Dyskinesia Flashcards
dyskinesia
rhythmic sinusoidal movements - tremors
jerks
muscle spasms
tremors
many causes
lots of categories
can be drug induced
drug induced tremors
tetrabenazine
anticancer drugs
diagnosis of tremors
parkinson's essential tremor - benign hyperthyroidism dystonic tremor orthostatic functional
which are primary tremors?
parkinson’s
essential tremor
secondary tremors?
drug induced
hyperthyroidism
what is a dystonic tremor?
involuntary muscle contractions resulting in postural abnormalities
What is an orthostatic tremor?
Standing tremor in legs
Not present when lying down or when walking
Helicopter sound on auscultation of legs
What is a functional tremor?
No cause identified
Imaging of tremors
Unlikely to appear on scan
Treatments for tremors
Reassurance Limited number of effective drugs Devices Deep brain stimulation New drugs and procedures Avoid precipitants
Drugs used for tremors
Propranolol
Primidone
Precipitants of tremors
Lithium
Anticonvulsants
Treatment of orthostatic tremor
Propranolol Clonazepam Gabapentin Reassurance Tripod seat for queues
New tremor therapies
MRI focused ultrasound thalamtomy
Induce lesion using ultrasound waves to burn a whole into thalamus
1 off treatment
Cervical dystonia
Muscle spasm in the neck
Usually a late diagnosis
Correction of cervical dystonia
Geste antagoniste - sensory trick to return to normal position
Treatment for cervical dystonia
Artane/ trihexylphenidyl Baclofen Clonazepam Valium Tetrabenazine L dopa Amantadine Dopamine agonists Anti-epileptics Best = Botox injection Deep brain stimulation
Tics
Linked to Tourette’s syndrome
Features of tics
Can be suppressed for a small amount of time
Coprolalia
Copropraxia
Coprolalia
Abusive or rude language
Copropraxia
Inappropriate movements and actions
Types of tics/ what happens
Movements - motor Sounds - phonic Sudden Rapid Recurrent Non-rhythmic Non-voluntary Can be preceded by an urge Affected by behavioural states Repetitive Focal Sniffs Grunts Coughs Vocal utterances
Suppression of tics
Can be done voluntarily for a very short period of time but this is mentally and physically draining
Causes of tics
Tourette’s syndrome is main cause
Genetic
Many other causes
Drug induced - methylphenidate
What are the clinical features of Tourette’s syndrome?
Depression Tics OCD Anxiety ADHD Autism Gifted and skilled Learning difficulties
Treatment and management of Tourette’s syndrome
Psycho education Suppression techniques Mental health support Diversion tactics Tourette’s service Psychologists Avoid drug treatments Behavioural treatment Pharmacological treatment when advanced Deep brain stimulation
What are the pharmacological treatments of Tourette’s syndrome?
Dopamine receptors antagonists Monoamine depleters Dopamine receptors agonists Alpha 2 agonists Benzodiazepines Anticonvulsants Nicotine Cannabinoids
Problems with treating tics
Treatments for tics can worsen the other Tourette’s symptoms and vice versa
Deep brain stimulation for tics
Targets basal ganglia
Adverse effects = dysarthria, parathesia, haemorrhage, infection
Very expensive
What is chorea?
Fidgety
Cannot stay still
Huntington’s is the most common cause
tic attack/ storm
occurs in tourettes syndrome lots of tics occurring at once similar to seizure aware of surroundings can last from minutes to hours causes tiredness
potential tourettes treatments
botox - downregulates motor feedback loop psychological treatments talking therapies diazepam gas and air - nitrous oxide aripiprazole - antipsychotic topiramate deep brain stimulation tetrabenazine
topiramate
anticonvulsant
beneficial for tics
less psychologcail side effects
