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Medicine Notes Neurology Notes

Symposium On Movement Disorders Notes

Updated Symposium On Movement Disorders Notes

Neurology Notes

Neurology

Approximately 117 pages

These notes helped me achieve a mark of 76% in my neurology exam, which is the equivalent of a 1st. The notes are based on a series of 49 lectures on the subject. This is a very good, thorough and in depth review of the nervous system. They are very clearly laid out and easy to follow. They cut out unnecessary information on the topic, making the notes very concise, and fast to get through. Anyone studying medicine, or any other subject requiring knowledge of the nervous system (e.g. physiology o...

The following is a more accessible plain text extract of the PDF sample above, taken from our Neurology Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

SYMPOSIUM ON MOVEMENT DISORDERS

Clinical Aspects of Parkinson’s Disease and Huntington’s Disease

  • Pathology

    • Usually, axons from substantia nigra stretch out to putamen and DA released at terminals (but not in PD)

    • Cells in substantia nigra die off

      • Unilateral symptoms at first

      • 2 nigra striated pathways. One begins to die off faster than other. If left, see symptoms on right

    • Number of different genes that have been found to cause PD

      • Lark 2 gene

        • Autosomal dominant

        • 40% of Arabians with PD have gene

      • But genes cannot explain all cases

    • Environmental causes

  • Cardinal signs

    • TREMOR

      • Rhythmic, involuntary movements; Asymmetric; At rest

      • 1/3 never have tremor

      • May not respond to meds

    • RIGIDITY

      • ‘Cogwheel’

      • Try to move limb but very stiff

    • BRADYKINESIA

      • Slowness of movement & fatigue over time

      • Degeneration of PD causes this

      • Reduced speed and amplitude

      • Absent facial expression

    • Postural instability

      • Loss of so-called reflexes

      • Sluggish, stooped gait

  • Medication

    • L-Dopa

      • Can’t just give dopamine, won’t cross BBB

      • Give this pro-form that crosses and is then converted to dopamine

    • Dopamine agonists

      • Can cause impulsive behaviours

      • Works on receptor of next (post synaptic) nerve

    • MAOI

      • Stop breakdown of transmitters= around for longer

    • NMDA antagonist

      • Glutamate receptors

      • Antagonise and may make symptoms better

    • Anticholinergic

      • Reduce dopamine

      • ACh may decrease & so these give

    • COMT inhibitor

  • Motor complication

    • End of dose tail off

    • Sudden switching off

    • Dyskinesias

    • Freezing

    • Postural instability

    • Falling

    • Unable to swallow

  • Non-motor complications

    • Dementia (70-80%)

    • Depression

    • Anxiety

    • REMSBD (Body=paralysis. Patients act out dreams in REM sleep)

    • Daytime drowsiness

    • Restless Leg Syndrome

Treatment of movement disorders:

Parkinson’s disease and Huntington’s disease

Parkinson’s disease

  • Treatment options

    • Preventative

      • None

    • Symptomatic

      • Pharmacological

      • Surgical- Deep brain stimulation

    • Non-motor management

      • Cognitive & speech therapy

      • Physiotherapy

      • Dietician

      • Psychologist

    • Restorative (experimental)

      • Transplantation of stem cells

      • Gene therapy

      • Neurotrophic factors- support surviving cells

  • Drug classes

    • DOPAMINERGIC AGENTS

      • L-Dopa

        • Most effective

        • Always given with decarboxylase inhibitor to limit peripheral...

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