Essential Tremor

Question 1

motor system involved in mostly voluntary muscle movement

Answer 1

pyramidal

Question 2

motor system that target neurons in spinal cord responsible for control of motor tone, movement amount/velocity, suppression of undesirable motor activity, and reflexes

Answer 2

extrapyramidal

Question 3

motor system that is direct and monosynaptic

Answer 3

pyramidal

Question 4

motor system that is indirect and polysynaptic

Answer 4

extrapyramidal

Question 5

which component of the extrapyramidal system is responsible for excitatory output?

Answer 5

cerebellum

Question 6

which component of the extrapyramidal system is responsible for inhibitory output?

Answer 6

basal nuclei

Question 7

that most common cause of action (postural) tremor

Answer 7

essential tremor

Question 8

where is the problem in essential tremor most likely localized? (2)

Answer 8

brainstem
cerebellum

Question 9

what 2 actions can initiate an essential tremor?

Answer 9

voluntary movement
fixed posture against gravity

Question 10

how does essential tremor affect one side of the body vs the other? (2)

Answer 10

bilateral
asymmetric

Question 11

what part of the body is NOT involved in essential tremor?

Answer 11

legs

Question 12

what 3 difficulties will a patient report having?

Answer 12

difficulty handwriting
manual skill difficulty
difficullty speaking

Question 13

what makes an essential tremor worse?

Answer 13

anxiety/excitement

Question 14

what makes an essential tremor improve?

Answer 14

mild alcohol consumption

Question 15

what 4 criteria must be met to be diagnosed with essential tremor?

Answer 15

bilateral upper limb action tremor
for at least 3 years
can involve tremor in other locations
absence of other neurological signs

Question 16

what should all patients with essential tremor receive?

Answer 16

referral to neurologist

Question 17

what’s important to remember about treatment for essential tremor?

Answer 17

not needed if symptoms are mild

Question 18

what 3 medication options can be used for mild, situational exacerbations of essential tremor?

Answer 18

propranolol
alprazolam
primidone

Question 19

what medication can be used for persistent functional or psychological disability? (2)

Answer 19

propranolol
primidone
OR BOTH

Question 20

what are 2 medication options if a patient has continuous symptoms despite treatment?

Answer 20

topiramate
gabapentin

Question 21

what can be used for essential tremor in the head or voal cord if all medications fail?

Answer 21

botulinum toxin A

Question 22

what can be used for essential tremor of the limbs if all medications fail? (2)

Answer 22

deep brain stimulation/thalamotomy