Common Movement disorders - Melanie Flashcards
what is Tremor
rhythmical, involuntary and oscillatory movement of body part
what is rhythmic
regular and repetitive in timing (though the amplitude may vary)
what is Oscillatory
moves about an axis
what is involuntary
does not go away (or often enhanced) with distraction
what is the physiology of a tremor
arise from an overactive or unchecked basal ganglia system i which neurons with spontaneous oscillatory activity override the normal balance of inhibitory vs excitatory transmission
what is the epidemiology of a tremor
most common movement disorder
most common action tremor is essential tremor
most common rest tremor is parkinson’s disease
what are the types of tremors
essential, physiologic, dystonic, orthostatic, cerebellar, homes, functional, etc
what is an essential tremor
generally bilateral, symmetrical postural/kinetic tremor. mostly seen in hands/arms. it is visible and persistent. can spread to head but less common in the legs
what is a physiologic tremor
natural tremor that every person has as a result of several factors including cardiac vibrations transmitted throughout the body, stretch reflexes generated from muscle contraction and natural oscillatory action of neuronal bodies in the brain.
what makes physiologic tremors worse?
worse with exercise, anxiety, hyperthyroidism, certain medications
what is the typical history presentation for essential tremors
slow, progressive nature of the tremor
+ FH
tremor with action/posture but not at rest
should not have other neurologic signs
tremor can be reduced with alcohol consumption
what are exam findings for essential tremors
tremor is usually bilateral and absent at rest. will see mild tremor with postural movements or kinetics
typically not seen in legs (should have normal gait, balance, romberg testing, reflexes)
what are diagnostics for essential tremors
spiral drawings with both hands - may see unidirectional tremor axis
handwriting is normal or large, no micrographia
what should patients absolutely NOT have with essential tremors
bradykinesia or rigidity on exam
what is a differential diagnosis for essential tremors
mild bilateral dystonic tremor or cerebellar tremor
what are labs or diagnostics used for tremor
no labs absolutely necessary
MRI/CT
EMG
when might patients obtain labs for tremors and what labs
might be indicated depending on history
(B12, renal function, LFTs, Hypocalcemia, hypoatremia, hyperthyroidism, hyperparathyroidism, serum ceruloplasmin, toxicity/exposures)
when are MRI/CT indicated for tremor
if there is neurological symptoms exist.
when are EMGs indicated for tremor
for difficult to differentiate tremor syndromes
what is the mainstay treatment for tremors
propranolol or primidone (level A).
Can be used alone or together.
how is propranolol prescribed and for what
for essential tremors
starting at 10mg TID
Not used in patients with severe asthma or COPD
what is primidone used for and how much
used to treat tremors - anticonvulsant/barbiturates.
needs to be tapered over 7 weeks and cannot stop suddenly.
what are the primary side effects of primidone
sedation, dizziness and CNS depression
what are level B treatments for tremors
alprazolam, atenolol, gabapentin, sotalol, topiramate
what is Kayser-fleisher rings
iron metabolism disorder