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Basal Ganglia Club by Mind Map: Basal Ganglia Club
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Basal Ganglia Club

Collaboration of EFNS w movement disorder society

Lecture Andrew Lees

Nosology of Parkinson's Disease

What is a disease?, recognized etiologic agent or well defined pathological process, identifiable group of signs and symptoms, consistent anatomical changes

Parkinsonian syndromes, Parkinson's disease, much more

The neurologists "tools of the trade", no notes

Whats in a name, Clinicians, the shaking palsy, paralysis agitans, parkinson's disease, idiopathic parkinsonism, parkinsons-lewy complex, New node, Patients, people w parkinson's disease, In support of eponyms, patients prefer often eponyms

Parkinson's Disease, a bradykinetic syndrome characterised by L-dopa responsiveness, Definition of Bradykinesia (Queen square Brain bank criteria step 1): "slowness of initiation of voluntary movement with progressive reduction in speed and amplitude of repetitive actions" - Gibbs 1988, PSP fast movement, yet small amplitude, no progressive reduction in velocity and amplitude is noted, PD progressive reduction in velocity and amplitude is observed in a PD, Pill rolling tremor, tremor DOES respond to L-dopa, tremor is usually SLOW in responding sometimes up to a year, Listen to the patient he's telling you the diagnosis, Benign tremor dominant parkinsonism, SWEDDS (see previous mindmap for abbrev), Risk factors for functional decline in PD, age of onset, axial symptoms vs tremor dominance, Paper J Evans, 2011 - the natural history of treated parkinson's disease in an incident, community based cohort, Dementia in PD, missed note, Relationships between age and late progression of PD: a clinico pathological study, Peter A Kempster, Brain 2010, The advanced disease phase played out in a similar phase whatever age it occurred, Lewy-and alzheimer type pathologies in PD dementia: which is important?, Yaroslau compta, Brain 2011, More than one Parkinson's Disease.., missed note, Brain stem pathology in PD: an evaluation of the Braak stagng model, study by Kingsbury, We still need to study where the non motor symptoms come from!, Functional somatic syndromes, fatigue, sleep difficulties, diarrhoea and cramping, poor concentration, rheumatic non articular pains, urinary frequency and dysuria, mood disturbances, temperature dysregulation, We need to be carefull in considering this in context of PD or not, The new neurology, slide

The David Marsden Lecture

Neurmelanin studies, 60s

PD was much more than melanin

short video: on next 40 years in neurology


case: Baby between 3 and 18 months of age

3 main signs: boobing head, torticollis, intermittent nystagmus, benign spontaneous improvement within 2 to 3 years

Differential diagnosis: tumor of the optic tracts, hydrocephalus

diagnostics, MRI

symptomatological diagnosis, Spasmus nutans

Case: 1 year old

desert comes closer, and baby starts moving more

Baby is fully alert

Driven by the environment

shuddering, shivering attacks, dd epilepsias, Full consciousness, trigger by excitment = normal, w maturation of the brain this disappears

case: Child reading a book, 7 years old

hands making stereotypical movements



likes reading a book over and over again, when atrtacted by something interested, when somethign is more interesting it stops

Syncinesia, physiological ntil the age of 7 years, familial susceptibility, sometimes persists in adulthood, triggered by emotion and excitement

Case: baby

trigemino-oculomotor synkinesis, aberrant innervation III to V nerve


may cause embarassment depending on gender/age

Case report

51 year old male, myoclonic movements

lost 8 kg of weight due to the movements

jerky movements at rest or in action

Alcohol consumption

Dystonia, neurometabolic disease

diagnosis: Myoclonic dystonia

Case report

history of present illness, weight loss, Dystonia, slowness, Asymmetrical left side more effected, posturing, Bradykinesia, Standing up apraxic, walking unaided, Applause sign positive, supposed to clap 3 times, but keeps clapping, progressive dementia, expressive aphasia and dysartria, ideomotor and constructive apraxia, agraphia, finger agnosia, acalculia, etc, Rapid progress

labs:, New node

EEG, unspecific slowing, periodic epileptic discharges

MRI and PET, normal

Diagnosis, cortico-basal syndrome, para neoplastic, prion, prion genetics test, missed