Neurology Exam Prep Podcast Clerkship Success Series #6 - Involuntary Movements (Part 1)
Mar 27, 2021
Dr. Sara Schaefer, a movement disorders specialist at Yale School of Medicine, dives deep into the fascinating world of involuntary movements. She outlines key descriptors for assessing movements, emphasizing the role of the basal ganglia and dopamine. Listeners learn the distinctions between various tremors and how to test for them. Dr. Schaefer also shares insights on Parkinsonism, detailing its defining characteristics and treatment principles. This episode promises a wealth of knowledge on the complexities of movement disorders.
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Describe Movements Before Labeling
- Start movement evaluation with descriptors: hyperkinetic vs hypokinetic, rhythmic vs arrhythmic, voluntariness, stereotypy, and quality of movement.
- Use descriptors first before naming a phenomenology to avoid misclassification.
Basal Ganglia Modulates Voluntary Movement
- Basal ganglia modulates the corticospinal (pyramidal) pathway via direct and indirect loops through the striatum and thalamus.
- Dopamine from substantia nigra enhances movement by acting on D1 (direct) and D2 (indirect) receptors.
Watch Patients Continuously And Provoke Tasks
- Observe patients from the moment they enter and during history taking to gather movement clues before formal testing.
- Tailor provocative tasks (e.g., pouring, applying makeup) to reveal movements relevant to the patient's complaints.