occurs at any age, but highest in 50/60s

Hallmarks for disease:

RESTING tremor -pill rolling tremor

Bradykinesia (slowness of mvmt, absence of automatic mvmts)

Rigidity

Loss of postural reflexes

most affected side has a reduced arm swing

don't swallow saliva well-can drool-produce a normal amount just can't swallow what have

loss of dopaminergic neurons in the substntia nigra (motor)

Loss of cholinergic neuorns in cortex (cognitive)

Loss of cholinergic neurons in brainstem (postural loss)

Loss of serontonergic neurons in brainstem (affective)

aim is to replace dopamine for motor symptoms

1. Dopamine itself doesn't cross BBB

2. A precursor of dopamine, L-DOPA does cross BBB

3. Most of orally administered L-DOPA is decarboxylated to dopamine outside the BBB

4. Orally administered L-DOPA can be combined with a DOPA decarboxylase inhibitor

1. Fetal mesencephaic tissue transplantation

2. Deep brain stimulation of STN or GP

3. New drugs involved in catabolism of L-DOPA

4. Trophic factors & anti-apoptotic agents

Gait freezing: tx: turn automatic function into a voluntary fx--> i.e. shine a light on ground-have step over line-makes it a voluntary task

Chorea

definition: relatively rapid non-sterotypic mvmt that flows from one body part to another

Most common cause=Huntington's disease

distally pre-dominant

chorea that affects the proximal extremities & is of large amplitude

lesion in Subthalamic nucleu

autosomal dominant (with age dependent onset)

Genetics: have an expanded trinucleotide repeat

1. typical onset after child-bearing years

2. generalized chorea

3. dementia

4. pre-symptomatic diagnosis possible

definition: twisting (around an axis) slwo & sustained abnormal mvmts of trunk & extremities or cranial musculature

variety of lesions in CNS and PNS can cause-most common=PUTAMEN LESION

an example of generalized dystonia

-autosomal dominant

-defect gene (DYT) is on chromosome 9

-Genetic abnormality is a trinucleoitide (GAG) deletion

-Pentrance of the gene is much less in comparison to Huntington's diesease

-No clear CNS structural abnormality

-Pallidal stimulation may improve

RNA interference to silence the abnormal gene is being researched

Begins in childhood

Lower extremities affected first

generatlization ultimately occurs

no strucutral CNS abnormality

is the result of aberrations of receptor function

is an incessant desire to keep in motion

movements consist of= fidgeting, marching in place, moving the extremities, speaking incessantly

induced by Dr-results from med

starts in childhood

overtime ticks change, but at nay time they are the same

to be diagnosed-must have phonic AND motor ticks