0904 Hyperkinetic Movement Disorders

Question 1

Define tremor.

Answer 1

An involuntary, rhythmic, repetitive, oscillatory movement of body part caused by alternate contraction of agonist and antagonist muscle groups.

Question 2

What are the three main types of tremor?

Answer 2

Resting tremor, Postural tremor, Intention tremor

Question 3

List some diseases/disorders that have a resting tremor as a clinical feature (or other causes of).

Answer 3

Parkinson’s disease and PD mimics. Wilson’s disease. Drug-induced tremor (dopamine antagonist, valproate, lithium, amiodarone, Calcium channel blocker)

Question 4

List some diseases/disorders that have a postural tremor as a clinical feature (or other causes of).

Answer 4

Toxins/drugs (caffeine,, beta agonists, anticonvulsants, valproate, thyroxine, lithium, tricyclic antidepressants, nicotine, cocaine, amphetamines.), metabolic cause (hyperthyroidism), PD and Wilsons.

Question 5

List some diseases/disorders that have an intention tremor as a clinical feature (or other causes of).

Answer 5

Cerebellar pathology, multiple sclerosis, midbrain pathology

Question 6

Define myoclonus

Answer 6

a brief, shock-like, involuntary movement caused by muscular contractions (positive myoclonus) or inhibitions (negative myoclonus)

Question 7

Define tic.

Answer 7

A sudden, brief, intermittent repetitive movement (motor tic) or vocalisation (phonic tic). May be (temporarily) voluntarily suppressed.

Question 8

Define dystonia.

Answer 8

a movement disorder characterised by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures or both. E.g. cervical dystonia (abnormal head posture)

Question 9

Contrast chorea to athetosis to ballism.

Answer 9

Chorea - rapid, distal, dance-like;
Athetosis - writhing, slower, random;
Ballism - large amplitude, proximal, flinging (may be hemi)

Question 10

List some diseases/disorders that have an chorea/athetosis/ballism as a clinical feature (or other causes of).

Answer 10

Huntington’s disease, Wilson’s, SLA, paraneoplastic, neuroleptics, phenytoin, levodopa, cocaine, toxoplasmosis, thyrotoxicosis, hyperglycemia, stroke, tumour, vascular malformation.