Dyskinesias

Question 1

What is a dyskinesia?

Answer 1

Involuntary abnormal movement

Question 2

What are dyskinesia’s characterised by?

Answer 2

Frequency
Amplitude
Exacerbating factors - stress and fatigue

Question 3

Describe rest tremor

Answer 3

Abolished on voluntary movement

Question 4

Give a cause for rest tremor

Answer 4

Parkinsonism

Question 5

Describe intention tremor

Answer 5

Irregular, large amplitude, worse at the end of purposeful acts

Question 6

Give some causes of intention tremor

Answer 6

Cerebellar damage - MS, stroke

Question 7

Describe postural tremor

Answer 7

Absent at rest, present on maintained posture (arms outstretched) and may persist (but is not worse) on movement

Question 8

Give some causes of postural tremor

Answer 8

Benign essential tremor
Thyrotoxicosis
Beta- agonists

Question 9

Describe re-emergent tremor

Answer 9

Postural tremor developing after a delay of 10 seconds

Question 10

What are the causes of re-emergent tremor

Answer 10

Parkinson’s disease

Question 11

Describe chorea

Answer 11

Non-rhythmic jerky, purposeless movements flitting from one place to another

Question 12

Give some examples of choreas

Answer 12

Grimacing
Raising the shoulders
Flexing/extending the fingers

Question 13

Give some causes of chorea

Answer 13

Huntington’s disease

Sydenham’s chorea

Question 14

Which drug worsens chorea

Answer 14

Levodopa

Question 15

What is Sydenham’s chorea

Answer 15

Rare complication of group A streptococcal infection

Question 16

Describe hemiballismus

Answer 16

Large amplitude flinging hemichorea affecting proximal muscles contralateral to a vascular lesion of the subthalamic nucleus

Question 17

What is the typical patient with hemiballismus

Answer 17

Elderly

Diabetic

Question 18

What is the prognosis of hemiballismus

Answer 18

Recovers spontaneously over a few months

Question 19

Describe athetosis

Answer 19

Slow, sinuous, confluent, purposeless movements (especially digits, hand, tongue and face)
Often difficult to distinguish from chorea

Question 20

What causes athetosis

Answer 20

Cerebral palsy

Question 21

What is psuedoathetosis caused by?

Answer 21

Severe proprioceptive loss

Question 22

What are tics?

Answer 22

Brief, repeated, stereotyped movements often difficult to distinguish from chorea

Question 23

What types of tics occur in tourettes syndrome?

Answer 23

Motor and vocal

Question 24

What might haloperidol cause if given to people for tics?

Answer 24

Tardive dyskinesia

Question 25

Which drugs are considered for severe tics

Answer 25

Clonidine or clonazepam

Question 26

Describe myoclonus

Answer 26

Sudden involuntary focal or general jerks arising from the cord, brainstem or cerebral cortex

Question 27

Which conditions is myoclonus seen in

Answer 27

``` Metabolic Neurodegenerative (lysosomal storage enzyme defects) CJD Myoclonic epilepsies (infantile spasms) Benign essential myoclonus Asterixis (metabolic flap) ```

Question 28

Describe benign essential myoclonus

Answer 28

Childhood onset with frequent generalised myoclonus without progression Often autosomal dominant

Question 29

Which drugs might benign essential myoclonus respond to?

Answer 29

Valproate Clonazepam Piracetam

Question 30

Describe the genetic inheritance pattern of benign essential myoclonus

Answer 30

Autosomal dominant

Question 31

Describe asterixis

Answer 31

Jerking of outstretched hands Worse when wrists extended (loss of extensor tone as there is incoordination between flexors and extensors - negative myoclonus)

Question 32

What causes asterixis

Answer 32

``` Liver or kidney failure Hyponatraemia Hypercapnia Gabapentin Thalamic stroke if unilateral ```

Question 33

What are tardive syndromes?

Answer 33

Delayed onset yet potentially irreversible symptoms occurring after chronic exposure to dopamine antagonists

Question 34

Describe tardive dyskinesia

Answer 34

Orobuccolingual Truncal Choreiform

Question 35

Describe tardive dystonia

Answer 35

Sustained, stereotyped muscle spasms of twisting, turning character

Question 36

Describe tardive akathisia

Answer 36

Sense of restlessness or unease +/- repetitive, purposeless movements

Question 37

How do you treat tardive dyskinesia

Answer 37

Gradually withdraw neuroleptics and wait 3-6 months | Tetrabenazine may help

Question 38

Which antipsychotics are less likely to cause tardive syndromes

Answer 38

Quetiapine, olanzapine and clozapine - Atypical antipsychotics

Question 39

Describe dystonia

Answer 39

Prolonged muscle contractions causing abnormal posture or repetitive movements

Question 40

Describe idiopathic generalized dystonia

Answer 40

Childhood onset dystonia often starting in one leg with ipsilateral progression over 5-10yrs

Question 41

What inheritance pattern is idiopathic generalized dystonia

Answer 41

Autosomal dominant (DYT1 deletion)

Question 42

What must you exclude in idiopathic generalized dystonia

Answer 42

Wilsons disease | Dopa responsive dystonia

Question 43

What drugs may be used to treat idiopathic generalized dystonia

Answer 43

Anticholinergics Muscle relaxants Deep brain stimulation

Question 44

Describe focal dystonia

Answer 44

Confined to one part of the body Idiopathic and rarely generalise Worsened by stress Patients might develop a geste antagoniste to try to resist the dystonic posturing

Question 45

Give some examples of focal dystonias

Answer 45

Spasmodic torticollis - where head is pulled to one side of the body Writers cramp Blepharospasm - involuntary contraction of orbicularis oris

Question 46

How are focal dystonia's treated?

Answer 46

Injection into the overactive muscles

Question 47

What is acute dystonia

Answer 47

Torticollis (head drawn up) Oculogyric crisis (eyes drawn up) Trismus (oromandibular spasm)

Question 48

What causes an acute dystonia?

Answer 48

Staring neuroleptics and some anti-emetics (metoclopramide and Cyclizine)

Question 49

How do you treat acute dystonic reactions

Answer 49

A dose of anticholinergic