Department of Neurology

Milestone 4: Movement Disorders — Patient Care

Specifics about each Level and each Item:  What you do you need to know:
 

Level 2:

• Identifies movement disorder phenomenology and categories (hypokinetic and hyperkinetic)

Hypokinetic:

Parkinson’s disease
Atypical parkinsonism

Hyperkinetic:

Chorea
Hemiballism
Tics
Dystonia

Level 3:

• Diagnoses and manages common movement disorders

Idiopathic Parkinson’s disease
Essential Tremor
Primary Generalized Dystonia
Spasmodic Torticollis
Restless Legs Syndrome
Huntington’s Disease
Tourette Syndrome

• Identifies movement disorder emergencies

Neuroleptic Malignant Syndrome
Oculogyric Crisis
Serotonin Syndrome
Hemiballism
Status Dystonicus
Acute Dystonic Reaction

Level 4:

• Diagnoses uncommon movement disorders

Progressive Supranuclear Palsy
Cortocobasal Ganglionic Degeneration
Multiple Systems Atrophy
Diffuse Lewy Body disease
Parkinson’s Disease Dementia
Normal Pressure Hydrocephalus
Parkinsonism-Dementia-ALS complex of Guam
Lubag (X-linked dystonia parkinsonism)
Familial basal ganglial calcification (Fahr's disease)
Neuroacanthocytosis
Neurodegeneration with Brain Iron Accumulation (NBIA)
DRPLA
Autosomal Dominant Cerebellar Ataxia
Episodic Ataxia
Orthostatic Tremor
Holmes Tremor
Palatal Tremor
Senile Chorea
Wilson’s Disease
Tardive Dyskinesia

• Appropriately refers a movement disorder patient for a surgical evaluation or other interventional therapies

Parkinson’s disease

Motor fluctuations, medication refractory tremor, and or dyskinesia
UPDRSIII >30, >30% improvement with ldopa, adequate medication trial Without dementia, or uncontrolled depression
Appropriate goals and expectations

Essential Tremor

Adequate medication trial
Without dementia, or uncontrolled depression
Appropriate goals and expectations

Dystonia

Adequate medication trial
Without dementia, or uncontrolled depression
Appropriate goals and expectations

• Manages movement disorders emergencies

Neuroleptic Malignant Syndrome
Oculogyric Crisis
Serotonin Syndrome
Hemiballism
Status Dystonicus
Acute Dystonic Reaction

Level 5:

• Manages uncommon movement disorders

Parkinson’s Disease Dementia (PDD)
Psychosis associated with Parkinson’s disease
Dopamine dysregulation syndrome
Orthostatic hypotension in Parkinson’s disease and MSA
PD associated sleep disorders (RBD, RLS, Sleep Fragmentation)
Huntington’s Disease
Tardive Dyskinesia

• Engages in scholarly activity in movement disorders (e.g., teaching, research)

Resources for each Level:

Level 2 Resources

Movement Disorders Clinic
Grand Rounds

Level 3 Resources

Movement Disorders Clinic
Movement Disorders Elective Rotation and required reading
Movement Disorder Emergency Lectures

Level 4 resources

Books:

1. Watts R.L., Standaertt D.G. and Obeso J.A. (2012) Movement disorders. McGraw-Hill Medical, New York, xv, 1033 p. pp.

Articles:

1. Robottom B.J., Factor S.A. and Weiner W.J. (2011) Movement disorders emergencies Part 2: hyperkinetic disorders. Arch Neurol 68: 719-724.
2. Robottom B.J., Weiner W.J. and Factor S.A. (2011) Movement disorders emergencies. Part 1: Hypokinetic disorders. Arch Neurol 68: 567-572.