Movement_Disorders

Movement_Disorders - Ali Alrefai M.D Movement Disorders...

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Unformatted text preview: Ali Alrefai, M.D Movement Disorders Objectives • Anatomy • Definitions • Clinical evaluation of movement disorders • ET & PD • Huntington’s chorea • Wilson’s disease • Drug-Induced movement disorders Anatomy & Physiology of Basal Ganglia • Input zone (striatum: Putamen, caudate nucleus) • Output zone (GPi, SNr) • Intermediate zone (Gpe, STN) • Input: Cerebral cortex, ventral midbrain • Output: thalamus → Premotor & prefrontal lobe; brainstem (SNr) • Striatal neurons: 90% medium spiny neurons (GABA); Large spiny neurons (Ach); GABA interneurons Cerebral Cortex Striatum + GLU GLU + GABA D1>>D2 GABA D1>>D2 GPi-SNR SNC-Ventrolateral Thalamus GABA-GLU +-GABA SC-DA-Direct pathway: + & - signs indicates Excitatory or Inhibitory nature of NT. Activated pathways in large arrows. Inhibited pathways are shown in small arrows. Cerebral Cortex Striatum ENK/GABA D2>>D1 +GLU GPe GABA-STN GLU+ GPi GABA-GLU SNR SNC DA-Ventrolateral Thalamus GABA-+ GLU GABA-SC + + Indirect pathway: + & - signs indicates Excitatory or Inhibitory nature of NT. Activated pathways in large arrows. Inhibited pathways are shown in small arrows.-Symptoms of Movement Disorders • Tremor: Rhythmic, mechanical oscillations • Chorea: Abnormal involuntary purposeless brief dancing like movements, usually distal • Dystonia: Involuntary sustained muscle contractions causing twisting movements or abnormal postures • Ataxia: Disorganized poorly controlled movements • Myoclonus; Tics; Ballism Clinical Evaluation of Movement Disorders • History: Age of onset Mode of onset Course Drug history General medical background FH Cont....
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Movement_Disorders - Ali Alrefai M.D Movement Disorders...

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