Movement Disorders

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    Restless Leg Syndrome

    • Definition:
      • deep, ill-defined discomfort or dysesthesia usually involving the legs that occurs when a person is trying to fall asleep (i.e. crawling sensation). 
      • Coupled with urge to move, and movement reduces or eliminates the sensation. 
      • Typically occurs during middle age (rarely start in 20s).
      • Often familial, restless legs syndrome may worsen over time. 
    • Treatment:
      • Dopamine agonists or opiates can alleviate symptoms.
      • Dopamine agonists
        • Pramipexole
        • Ropinirole

     

    Periodic Limb Movements

    • Recurrent, patterned leg jerks and tonic spasms that sometimes resemble a flexion reflex, usually occur every 20 seconds during early-stage sleep, and generally resolve deeper in the sleep cycle. 
    • May disturb the sleeping partner and also awaken the patient
    • Leads to inadequate or fragmented sleep + daytime drowsiness. 
    • Diagnosis:
      • Confirmed by polysomnography. 
    • Workup
      • Check ferritin (can be ass'd w/ iron deficiency)
    • Treatment
      • Just like restless leg syndrome, can result from dopaminergic deficiency 
      • Treated with dopamine agonists, such as pramipexole or ropinirole.
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    Tics

    Source: MKSAP 17

    • Tourette Syndrome
    • Ticks:
      • Repetitive
      • Stereotyped
      • Suppressible 
      • Typically preceded by an abnormal sensation (premonitory urge)
    • Typically patients can suppress the movements, but eventually sensation builds up to the point that they have to move. 
    • Types:
      • Vocal (clearing throat)
      • Compex Motor (shoudler elevation + neck rolling)
    • Typically have co-morbid OCD disorder.
    • Can wax/wane, old tics can be replaced by new ones over time, but typically some movements present on exam. 

    Chorea

    • Random, diffuse, and nonsuppressible involuntary abnormal movements.
    • Corea is
      • NOT focal
      • NOT suppressible
      • NOT stereotyped
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