Essential Tremor Flashcards
define a tremor
involuntary, rhythmic, oscillatory movement of a body part
what is a resting tremor activation
presence in absence of voluntary muscle contration
types of action tremor activation behaviours
Postural: present while voluntarily maintaining a posture against gravity
Kinetic: present during movement
Isometric: result of muscular contraction against a rigid stationary object
Task specific: occurs only when performing a specific task
Normal, fine tremor in hands while maintaining posture or executing an action
Can be exacerbated by stress, anxiety, hypoglycemia, hypothermia, medications (salbutamol, caffeine)
physiologic tremor
common causes of cerebellar tremor include
stroke, MS, TBI
what type of tremor is based on situation/ anxiety
psychogenic tremor
Rapid lower limb tremor when moving from supine or seated to standing
Tremor ceases upon walking
orthostatic tremor
orthostatic tremor
1. occurs mainly when sitting from standing
2. stops upon walking
3. common causes are stroke, MS, TBI
4. is only present with lack of movement
2
A kinetic tremor with or without postural tremor
essential tremor
a simple ET is defined as (4)
Isolated tremor sx of bilateral upper limb action tremor
Of at least 3 yrs duration
w/ without tremor in other locations (head, voice, lower limbs)
An absence of other neurological signs like dystonia, ataxia, or parkinsonism
ET plus is defined as
A tremor with characteristics of ET
Additional neurological signs like impared tandem gait, questionable dystonic posturing, rest tremor, memory impairment or other mild neurologic signs of unknown significance that do not suffice to make an additional sx classification or diagnosis
essential tremors see the __________ involved in generation + propagation of abnormal oscillatory activity
inferior olivary nucleus and cerebellum
in pts diagnosed with tremors, there may be ______ neuronal damage and abnormalities of ______ recepotsr
cerebellar
GABA receptors
in pts diagnosed with tremors, there are decreased CSF concentrations of ____________
and increased concs of __________
decreased GABA, glycine, serine
increased glutamate, NE
what are the genetics of ET
autosomal dominant
replicated with gene that encodes LINGO1
associated with several single nucleotide polymorphisms
T or F: genetic testing is not recommended for ET
T
what is the most common MDO
ET
the epidemiology of ET has a ________ distribution
bimodal
15-20yrs, 50-70ysr
T or F: not many ET pts seek care or recieve emdication
T
what assessments of the tremor may be done?
Physiologic- ex- EMG
Clinical: handwriting, spiral drawing
Function: maze tests, water cup holding
Impact: functional measures, QoL
are there any biomarkers for ET
no
what must be ruled out in ET assessment
drug withdrawal, hypothermia, hypoglycemia, pheochromocytoma, thyrotoxicosis, Wilson’s disease
which 3 medications are the biggest culprits for ET
beta agonists
lithium
thyroid preps
what is the anatomical distribution of ET
hands 85-95%, head (can occur later in disease, 35-45%), voice (15-20%), legs (10-15%)
ET resolves with ________ in 50-70% of pst
alcohol
alcohol resolves ET with peak effect in _________ after ingestion, may result in rebound after ______hrs
in 45-90min
rebound after 3hrs
ET is a progressive disease, with greater amplitude in
hands
T or F: there is a cure for ET
F- only sx manageent
what devices may be used for ET
Wrist weights (hands), weighted utensils, plate guards, modified mouse/ keyboard
should be assessed by physio for proper weight + avoid further damage
what are 2 level A tx for ET
propranolol
primidone
propranolol SEs
bradycardia, bronchospasm, dizziness, ED
primidone SEs
severe fatigue, some malaise and dizziness
primidone SE of fatigue is due to
phenobarbital metabolite
T or F: primidone levels should be monitored for efficacy
F- only for toxicity sometimes
when should level B meds for ET be used
If CI for level A, need additional tx, or level A drugs can not be increased
what are the 4 level B tx for ET
primidone + propranolol
alprazolam
gabapentin
topiramate
what are 2 level C tx for ET
clonazepam, botox
surgery for ET is indicated for
medically intractable tremor
3 types of surgery for ET
deep brain stimulation
thalamotomy
thermoablation with guided ultrasound
