Movement Disorder: Mrs. Keerthana.B Assistant Professor MSN, PSG Con

MOVEMENT
DISORDER
Mrs. Keerthana.B
Assistant professor
MSN, PSG CON
2
•CHOREA
•SEIZURE
•EPILEPSY
Mrs.Keerthana.B, MSN, PSG CON 01/03/2022
CHOREA
3

Definition 4
• Chorea is a movement disorder that causes involuntary, irregular,

unpredictable muscle movements.
• The disorder can make look like dancing (the word chorea comes from
the Greek word for “dance”) or look restless or fidgety.

Epidemiology 5
• About 30,000 people in the United States have Huntington’s disease (a genetic condition
that causes chorea).
• Chorea is the most common symptom of Huntington’s disease.
• In the United States, about 4,000 kids a year develop Sydenham chorea after
having rheumatic fever. Girls are more likely than boys to get rheumatic fever. It usually
occurs between 5 and 15 years of age.

Causes of Chorea 6
• Huntington’s disease: People inherit this genetic disorder from their parents. In addition to
chorea, it causes changes in personality and problems with speech, coordination, and memory.
• Rheumatic fever: Around one to eight months after having rheumatic fever, children can
develop Sydenham chorea (also called St. Vitus dance). Rheumatic fever is a complication of
group A streptococcal infection, such as strep throat infection that wasn’t treated properly.
• Other infectious diseases (Rarely): Lyme
disease, toxoplasmosis, HIV/AIDS, endocarditis, syphilis,
Mrs.Keerthana.B, MSN, PSG CON
encephalitis, meningitis, Legionnaire
01/03/2022
disease, Creutzfeldt-Jakob disease are among infectious diseases that can cause chorea.

• Autoimmune diseases: People who have systemic lupus erythematosus can
develop chorea. Multiple sclerosis, sarcoidosis, are among other autoimmune 7
diseases that can cause chorea.
• Stroke: Some people develop chorea if they have a stroke or a tumor that occurs
in or near basal ganglia.
• Pregnancy: Though rare, a type of chorea called chorea gravidarum can occur

during pregnancy. (If pregnancy is the cause of the chorea, it may appear during
the first three months of pregnancy and stop shortly after the birth of the baby.)
• Toxins: Carbon monoxide poisoning, mercury, alcohol intoxication can cause

chorea.
• Endocrine and metabolic disorders: Hypoglycemia, hyperglycemia,
hyperthyroidism,hypoparathyroidism, hyperparathyroidism, hyponatremia, 8
hypernatremia, hypocalcemia, hypomagnesemia, polycythemia vera and hepatic
failure are some of the conditions that can cause chorea.
• Medications: Levodopa, neuroleptics, amphetamines, antihistamines, tricyclic
antidepressants, anticonvulsants, cocaine, oral contraceptives are among the many
medications known to cause chorea. Antipsychotic drugs can also cause chorea
called tardive dyskinesia.
• Older age: Sometimes chorea develops in older people without a known cause. This is
called senile chorea and tends to affect the muscles in and around the mouth.
01/03/2022
SYMPTOMS OF CHOREA
• Involuntary muscle movements: Also called fidgety movements or dance-like 9

movements usually appear in the hands, feet, and face. They can affect the walk,
swallow and talk. The movements may be fluid or somewhat jerky. They can make
it look as if dancing, playing the piano, or even writhing in pain. The movements
often get worse if stressed or anxious and go away when sleeping.
• Milkmaid’s grip: Rather than holding hand steady when the patient try to shake
someone’s hand, may grip and release your fingers over and over again.
https://www.youtube.com/watch?v=-BuB_Mbhs7o
10

• Jack-in-the-box tongue: When the patient try to stick out the tongue, it may slide in
11or
and out of mouth. This sign of chorea is sometimes called jack-in-the-box tongue
harlequin tongue.
• https://www.youtube.com/watch?v=ZlnT3ECKlWM
• Speech problems: Kids and adults may develop slurred speech as the muscles involved
in making speech lose coordination.
• Headaches and seizures: Kids who develop chorea after rheumatic fever can have
seizures and headaches. Some children also have behavioral and emotional issues.

