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.

[@Malferon]

Literally every video you make is gold. To me they've become the standard for even resident level reviews and education for Neurology. I share them with all my junior and even some senior Neurology and Child Neurology resident colleagues. Thanks for all you do

[@theneurophile]

Thank you so much!

[@user-op5cw6hg1l]

It's so Amazing, you're bringing the neurology to the world with your expertise experiences in a matter of few hours..... How dedicated & 'delicious' .... preparation by a wonderful person..... No words to appreciate you dear neurologist......

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My man is back 🫡🔥🥲😩

[@Kyle_spores_on_IG_sells696]

⬆️⬆️Psychedelic are proven to be cure for anxiety, depression,PTSD,ADHD,insomnia and other related disorders 🧠You make your research

[@teresasantana9121]

As a Neurology resident, I can't thank you enough for making these videos! They are definitely the best learning tool available on youtube. Keep up the excellent work!

[@Kyle_spores_on_IG_sells696]

⬆️⬆️Psychedelic are proven to be cure for anxiety, depression,PTSD,ADHD,insomnia and other related disorders 🧠You make your research

[@samiheikkinen5375]

A long waited video, and it didn't dissapoint. Thank you!

[@juneloveletter3901]

This video is so detailed and yet enjoyable. And you’re so witty! Not only did I learn something, I thoroughly enjoyed doing it. Many thanks! 😊

[@theneurophile]

Thank you!

[@giricr]

❤​@@theneurophile

[@hldmyhndPX]

This channel is pure gold. I'm still in 3rd year of med but i can't stop binge watching and gathering new info! Can't wait for the next video

[@magdacomanescu4193]

And the KZbin Oscars go to.....the Neurophile!! Can't thank you enough for posting these videos! So useful, well structured, so much passion and hard work behind each one of them!! Congratulations!!

[@theneurophile]

Wow. Thank you!

[@rojeenabdullah6951]

Literally a LIFE SAVER! Thank you for your videos!

[@58209]

i'm watching this as a patient, rather than as a medical student. this is an excellently presented lecture, and helps me understand why my neurologists ask me certain questions or does certain exam room tests. thank you for making this publicly available. and thank you for including manually written captions so i could follow along with some of the more difficult medical terminology.

[@theneurophile]

Thank you for your kind words and I am sorry that you suffer with a movement disorder. I hope have a therapeutic regimen that works.

[@fernandobehrens74]

Great lecture!

[@sabirmusthafa]

Amazing lecture... Looking forward for a Coma Recovery Scale soon..

[@drfakherimam3084]

great to see you after a while

[@62riad]

Excellent lecture. Helped me a lot as a trainee.

[@mazik33n]

Really enjoyed this. Very informative and I love how you add video examples with each section. Exactly what I love to see in a lecture!

[@DocJona]

Wow your videos are oustanding! I really enjoy how you explain it in a witty and simplistic way . Please continue with your great work!!. Greetings from 🇦🇷

[@drabdusshahid629]

Great lecture... Thank You Man... 🙂

[@pedroinarionovaisaraujo1859]

I'm a family medicine resident in Brazil, and watch all your videos. Never stop!

[@theneurophile]

That's awesome!

[@vxp999]

All your lectures are super amazing! Thank you Thank you and 1 million Thank you for you efforts and hard work! Waiting for you to drop a new video/lecture! We certainty miss you! Every Neurology Resident should be thankful for you channel!

[@theneurophile]

Next video is coming soon. It's almost done.

[@vxp999]

Yay! Cant wait!

[@MyCer1]

Great video!

[@marietrask8390]

Very educational thankyou.

[@ali_madhoun]

Great lecture, thank u ❤👏

[@Adam-xe9qy]

I sincerely thank you for all this amazing quality content. I just started my neurology rotation and each of your videos are just on point to review a certain topic.

[@theneurophile]

Awesome! That's the main point of this channel.

[@frankrobert1917]

great lectures.

[@glksivakaran]

Such a wonderful talk thank you so much

[@mimm2848]

Than k you for this a great Teaching video as usual nothing new. You are the best

[@AnitaSingh-tv7ci]

Wonderful

[@user-sw5wn8go3k]

I was so excited to see the notification! Always longing to watching your videos!

[@Kyle_spores_on_IG_sells696]

⬆️Psychedelic are proven to be cure for anxiety, depression,PTSD,ADHD,insomnia and other related disorders 🧠…..You make your research

[@thiagoschernikau4769]

You manage to brilliantly combine exceptional medical insights, subtle humor, and remarkable clarity-truly unparalleled content, I'm very grateful!

[@theneurophile]

Thank you very much!

