From
Dr. Amr Moursi
Movement Disorder Exam Questions for Neurosurgeons | MCQs, Concepts and Key Topics
With Dr. Amr Moursi
Part of
Parkinson's Disease 7 items
Chapter 1 of 6 · Fundamentals
Exam overview
Introduction to Functional Neurosurgery Examination Topics
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Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Functional neurosurgery is under-taught in basic training and most units don't do much of it
Examiner expectations for functional neurosurgery are low and the basics are all you need
Functional neurosurgery splits into three exam topics: movement disorders, pain surgery, and epilepsy
Parkinson's disease has 4 cardinal features and bradykinesia is mandatory for the diagnosis
Tremor responds best to deep brain stimulation in Parkinson's disease
Gait freezing, speech and cognition respond poorly to deep brain stimulation
Cognition can be worsened by deep brain stimulation
Balance, speech, and postural instability all respond poorly to deep brain stimulation
Subthalamic nucleus is the first choice target for deep brain stimulation in Parkinson's disease
Globus pallidus internus is the second choice target for deep brain stimulation in Parkinson's disease
When dyskinesia dominates, the globus pallidus internus is preferred because it smooths dyskinesia directly
When tremor dominates, the ventral intermediate nucleus of the thalamus is the tremor target
The anterior limb of the internal capsule is an obsessive compulsive disorder target, not a Parkinson's target
Inclusion criteria for DBS include disease over 5 years, a meaningful levodopa response, disabling fluctuations, or refractory tremor
Exclusion criteria for DBS include dementia, untreated depression or psychosis, and atypical Parkinsonism like progressive supranuclear palsy and multiple system atrophy
The levodopa challenge predicts the response to deep brain stimulation, not severity
Stimulation of the subthalamic nucleus roughly reproduces the patient's best medication on state, so a good levodopa response predicts a good stimulation response
Atypical Parkinsonism doesn't respond to deep brain stimulation and is a contraindication
At the subthalamic nucleus, medial spread hits the 3rd cranial nerve and red nucleus, giving diplopia
At the subthalamic nucleus, lateral spread hits the internal capsule, giving contralateral twitching and dysarthria
At the globus pallidus internus, ventral spread hits the optic tract, giving phosphenes (flashes of light)
At the globus pallidus internus, posteromedial spread hits the capsule, giving muscle contraction
The side effect tells you where the electrode is, and you correct by moving away from the structure you're hitting
Motor fibers run in the internal capsule just lateral to the subthalamic nucleus
Twitching during STN stimulation means you're too lateral and should move medially away from the capsule
Reducing voltage just shrinks your therapeutic window and doesn't fix electrode position
Red nucleus diplopia is the medial side effect from spread toward the 3rd cranial nerve and red nucleus
The optic tract is ventral to the globus pallidus internus, so ventral spread produces flashes of light (phosphenes)
The dopamine transporter scan separates Parkinson's from essential tremor and drug-induced tremor, showing reduced uptake in the posterior putamen
The dopamine transporter scan does not distinguish Parkinson's from atypical Parkinsonism