Basal Ganglia Disorders

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Author:
dmshaw9
ID:
255409
Filename:
Basal Ganglia Disorders
Updated:
2014-02-13 11:06:15
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Basal Ganglia Disorders
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NM2
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NM2
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  1. 5 nuclei of the basal ganglia
    • Caudate nucleus
    • Putamen
    • Globus pallidus
    • Subthalamic nuclei
    • Substantia nigra (para reticulate & para compacta)

    • Input from premotor/motor cortex →
    • striatum (caudate + putamen)
    • Output from globus pallidus → thalamus
  2. Basal Ganglia Functions
    • Planning, programming & execution
    • Control of contralateral limb movements (via cortical regions)
    • Control of postural control, balance & locomotion (via brainstem)
    • Regulates muscle tone
    • Perception, cognition, sleep & mood
  3. Basal Ganglia -- Linkages
    • Motor
    • Oculomotor
    • Dorsolateral prefrontal
    • Lateral orbitofrontal
    • Anterior cingluate
  4. Hypokinetic Movement Disorders
    • Bradykinesia
    • Akinesia
    • Postural instability
    • Rigidity
    • Resting tremor
  5. Hyperkinetic Movement Disorders
    • Athetosis
    • Chorea
    • Hemiballismus
    • Dyskinesia
  6. Parkinson's Disease: Signs/Symptoms
    • Resting tremor (pill rolling)
    • Rigidity (lead pipe, cogwheel)
    • Akinesia/bradykinesia
    • Postural instability
    • Flexed posture, decreased trunk rotation
    • Masked face (hypomimia)
    • Gait deviations: freezing; decreased stride length, velocity, arm swing; shuffling; destination
    • Decreased chest expansion
    • Depression
    • Cognition (impaired in later stages)
    • Oral motor control - speech, swallowing, chewing
    • Micrographia
    • ANS/BP (postural hypotension)
  7. Parkinson's: Disease Progression Scale
    • I: Minimal or absent, unilateral signs and symptoms
    • II: Minimal bilateral or midline signs, balance not involved
    • III: Impaired righting reflexes, unsteady when turning/rising from chair; some activities restricted, live independently/work
    • IV: All symptoms present & severe, standing & walking require assistance
    • V: Confined to bed/wheelchair
  8. Unified Parkinson's Disease Rating Scale (UPDRS)
    Rating tool to follow longitudinal course of PD

    • Sections:
    • Mentation/behavior/mood
    • ADL
    • Motor
    • Complications of therapy (medication side effects)
  9. Profile of Function & Impairment Level Experience w/ Parkinson Disease
    • PT specific scale (quantitative)
    • Measure of severity
    • 24 items (includes body systems, functional activities, cognition & community)
    • 0 = no problem, 4 = severe/marked problem
  10. Push-Release Test Scoring
    • 0 = recovers I, 1 step normal
    • 1 = recovers I, 2-3 small back steps
    • 2 = recovers I, 4 or > back steps
    • 3 = steps, needs assistance to prevent fall
    • 4 = falls w/o step attempt/unable to stand w/o assistance
  11. Pull Test (UPDRS) Scoring
    • 0 = normal
    • 1 = retropulsion, recovers unaided
    • 2 = absent postural response, falls if not caught
    • 3 = very unstable, spontaneous balance loss
    • 4 = unable to stand w/o assistance
  12. Progressive Supranuclear Palsy (PSP)
    • Parkinson's Plus Syndrome
    • Usually begins after 50 y/o and progresses more rapidly than PD
    • Imbalance, falls, trunk rigidity, dementia
    • Visual system: vertical gaze paralysis (primarily downward)
  13. Multiple System Atrophy (MSA)
    • Parkinson Plus Syndrome
    • Progresses more rapidly than PD
    • Mean age of onset = 50 y/o
    • Bradykinesia, imbalance, abnormal autonomic function (impotence, orthostatic hypotension, decreased/increased sweating, constipation), rigidity, poor coordination
    • Subtypes = Striatonigral Degeneration, Shy-Drager Syndrome, Oliyopontocerebellar Atrophy (OPCA)
  14. Corticobasal Degeneration (CBD)
    • Least common
    • Begins usually after 60, progresses more rapidly than PD
    • Asymmetric bradykinesia, rigidity, limb dystonia, postural instability, speech impairments, apraxia
  15. Diffuse Lewy Body Disease
    • Parkinson Plus Syndrome
    • Parkinsonism w/ progressive dementia
  16. Medication-Induced Parkinsonism
    • Parkinson's Plus Syndrome
    • Neuroleptic
    • Antidepressants, antihypertensives
    • Illicit drugs
  17. Toxicity-Induced Parkinsonism
    • Manganese
    • Carbon disulfide, carbon monoxide
  18. Wilson's Disease
    • Copper metabolism disorder, degenerates liver & basal ganglia
    • Rare, inherited autosomal recessive trait 
    • Onset after 20 → dystonic form; onset before 20 → chorea movements of the face & UE's, progresses rapidly 

    • Signs:
    • Kayser-Fleischer Ring (brownish-red/green @ sclerocorneal junction)
    • Speech/language deficits
    • Tremor, chorea dystonic movements
    • Clumsiness & impaired walking
    • Change in personality
  19. Tardive Dyskinesia
    • Medically induced by long-term antipsychotics
    • Hyperkinetic disorder
    • Examine for involuntary, uncontrollable movement (chorea) (mostly head, face, mouth, & tongue)
  20. Hemiballismus
    • Unilateral
    • Contralateral affects
    • Large amplitude, chorea-athetoid mvmt
    • Postural instability & falls

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