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13

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https://www.youtube.com/watch?v=J_wIDm1_ax4
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17

Diagnostic Studies for Chorea 18
• Blood tests to check for infections, lupus, thyroid levels or other endocrine or

metabolic abnormalities.
• Imaging studies such as magnetic resonance imaging (MRI) scan or

a computed tomography (CT) scan to look for changes in brain.
• Genetic testing to see if you have the gene for Huntington’s disease.

Treatment of Chorea 19
Form Treatment
A common treatment is dopaminergic antagonists, although treatment is largely
Huntington's-related supportive. Tetrabenazine is the only FDA approved drug for the treatment of
Huntington's disease-related chorea.
Haloperidol, carbamazepine and valproic acid. Usually involves antibiotic drugs
Sydenham's chorea
to treat the infection, followed by drug therapy to prevent recurrence.
Haloperidol, chlorpromazine alone or in combination with diazepam,
Chorea gravidarum
also pimozide can also be used.
Reducing levels of copper in the body using D-penicillamine, trientine
Wilson's disease
hydrochloride, tetrathiomolybdate, and other chelating agents
Drug-induced chorea Adjusting medication dosages.
Metabolic and endocrine-
Treated according to their causes.
related chorea
20

21

EPILEPSY
22

• Key facts
23
• Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages.
• Around 50 million people worldwide have epilepsy, making it one of the most common
neurological diseases globally.
• Nearly 80% of people with epilepsy live in low- and middle-income countries.
• It is estimated that up to 70% of people living with epilepsy could live seizure- free if
properly diagnosed and treated.
• In many parts of the world, people with epilepsy and their families suffer from stigma and
discrimination.
MEANING 24
• It is characterized by recurrent seizures, which are brief episodes of involuntary

movement that may involve a part of the body (partial) or the entire body (generalized)
and are sometimes accompanied by loss of consciousness and control of bowel or
bladder function.
• Epilepsy is defined as having two or more unprovoked seizures.

CAUSES 25
• Epilepsy is not contagious. Although many underlying disease mechanisms can lead to
epilepsy, the cause of the disease is still unknown in about 50% of cases globally. The
causes of epilepsy are divided into the following categories: structural, genetic,
infectious, metabolic, immune and unknown.

• brain damage from prenatal or perinatal causes (e.g. a loss of oxygen or
trauma during birth, low birth weight);

26
• congenital abnormalities or genetic conditions with associated brain
malformations;
• a severe head injury;
• a stroke that restricts the amount of oxygen to the brain;
• an infection of the brain such as meningitis, encephalitis or
neurocysticercosis,
• Mrs.Keerthana.B,
certain genetic syndromes; and
MSN, PSG CON 01/03/2022
• a brain tumour
Clinical Manifestations
• Characteristics of seizures vary and depend on where in the brain the disturbance 27
first starts, and how far it spreads.
• Temporary symptoms occur, such as loss of awareness or consciousness, and

disturbances of movement, sensation (including vision, hearing and taste), mood,
or other cognitive functions.
• People with epilepsy tend to have more physical problems (such as fractures and
bruising from injuries related to seizures), as well as higher rates of psychological
conditions, including anxiety and depression.
• A Mrs.Keerthana.B,
great proportion MSN, PSG CON of the causes of death related to epilepsy, are potentially
01/03/2022
preventable, such as falls, drowning, burns and prolonged seizures.

SEIZURE 28
DISORDER
DEFINITION 29
• Seizure is a paroxysmal, uncontrolled electrical discharge of

neurons in the brain that interrupts normal function.
• Epidemiology:
• Males
• Alzheimer’s disease or stroke
• Family history 01/03/2022

Etiology 30
• Based on Age:
• First 6 months of life:

• Severe birth injury
• Congenital defects
• Infections
• Inborn error of metabolism
01/03/2022
2 years to 20 years 31
• Birth injury
• Infection
• Trauma
• Genetic factors
20 years to 30 years 32
• Structural lesions as trauma, brain tumor or vascular disease
After 50 years
• Stroke and metastatic brain tumor

Other causes 33
• Head trauma
 Epidural hematoma
 Subdural hematoma
 Intracranial hematoma
 Cerebral contusion
 Traumatic birth injury

