General Medicine
Movement Disorders
Movement disorders for MBBS: hypokinetic and hyperkinetic types, Parkinson disease and levodopa therapy, tremor, chorea and dystonia, mapped to NMC codes IM19.1 to IM19.9.
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Movement Disorders
Movement disorders for MBBS: hypokinetic and hyperkinetic types, Parkinson disease and levodopa therapy, tremor, chorea and dystonia, mapped to NMC codes IM19.1 to IM19.9.
This chapter covers movement disorders, dividing them into hypokinetic and hyperkinetic types and grounding them in basal ganglia function. It focuses on Parkinson disease and its dopaminergic treatment, the recognition of tremor, chorea and dystonia, and the roles of deep brain stimulation and botulinum toxin.
High-yield: Movement Disorders
- Movement disorders are broadly divided into hypokinetic, such as parkinsonism, and hyperkinetic, such as tremor, chorea and dystonia.
- The basal ganglia circuits control the initiation and smoothness of movement.
- Parkinson disease features the classic triad of resting tremor, rigidity and bradykinesia.
- The resting tremor of Parkinson disease is a pill-rolling tremor that lessens on voluntary movement.
- Cogwheel rigidity combines increased tone with the superimposed tremor.
- Parkinson disease is due to loss of dopaminergic neurons in the substantia nigra.
- Levodopa combined with a peripheral decarboxylase inhibitor is the most effective symptomatic therapy.
- Long-term levodopa use is complicated by motor fluctuations and dyskinesias.
- Essential tremor is a postural and action tremor, often familial, that improves with alcohol and beta-blockers.
- Chorea is an irregular, flowing, involuntary movement seen in Huntington disease and Sydenham chorea.
- Wilson disease should be considered in a young patient with movement disorder and liver disease.
- Deep brain stimulation helps selected patients with advanced Parkinson disease and refractory tremor.
- Botulinum toxin is used to treat focal dystonias such as cervical dystonia and blepharospasm.
- Drug-induced parkinsonism from dopamine-blocking agents is an important reversible mimic.
- A structured examination and rating scales help quantify severity and monitor treatment response.
Movement disorders essentials
- **Parkinson triad:** Resting pill-rolling tremor, rigidity and bradykinesia from nigral dopamine loss.
- **First-line:** Levodopa with a peripheral decarboxylase inhibitor; watch for later dyskinesias.
- **Essential tremor:** Postural and action tremor, often familial, responsive to beta-blockers.
- **Interventions:** Deep brain stimulation in advanced disease; botulinum toxin for focal dystonia.
NMC competencies in this chapter
- **IM19.1:** Functional anatomy of locomotor control
- **IM19.2:** Clinical classification of movement disorders
- **IM19.4:** Examination and rating scales
- **IM19.5:** Differential diagnosis and prioritisation
- **IM19.6:** Clinical diagnosis by site, nature and cause
- **IM19.7:** Diagnostic and imaging tests
- **IM19.8:** Drug therapy of parkinsonian syndromes
- **IM19.9:** Surgery and botulinum toxin in movement disorders
Frequently Asked Questions
What is the classic triad of Parkinson disease?
The classic triad is a resting pill-rolling tremor, cogwheel rigidity and bradykinesia, arising from loss of dopaminergic neurons in the substantia nigra.
What is the most effective drug for Parkinson disease?
Levodopa combined with a peripheral decarboxylase inhibitor is the most effective symptomatic therapy, though long-term use leads to motor fluctuations and dyskinesias.
How is essential tremor distinguished from Parkinson tremor?
Essential tremor is a postural and action tremor that worsens with movement and improves with alcohol and beta-blockers, unlike the resting tremor of Parkinson disease.
How does this chapter help for NEET-PG?
The Parkinson triad, levodopa complications, tremor differentiation and the use of deep brain stimulation and botulinum toxin are common exam themes that map directly to questions.
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