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 Huntingtons chorea Wilsons 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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