Drug- Related Processes 34
• Overdose
• Withdrawal of alcohol, opioids, antiseizure drugs
• Ingestion, Inhalation
Infectious Processes
• Meningitis
• Septicemia
• Encephalitis
01/03/2022
Intracranial Events 35
• Brain tumor
• Subarachnoid hemorrhage
• Stroke
• Hypertensive crisis
• Increased ICP
Metabolic Imbalances
• Fluid and Electrolyte balance
• Hypoglycemia
Medical disorders 36
• Heart, liver, lung or kidney disease
• Systemic lupus erythematous
Other
• Cardiac arrest
• Idiopathic
• Psychiatric disorder
• High fever
Pathophysiology 37
Group of abnormal neurons that undergo spontaneous firing
This firing spreads by physiologic pathways to involve adjacent

or distant the whole brain
If this activity spreads to involve the whole brain, a generalized

seizure occurs
The factor that causes this abnormal firing is not clear
38
Any stimulus that causes the cell membrane of the neuron to
depolarize induces a tendency for spontaneous firing
Scar tissue (gliosis) is often found in the area of the brain from which
the epileptic activity rises
Scarring is believed to interfere with the normal chemical and

structural environment of the brain neurons
Phases of Seizure 39
Prodroma • Signs or activity that precede a seizure

l
Aural • Sensory Warning
• Full Seizure
Ictal
Postictal • Period of recovery after seizure

Generalized tonic-clonic
Seizures
Typical
Absence Seizures
Atypical
Myoclonic Seizures
Generalized
Seizures
Tonic Seizures
Clonic Seizures
Seizure
Classification
Atonic Seizures
Simple focal
Focal
Seizures
Complex focal
41

Generalized Seizures 42
• Involve both sides of the brain
• Characterized by bilateral synchronous epileptic discharges in

the brain from the onset of the seizure
• Lose consciousness for a few seconds to several minutes.

Tonic-Clonic Seizure 43
• Grand mal
• Losing consciousness and falling to the ground
• Stiffening of the body for 10 – 20 sec (Tonic)
• Subsequent jerking of the extremities for 30 – 40 sec (Clonic)
• Cyanosis
 Postictal phase
• Excessive salivation
 Tiredness
• Tongue or cheek biting
 Sleep for hours
• Incontinence
 No memory
44

Typical Absence seizures 45
• Petit Mal
• In children rarely adolescence
• Brief staring called daydreaming
• When untreated occurs 100 times per day
• EEG – 3HZ cycles per second spike and wave pattern
• Hyperventilation and flashing lights

Atypical absence seizures 46
• Brief warnings, peculiar behavior during and confusion after

seizure
• Loss of postural tone
• EEG : spike and wave pattern / greater or less than 3 Hz
01/03/2022
47

Myoclonic seizure 48
• Sudden, Excessive jerk of the body or extremities
• Jerk may be forceful
• Brief and occur in clusters

49

Tonic Seizure 50
• Sudden onset of maintained increased tone in the

extensor muscles
• Patients fall often

Clonic Seizure 51
• Loss of consciousness and sudden loss of muscle tone followed

by limb jerking

Atonic seizures 52
• Drop attack
• Paroxysmal muscle tone
• Suddenly falling on the ground
• Consciousness returns by the time the person hits the ground

53

Focal seizures 54
• Begin in one hemisphere of the brain in a specific region of the

cortex
• Signs and symptoms related to the area
• Example: Postcentral gyrus may experience paresthesia and

tingling or numbness on opposite side leg
Simple focal seizure 55
• Patients remain conscious
• Sudden and unexplainable feelings of joy, anger, sadness or

nausea
• They also hear, taste, smell, see or feel things that are not real

Complex focal seizure 56
• Loss of consciousness
• Smacking and automatisms
• No memory during the seizure

Psychogenic seizures / Pseudoseizure 57
• Psychogenic in nature
• Resemble epileptic seizure

Diagnostic studies 58
• Health History
• Clinical signs
• EEG: within 24 hours of seizures
• Magnetoencephalography
• CBC
• Liver and Kidney function
• Urinalysis
• CT, MRI, Cerebral angiography, SPECT, MRS, MRA and PET
01/03/2022
Collaborative Management of Seizures
Emergency Management
59
Ensure patent airway

