvement >30% of motor
component in UPDRS)
3. Disabling symptoms
4. Normal cognition
5. Realistic expectation and good family support
6. Access & commitment to programming stimulation
*age < 70 yrs
79. DBS for PD
Exclusion Criteria:
1. Minimal / Absent response to Levodopa
2. Atypical Parkinsonism / Secondary Parkinsonism
3. Poor functional state while “ON”
4. Significant cognitive dysfunction
5. Untreated depression / psychiatric disease
80. Other assessment
MMSE/MOCA
UPDRS
DRS-2 (Dyskinesia Rating scale)
GCSI (Gastroparesis Cardinal Symptom Index )
QUIP ( Parkinson's Disease Impulsive-Compulsive Disorders
Questionnaire )
MADRS (Montgomery and Asberg Depression Rating Scale )
Euro QoL (Euro Quality of Life)
DQ-39
81. BS Stimulation of the Subthalamic Nucleus (STN).
•In 2 large randomized 6-mth trials versus best medical treatment,
UPDRS motor scores improved by 54% for STN and 28% for STN or
pallidal stimulation.
• A meta-analysis showed:
an average improvement of 53% .
Levodopa-equivalent dosage could be reduced by 50–60%.
UPDRS motor scores were still improved after 5 years, although
deteriorated compared with 1 year after surgery (Class III ).
Dyskinesias were reduced by 54%.
OFF time improved from 6.2 to 2h or 5.7 to 3.4h versus no
change in the medical group
The German Parkinson Study Group, Neurostimulation Section. N Engl J Med 2006;
Weaver et al, JAMA 2009; 301: 63–73.
83. Bilateral DBS STN versus Gpi in
advanced PD
Dutch NSTAPS study :
No significant difference in primary outcome
between STN vs Gpi.
Bilateral STN DBS and Gpi DBS are both
efficacious
(Lancet Neurology 2013)
84. Paul Krack, Deep Brain Stimulation in Movement Disorders: From Experimental
Surgery to Evidence-Based Therapy, Movement Disorders, 2019
93. Treatment of Advanced Parkinson Disease and Related Disorders
Janis M. Miyasaki, MD, MEd, FRCPC, FAAN, Continuum (Minneap Minn)
2016;22(4):1104–1116.
