Dyskinesia

Question 1

dyskinesia

Answer 1

rhythmic sinusoidal movements - tremors
jerks
muscle spasms

Question 2

tremors

Answer 2

many causes
lots of categories
can be drug induced

Question 3

drug induced tremors

Answer 3

tetrabenazine

anticancer drugs

Question 4

diagnosis of tremors

Answer 4

parkinson's 
essential tremor - benign 
hyperthyroidism
dystonic tremor 
orthostatic 
functional

Question 5

which are primary tremors?

Answer 5

parkinson’s

essential tremor

Question 6

secondary tremors?

Answer 6

drug induced

hyperthyroidism

Question 7

what is a dystonic tremor?

Answer 7

involuntary muscle contractions resulting in postural abnormalities

Question 8

What is an orthostatic tremor?

Answer 8

Standing tremor in legs
Not present when lying down or when walking
Helicopter sound on auscultation of legs

Question 9

What is a functional tremor?

Answer 9

No cause identified

Question 10

Imaging of tremors

Answer 10

Unlikely to appear on scan

Question 11

Treatments for tremors

Answer 11

Reassurance 
Limited number of effective drugs
Devices
Deep brain stimulation
New drugs and procedures
Avoid precipitants

Question 12

Drugs used for tremors

Answer 12

Propranolol

Primidone

Question 13

Precipitants of tremors

Answer 13

Lithium

Anticonvulsants

Question 14

Treatment of orthostatic tremor

Answer 14

Propranolol
Clonazepam
Gabapentin 
Reassurance 
Tripod seat for queues

Question 15

New tremor therapies

Answer 15

MRI focused ultrasound thalamtomy
Induce lesion using ultrasound waves to burn a whole into thalamus
1 off treatment

Question 16

Cervical dystonia

Answer 16

Muscle spasm in the neck

Usually a late diagnosis

Question 17

Correction of cervical dystonia

Answer 17

Geste antagoniste - sensory trick to return to normal position

Question 18

Treatment for cervical dystonia

Answer 18

Artane/ trihexylphenidyl 
Baclofen
Clonazepam
Valium
Tetrabenazine
L dopa
Amantadine 
Dopamine agonists 
Anti-epileptics
Best = Botox injection
Deep brain stimulation

Question 19

Tics

Answer 19

Linked to Tourette’s syndrome

Question 20

Features of tics

Answer 20

Can be suppressed for a small amount of time
Coprolalia
Copropraxia

Question 21

Coprolalia

Answer 21

Abusive or rude language

Question 22

Copropraxia

Answer 22

Inappropriate movements and actions

Question 23

Types of tics/ what happens

Answer 23

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

Question 24

Suppression of tics

Answer 24

Can be done voluntarily for a very short period of time but this is mentally and physically draining

Question 25

Causes of tics

Answer 25

Tourette’s syndrome is main cause Genetic Many other causes Drug induced - methylphenidate

Question 26

What are the clinical features of Tourette’s syndrome?

Answer 26

``` Depression Tics OCD Anxiety ADHD Autism Gifted and skilled Learning difficulties ```

Question 27

Treatment and management of Tourette’s syndrome

Answer 27

``` 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 ```

Question 28

What are the pharmacological treatments of Tourette’s syndrome?

Answer 28

``` Dopamine receptors antagonists Monoamine depleters Dopamine receptors agonists Alpha 2 agonists Benzodiazepines Anticonvulsants Nicotine Cannabinoids ```

Question 29

Problems with treating tics

Answer 29

Treatments for tics can worsen the other Tourette’s symptoms and vice versa

Question 30

Deep brain stimulation for tics

Answer 30

Targets basal ganglia Adverse effects = dysarthria, parathesia, haemorrhage, infection Very expensive

Question 31

What is chorea?

Answer 31

Fidgety Cannot stay still Huntington’s is the most common cause

Question 32

tic attack/ storm

Answer 32

``` occurs in tourettes syndrome lots of tics occurring at once similar to seizure aware of surroundings can last from minutes to hours causes tiredness ```

Question 33

potential tourettes treatments

Answer 33

``` botox - downregulates motor feedback loop psychological treatments talking therapies diazepam gas and air - nitrous oxide aripiprazole - antipsychotic topiramate deep brain stimulation tetrabenazine ```

Question 34

topiramate

Answer 34

anticonvulsant beneficial for tics less psychologcail side effects