Protect patient from injury without restrain
Remove or loosen tight clothing
Establish IV access
Stay with patient until seizure passed
Anticipate drug administration
Suction as needed. Assist ventilation and anticipate intubation
Drug therapy 60
Generalized, Tonic-clonic, Focal Absence, myoclonic seizure
• Carbamazepine • Clonazepam
• Divalproex • Divalproex
• Gabapentin • Ethosuximide
• Pregabalin • Zonisamide
• Topiramate
• Valproic acid
• Phenobarbital
61

Surgery therapy 62
• Anterior temporal lobe resection
• Indications:
• A confirmed diagnosis of epilepsy
• An adequate trial with drug therapy without satisfactory results
• Electroclinical syndrome
Other Therapies 63
• Vagal nerve stimulation (electric impulse to vagus nerve)
• Ketogenic diet (high fat and low carbohydrate diet)
• Biofeedback

Nursing Management 64
Nursing Assessment:
Aura
Loss of consciousness
Bowel and bladder incontinence
Tachycardia
Diaphoresis
Warm skin
Pallor, flushing or cyanosis
Types of seizures
01/03/2022
Nursing Diagnosis 65
• Ineffective breathing pattern related to neuromuscular impairment
• Ineffective self-health management related to drug therapy and

lifestyle adjustments
• Risk for injury related to loss of consciousness during seizure

activity and postictal physical weakness

Nursing Intervention 66
• Promoting general safety measures

• Good health habits
• Identify triggers and avoid
• Observe and record the events
• Maintain airway, suctioning and oxygen
• Teaching patient and caregiver
• Coping
• Alert bracelets
Status epileptics 67
• Is a state of continuous seizure activity or a condition in which seizures

recur in rapid succession without return to consciousness between
seizures
• Neurons become exhausted and cease to function
• Permanent brain damage occurs
• Tonic Clonic status epileptics is most dangerous

01/03/2022
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MOVEMENT

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

• Chorea is a movement disorder that causes involuntary, irregular,

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

that causes chorea).

• Chorea is the most common symptom of Huntington’s disease.

occurs between 5 and 15 years of age.

• Other infectious diseases (Rarely): Lyme

disease, Creutzfeldt-Jakob disease are among infectious diseases that can cause chorea.

• Pregnancy: Though rare, a type of chorea called chorea gravidarum can occur

• Toxins: Carbon monoxide poisoning, mercury, alcohol intoxication can cause

failure are some of the conditions that can cause chorea.

• Medications: Levodopa, neuroleptics, amphetamines, antihistamines, tricyclic

antidepressants, anticonvulsants, cocaine, oral contraceptives are among the many

• Involuntary muscle movements: Also called fidgety movements or dance-like 9

often get worse if stressed or anxious and go away when sleeping.

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

• Blood tests to check for infections, lupus, thyroid levels or other endocrine or

• Imaging studies such as magnetic resonance imaging (MRI) scan or

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

neurological diseases globally.

properly diagnosed and treated.

• It is characterized by recurrent seizures, which are brief episodes of involuntary

• Epilepsy is defined as having two or more unprovoked seizures.

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

infectious, metabolic, immune and unknown.

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

trauma during birth, low birth weight);

• a severe head injury;

• a stroke that restricts the amount of oxygen to the brain;

• an infection of the brain such as meningitis, encephalitis or

• Temporary symptoms occur, such as loss of awareness or consciousness, and

preventable, such as falls, drowning, burns and prolonged seizures.

• Seizure is a paroxysmal, uncontrolled electrical discharge of

• Alzheimer’s disease or stroke

• Family history 01/03/2022

Mrs.Keerthana.B, MSN, PSG CON

• First 6 months of life:

• Structural lesions as trauma, brain tumor or vascular disease

• Stroke and metastatic brain tumor

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

 Traumatic birth injury

Group of abnormal neurons that undergo spontaneous firing

This firing spreads by physiologic pathways to involve adjacent

If this activity spreads to involve the whole brain, a generalized

Scarring is believed to interfere with the normal chemical and

Prodroma • Signs or activity that precede a seizure

Aural • Sensory Warning

Postictal • Period of recovery after seizure

Mrs.Keerthana.B, MSN, PSG CON 01/03/2022

• Involve both sides of the brain

• Characterized by bilateral synchronous epileptic discharges in

• Lose consciousness for a few seconds to several minutes.