[@MBBSZaraHutKay]

As always Love and Respect Sir ❤

[@adewunmibamgbose5291]

good insight

[@samiabgb4084]

thank you so so much from Algeria

[@user-ho4hz8ns8l]

Thank u for comming back with great video!!

[@Kyle_spores_on_IG_sells696]

⬆️⬆️Psychedelic are proven to be cure for anxiety, depression,PTSD,ADHD,insomnia and other related disorders 🧠You make your research

[@dr.alaaelhag8619]

Amazing ❤

[@jakallebron]

You guys are the best. Big fan of your every video. Greetings from Germany.

[@theneurophile]

Wow, thank you!

[@MrAbdalrahim]

Welcome Back Doc, glad to see your lectures again, keep it up please. Can you describe what is the exact difference between yesterday and today video ??

[@theneurophile]

Of course. We used a video of a dystonia in a musician, but it wasn’t obvious enough, so I replaced it with a hand dystonia. Also, I talked about the null point in patients with dystonia, but that really only applies to dystonia tremor. This would introduce confusion to new learners, so we removed it.

[@gbajusstone6434]

Finally new video I really appropriate the efforts You are amazing I hope you can make videos everyday 😊

[@Kyle_spores_on_IG_sells696]

⬆️⬆️Psychedelic are proven to be cure for anxiety, depression,PTSD,ADHD,insomnia and microdosing You make your research………

[@abdullahalshighri]

wow what a lecture . Helps a lot in understanding the bigger picture something many medical students struggle with . You read something but never see that exact thing in rotations and you are great at showing the disease natural history and variation in disease presentation. Is there any way we can access these lectures as in download them?

[@theneurophile]

I am working on a website to provide the downloads.

[@TimZomb]

New video! Great!

[@antonribkin5319]

As always great content! That essential tremor patient with the knife almost made me faint tho..

[@theneurophile]

When I saw that video, I thought to myself, “please put the knife down.”

[@gonzaloalbertomonroycortes3105]

Thank u!!! What a great video

[@Kyle_spores_on_IG_sells696]

⬆️⬆️Psychedelic are proven to be cure for anxiety, depression,PTSD,ADHD,insomnia and other related disorders 🧠You make your research

[@zhiyako4032]

4:57 Parkinsonism also causes fractionated turning. Instead of a smooth 180 degrees turn, they take multiple steps to complete it.

[@theneurophile]

Absolutely. Thank you for pointing that out.

[@ms.pwintphyusoesoe2745]

thank you :)

[@carolhu6942]

your videos are so amazing

[@theneurophile]

Glad you like them!

[@demaahmed8817]

You are awoesome

[@keikomunsell1220]

I am a NP works for neurology inpatients. Really help to gain knowledge for neuro patients. Wondering if you offer CME? and also wondering if we can get printed materials for each diseases/disorders? I watch each video multiple times, nicely done. Thx!

[@theneurophile]

Unfortunately, I don’t think you can get CME through KZbin.

[@georgebashour4333]

💙💙

[@pixie89]

👌

[@letslearnwithkavya]

😂 Although many diseases can have a mix of both. *Parkinsonism* Presents as bradykinesia (slowness of movement, starts distally, lacks precision of fingers, drag legs, reduced amplitude), Rigidity(explain how it is different from spasticity)and tremor( a hyperkinetic character of a hypokinetic disorder!) Tremor is a involuntary ,rythmic, oscillatory movement of a body part. Can occur in action (kinetic/postural) -essential ,drug induced, metabolic/endocrine, enhanced physiological,neuropathic, dystonic, cerebellar or can occur at rest-idiopathoc Parkinson disease, secondary and atypical Parkinsonism. Test-outstreched hand hold posture, finger to nose, Rigidity assess and rapido alternative movements (asesse bradykinesia),assess coordination,balance and gait Dystonia - phenomena characterized by intermittent or sustained muscle contraction causing abnormal often repetitive movements or posture which can be stopped by sesory trick -antagonist gesture( explain antagonist gesture), can be task specific. Chorea(Latin -dance)-involutary , breif and irregular movement " hemiballismus variant Ticks - sudden, rapid, recurrent, nonrythmic , individually recognisable motor movement : may be accompanied by vocal ticks (explain) coprolalia,echolalia, palililia. Also premonitory urge may be present Myoclonus is a hyperkinetic, involuntary movement that is uniquely very brief. Negative and Positive myoclonus (difference)

[@waleedkhalid1181]

❤

[@abdou.b3259]

Doctor Why there is a Babinski sign in Friedrich ataxia?

[@theneurophile]

There is demyelination of corticospinal tracts in the spine. There is atrophy of the spinal cord after damage. So injuring the corticospinal tracts results in “long tract signs” like Babinski and hyper-reflexia.

