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Movement Disorders

This video is intended to serve as an overview of movement disorders for medical students. Students This video is intended to serve as an overview of movement disorders for medical students. Students will learn to identify and classify a movement disorder, look for parkinsonism on the neurological examination, list differential diagnoses of tremor and parkinsonism, and recall early and late treatment options for Parkinson's disease. 00:06 - Intro 00:33 - Objectives 01:41​ - Case of a person with hand shaking 03:07 - MOVEMENT PHENOMENOLOGY 04:06 - Parkinsonism 07:13 - Tremor 08:50 - Dystonia 11:35 - Chorea and hemiballismus 13:23 - Tics 15:58 - Myoclonus 17:38 - MOVEMENT PHENOMENOLOGY: Summary 19:00 - Back to the case: What is the movement phenomenology? 19:35 - MOVEMENT DISORDER EXAMINATION 20:00 - Classification of tremor and tremor exam 22:51 - Examining rigidity 24:04 - Examining bradykinesia 25:35 - Examining ataxia and gait 27:47 - Our patient's examination 28:56 - PATHOLOGICAL DIFFERENTIAL OF TREMOR 32:19 - Parkinsonian tremor versus essential tremor 34:28 - Back to the case: What type of tremor is our patient exhibiting? 37:31 - DaT Scan: Differentiating parkinson's from essential tremor 39:43 - EARLY TREATMENT OF PARKINSON'S DISEASE: Levodopa, dopamine agonists, MAO-B inhibitors 47:47 - Back to the case: Progression of disease 49:10 - NON-MOTOR FEATURES OF PARKINSON'S DISEASE 53:10 - Progressive motor symptoms 55:16 - DIFFERENTIAL DIAGNOSIS OF PARKINSONISM 57:56 - Atypical parkinsonisms 1:03:18 - DIAGNOSTIC APPROACH TO PARKINSON'S DISEASE 1:05:53 - TREATING ADVANCING PARKINSON'S DISEASE 1:06:01 - Dyskinesias 1:08:44 - Gait freezing 1:09:42 - Amantadine, anticholinergics, COMT inhibitors 1:11:39 - Deep brain stimulation Created, produced, and narrated by: Igor Rybinnik MD Neurology Clerkship Director Rutgers Robert Wood Johnson Medical School Content experts: Jennifer Chen MD, Marco Russo MD, Gian Pal MD Division of Movement Disorders Department of Neurology Rutgers Robert Wood Johnson Medical School Images, videos adapted from: - Symptoms and Diagnosis of PSP, CBD and MSA - CurePSP TV - "A Day with Jeff — Technology and Essential Tremor," Google.org - Joss Whedon, director. Avengers Age Of Ultron. Marvel Studios, 2015 - Anthony Russo, Joe Russo, directors. Captain America: Civil War. Marvel Studios, 2016 - "Breaking the Fourth Wall." WandaVision, created by Jac Schaeffer, S01E07, Marvel Studios, 2021 - "The Tourette's Dictionary." Snapple and Cats, 2017 - Schenck C, Mahowald M. REM Sleep Behavior Disorder (RBD). University of Minnesota, 1986. - "Presentations of tardive dyskinesia symptoms," "Involuntary facial and neck movements in TD." Teva Neuroscience, 2021. - Hutchinson, "Topic 14: Parkinson's disease - Examining a patient." University Colege of Dublin School of Medicine, 2013 - Tubridy N, "Topic 13: Parkinson's disease female patient." University Colege of Dublin School of Medicine, 2013 - Barton B. "My Parkinson's Story: Medications." Veterans Health Administration, 2013 - Reich SG. Hemiballismus. Department of Neurology, University of Maryland. Neurosigns.org. - Rodriguez-Porcel F, et al. Fulminant Corticobasal Degeneration. Neurology 2016;86(12):1164–1166 - Nonnekes J, et al. Freezing of gait: a practical approach to management. Lancet Neurol 2015;14(7):768-778 - Multifocal motor tics and vocal tics in Tourette's syndrome. Neurosigns.org, 2016. - Poston K. "Approach to the Exam for Parkinson's Disease," Stanford Medicine 25, 2018. - Bhidayasiri R, Tarsy D. Movement Disorders: A Video Atlas (Current Clinical Neurology). 1st Ed, Humana Press, 2012. - Poewe W, et al. Nature Rev 2017;3(17013):1-21 - DaT scan image, Parkinson’s Foundation - Haggstrom M. Histopathology of neurofibrillary tangles in the hippocampus in Alzheimer's disease. H&E stain. Wikimedia.org, 2020 - Rajan, S. Lewy bodies (alpha synuclein inclusions). Wikipedia.org, 2012. - Hauser RA. Motor fluctuations. Music: - "The Plan's Working" by Cooper Cannell DISCLAIMER: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions of the presenters do not necessarily reflect those of Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, RWJBarnabus Health, or Rutgers University as a whole.