The document discusses various movement disorders including: 1. Hypokinetic-hypertonic disorders like parkinsonism which include Parkinson's disease as well as secondary causes. 2. Hyperkinetic-hypotonic dyskinesias like tremor, chorea, dystonia, tics, myoclonus, and ballism. Tremor is described as involuntary rhythmic oscillations while chorea involves irregular jerky movements. 3. Specific treatments are mentioned for different conditions, such as levodopa drugs for Parkinson's disease, beta-blockers for tremor, and clonazepam or botulinum toxin for dystonia.

1. Movement Disorders

2. Classification
of movement disorders
• Hypokinetic-hypertonic movement disorders
– parkinsonism
• Hyperkinetic-hypotonic movement disorders
(dyskinesias)
– tremor
– chorea
– dystonia
– tics
– myoclonus
– ballism

3. Classification
of parkinsonism
1. Primary, idiopathic parkinsonism
Parkinson’s disease - 80 %
2. Secondary parkinsonism
• drug-induced
• toxic
• vascular
• post-hypoxic
• post-encephalitic
• post-traumatic
3.Parkinsonism-plus syndromes
• Progressive supranuclear palsy
• Levy body dementia
• Multiple system atrophy
• Cortico-basal degeneration

4. Clinical features
of parkinsonism
• hypokinesia
• rigidity
• rest tremor
• postural
instability

5. Treatment of Parkinson’s disease
• Levadopa drugs (nakom, madopar)
• Dopamine agonists (mirapex, pronoran)
• MAO-B inhibitors (selegiline)
• Amantidine (midantan)
• COMT – inhibitors
• Anticholinergic drugs (ciclodol)

6. tremor
chorea
dystonia
tics
myoclonus
ballism
Hyperkinesis

7. Tremor
involuntary
rhytmic oscillating movements
in limbs or the whole body due to
alternating contraction of agonist and
antagonist muscles

8. • Rest (pill-rolling) tremor
• Action tremor
– postural (occurs during maintenance of a
posture )
– kinetic (occurs during voluntary movement
Types of tremor

9. • Physiological
• Pathological: essential tremor
Classification of tremor

10. • Fatigue
• Anxiety
• Cold
• Hypoglycemia
• Hyperthyriodism
• Drugs (coffein, steroids)
Increased physiological tremor

11. Essential tremor
• It’s type of postural tremor
• Rhythmic, usually symmetric movement in the
hands, may involve the head
• Autosomal-dominant inheritance
• Onset may be in adolescence or early adult
years; if it’s develops late – senile tremor
• Aggravated by emotional stress, disappears
with a small amount of alcohol
• Neurological examination is normal except for
tremor

12. Essential tremor

13. • β-adrenoblockers (propranolol)
• Anti-epileptic drugs (primidone,
clonazepam)
Treatment of tremor

14. sustained muscle contractions
frequently causing twisting and
repetitive movement or abnormal
postures
Dystonia

15. Dystonia
Focal (affects only one region of
the body)
Segmental (two adjacent
regions)
Multifocal (two or more
nonadjacent regions)
Hemidystonia
Generalized

16. Dystonia

17. Focal dystonia
blepharospasm
oromandibular dystonia
cervical dystonia: torticollis (head
rotation), laterocollis (head tilt to
one side), anterocollis,
posterocollis (flexion or extension
of the neck)
graphospasm (writer’s cramp)
spastic dysphonia
toy or foot dystonia
Cranial
distonia

18. • clonazepam
• Myorelaxants (baclofen, tizanidin)
• Anticholinergic drugs
• Botulotoxin (botox, disport)
Treatment of dystonia

19. is irregular, arrhythmic,
unpredictable, jerky movement,
which involves the extremities and
the face in continuous, random
sequence
Chorea

20. • Hereditary: Huntington disease, Wilson disease
• Secondary: Sydenham chorea (rheumatic),
infections, encephalitis, systemic lupus
erythematosus
• Drug-induced chorea: antipsychotic, estrogens,
levadopa
• Metabolic and endocrine: hyperthyroidism,
hyperglycemic non-ketotic encephalopathy
• Senile chorea
Classification of chorea

21. Huntington disease
• Autosomal-dominant inheritance
• Abnormal irregular rapid jerky movements
• Progressive dementia
• The gait is unsteady with a tendency to bob
and weave
• Facial grimacing with involuntary movements
of the tongue

22. Chorea

23. • Psychotic drugs
– Haloperidol 3-6 mg daily
– sulpiride
– sonopax
Treatment of chorea

24. is involuntary,
brief, sudden
(till 0,1 sec) muscle contractions
producing visible movement
Myoclonus

25. Essential
Symptomatic (Alzheimer disease,
Huntington disease, liver disease,
paraneoplastic syndromes)
Physiological (sleep myoclonus, hiccups)
Epileptic
Classification of myoclonus

26. Myoclonus

27. • clonazepam
• Valproat acid (depakin)
• Carbamazepin, hexamidin
• Nootropic drug (pyracetam) in high dosage
- 12 g i/v (in posthypoxic myoclonus)
Treatment of myoclonus

28. - are repetitive, rapid, usually brief
involuntary non-rhitmic stereotyped
movements, which involve the face,
axial muscles and proximal limbs.
Tics interrupt normal voluntary motor
activity
Tics

29. -sudden onset of violent involuntary flinging
movements of the limbs. Usually affects only one
side of the body (hemiballism).
The appearance is similar to a baseball pitcher’s
windup.
Caused by a lesion of the subthalamic nucleus,
usually as a result of stroke
Ballism

30. Thank you!!!