[@fafster5368]

Waiting for the next videos

[@theneurophile]

Working on it.

[@rodrigosanjinez]

Its back!!!!!

[@Kyle_spores_on_IG_sells696]

⬆️⬆️Psychedelic are proven to be cure for anxiety, depression,PTSD,ADHD,insomnia and other related disorders 🧠You make your research…..

[@xDomglmao]

finally back

[@Kyle_spores_on_IG_sells696]

⬆️⬆️Psychedelic are proven to be cure for anxiety, depression,PTSD,ADHD,insomnia and other related disorders 🧠You make your research…..

[@Kyle_spores_on_IG_sells696]

⬆️⬆️Psychedelic are proven to be cure for anxiety, depression,PTSD,ADHD,insomnia and other related disorders 🧠You make your research…..

[@ThePublicHealthHeaux]

Hi! At 55:36 the audio has a (big!) error where it says "Every patient with Parkinsonism has Parkinson's disease." The caption is correct: "But not every patient..." Seems like a crucial thing to fix! ;)

[@ThePublicHealthHeaux]

PS--I'm a medical copy editor who used to work in pharma and is AVAILABLE for remote work. I'd LOVE to do more work directly with physicians, scientific articles, and/or in medical education.

[@theneurophile]

It should say, “not every patient with Parkinsonism…”

[@theneurophile]

I listened to it again… I do say the correct statement in the video: “But not every patient with Parkinsonism has Parkinson’s disease”

[@ThePublicHealthHeaux]

​@@theneurophile I'm SURE you are saying the correct statement! :) But there’s a clear audio/tech issue somehwere. Is this happening to others listening too? 
 Listening to that whole little section again, I'm hearing MANY recurring "hiccups" actually, where the caption is fine but the first part of one of your words isn't coming through. Ex: 55:25, where only the last 2 syllables (maybe 3) of “bradykinesia” can be heard (“‘nesia.”). 55:31, same thing occurs with the word “Parkinsonism” (the second occurrence, starting the sentence “Parkinsonism is absolutely necessary to diagnose Parkinson’s disease.”) where again the first part of this word gets muffled out. Then the next sentence (the ONLY instance I even consciously noticed first time listening) the audio cuts out “But not” from “But not every patient…” Then the word "Parkinsonism" is cut off in another instance (same exact way); then the sentence “Drugs!” gets cut out from the audio (but again, captioning is perfect). 

 I second everybody's THANKS for this amazing video--and the WHOLE series I’ve yet to dig into--btw! Given how I’m using it to help figure out my own really debilitating medical mystery that has led two impeccable compassionate specialists (neuro + neurosurgeon) to separately refer me to a movement disorder specialist, I may appreciate it differently--dare I say more, as it's not a purely academic concern?--than most of the folks commenting. Hopefully these audio hiccups are NOT another symptom emerging! ;D Thank you again!

[@theneurophile]

@@ThePublicHealthHeaux Thank you for that feedback. Technical hiccups are not good. On my end, I tried it on several devices and in multiple locations, and it sounds ok. Is anyone else experiencing these problems? If so, I would have to escalate it to KZbin.

[@feruzabdullayev640]

Hello. Do you have other colleagues who explain radiology like you?

[@theneurophile]

Sure. A few of us. We can't really measure up to Dr. Gaillard of radiopaedia.org, but we aspire.

[@feruzabdullayev640]

@@theneurophile thank you. Do you have friends who explain the same as you, but only the chest? On KZbin or on radiopedia?

[@abdou.b3259]

please ataxia you are the best in the world

[@theneurophile]

Thank you. If you want a review of the coordination pathway, take a look at our dizziness video. I will add ataxia to the list of things to work on

[@taiwofaruq3105]

Is movement disorder curable?

[@theneurophile]

It unfortunately depends on the cause.

[@pritamshil5765]

Sir there are Adults who find it difficult to concentrate,focus. Can these problems be totally cured in Adulthood?

[@theneurophile]

This is a very difficult question to answer since there are many causes for concentration difficulties.

[@Hamza-bhatti]

Man.... why didn't u make video bout brainstem lesions....😢

[@theneurophile]

Will do.

[@kevk741]

The question is how many of you watching understand medication injury and things like akathisia? I couldn’t find a neurologist that could identify akathisia or tardive symptoms with someone there screaming that they had it. Even top movement disorder specialists. No one should be prescribing antidepressants or benzodiazepines or stimulants or opiates or any psychotropic until they can identify akathisia. You cannot treat akathisia without turning it into a monster. Benzodiazepine Induced Neurological disorder is real and crippling people. Antidepressant injury and antidepressant tapering issues are also very real. Especially tardive akathisia after years of cumulative use.