1. The document discusses various movement disorders including tremors, myoclonus, tics, and extrapyramidal movement disorders. 2. Specific movement disorders covered include Parkinson's disease, essential tremor, chorea, dystonia, athetosis, hemibalismus, and tardive dyskinesia. 3. The causes, characteristics, and treatments of each disorder are described. Common causes include neurological diseases, drugs, toxins, and various medical conditions.

1. Movement disorders Dr. Mohamad Shaikhani.

2. 1. Tremor: Rest tremore of parkisonism. Action tremore Flabing tremor of organ failure Intention tremore of cerebellar diseases 2. Myclonus 3.Tics 4. Extrapyramidal movement disorders

3. CAUSES OF ACTION TREMOR : Exaggerated physiological tremor Essential tremor (familial) Wilson's disease Postural ('Holmes', 'rubral') tremor Multiple sclerosis Intention tremor of cerebellar lesions

4. CAUSES OF EXAGGERATED PHYSIOLOGICAL TREMOR Anxiety/Fatigue Endocrine Thyrotoxicosis Cushing's disease Phaeochromocytoma Hypoglycaemia Drugs β-agonists (e.g. salbutamol) /Theophylline Caffeine /Lithium Dopamine agonists /Sodium valproate Tricyclics /Phenothiazines /Amphetamines Toxins Mercury /Lead /Arsenic Alcohol withdrawal

5. CAUSES OF ASTERIXIS (flabing tremor) Renal failure Liver failure Hypercapnic Resp Failure Drug toxicity (e.g. phenytoin) Acute focal parietal or thalamic lesions

6. Myoclonus: Brief, isolated, random, non-purposeful jerks of muscle groups in the limbs, may occur normally at the onset of sleep (hypnic jerks). A myoclonic jerk is a component of the normal startle response which may be exaggerated in some rare (mostly genetic) disorders. Unlike EP movement disorders, myoclonus may occur in disorders of the cerebral cortex, when groups of pyramidal cells fire spontaneously. Causes: M yoclonic epilepsy in which the jerks are fragments of seizure activity. Subcortical structures. Rarely, from diseased segments of the spinal cord. Treatment: Myoclonus, especially of cortical origin, often responds to clonazepam, sodium valproate or piracetam.

7. Tics: Repetitive semi-purposeful movements as blinking, winking, grinning or screwing up of the eyes. Distinguished from other involuntary movements by the ability of the patient to suppress their occurrence, at least for a short time. An isolated tic may be no more than a mild embarrassment, but may become frequent at certain times in childhood & then disappear. The uncommon syndrome of Gilles de la Tourette consists of a tendency to multiple tics & odd vocalisations, with obsessive behavioural abnormalities. The pathogenic basis is not understood, but there may be some response to major tranquillisers.

8. Extrapyramidal Movement disorders

9. Movement disorder Site of lesion. Parkinsonism. Chorea. Dystonia& athetosis. Hemibalismus. Substantia nigra & corpus striatum. Caudate nucleus. Putamin & corpus striatum. Subthalamic nucleus.

10. Other movement disorders: Chorea Hemibalismus. Athetosis & dystonias: Tardive dyskinesia:

14. Chorea :causes Hereditary Huntington's disease /Wilson's/Neuroacanthocytosis Porphyria Paroxysmal choreoathetosis Cerebral birth injury (including kernicterus) Cerebral trauma Drugs Levodopa /Dopamine agonists /Phenothiazines /Tricyclics Oral contraceptive Pregnancy Endocrine: Thyrotoxicosis /Hypoparathyroidism /Hypoglycaemia Infective/inflammatory Post-streptococcal (Sydenham's chorea) Henoch-Schönlein purpura Creutzfeldt-Jakob disease Antiphospholipid antibody syndrome SLE Vascular: Lacunar infarction /Arteriovenous malformation

20. Paraneoplastic neurological features: Brain & cerebellum. Neuroblastoma, Lung Ca. Dancing eye & feet,ataxia. Opsoclonus – myoclonus. SCC,Ovarian,breast,Hodgkin. Ataxia, dysarthria. Subacute cerebellar degener SCC Nystagmus,diplopia,vertigo. Brainstem = SCC Agitation,confusion, dementia. Limbic encephalitis. SCC,rarely cerv Visual loss to blind Photorec retinal degeneration.

21. Paraneoplastic neurological features: spinal cord. SCC Nystagmus,diplopia,vertigo. Subacute motor neuropathy. SCC, lymphoma Para, quadriplegia,areflexia, sensory loss, bladder dysf. Necrotizing myelopathy. Causative Ca. Features Site

22. Paraneoplastic neurological features: Peripheral nerve. SCC & others. Distal sensory & motor loss with areflexia. Subacute sensory & sensimotor neuropathy. Neuroblastoma, Lung Ca. Dancing eye & feet,ataxia. Opsoclonus – myoclonus. Myeloma specially osteosclerotic type. Chronic, sensory or motor. Neuropathy with paraproteinemia. Lung, breast,gastric,lymphoma,myeloma. Chronic weakness & sensory loss Chronic demyelinating PN. Hohgkin lymphoma Assending paralysis, areflexia. Gullain Barre. Causative Ca. Features Site

23. Paraneoplastic neurological features: NMJ. = = Myasthenia gravis. SCC,Thymoma, breast,prostate, stomach. Mentioned before. Eaton – Lambert or myasthenic syndrome. Causative Ca. Features Site

24. Paraneoplastic neurological features: Muscle. SCC, other lung Cas. Rapidly progressive Proximal weakness, dysphagia & dyspnea Necrotizing myopathy. breast,ovary, lung,lymphoma. Proximal weakness,myalgia,CMP, High CK. Polymyositis. Causative Ca. Features Site