Essential Tremor, Huntington's Restless Leg Syndrome Flashcards
Risk Factors for Essential Tremor
Age and Genetics
Pathophysiology involved
Synchronous or Alternating contractions of antagonist muscles
Classic Presentation of Essential Tremors (what body parts, what type of activity)
Bilateral hand + forearm tremor
Head Tremor
Alleviating factors for Essential Tremors
Alcohol is a common alleviating factor that should be avoided
What is the important first step to rule out other causes of Essential Tremors
Brain MRI: Helps rule out other structural causes that may cause essential tremor
Labs/Imaging done for Essential Tremors and why?
Labs:
Chemistry panel + Liver Enzymes –> rules out Wilsons disease
Treatment for Essential Tremor
1st Line: Propranolol (Beta blocker)
Primidone –> Anticonvulsant
What is the genetic pattern with Huntingtons disease
Autosomal dominant
What is the genetic abnormality
Tri-nucleic repeat forming the “HIT” protein
Seen on the HD gene on chromosome 4
What is the typical age of onset of Huntingtons
32-38
What are clues in family history that can lead to Huntingtons disease
- Dementia (short-term memory clue)
2. Family hx of Multiple suicides
What are personality and behavioral changes that are seen in Huntingtons
Changes in mood, depression, OCD, thoughts of suicide
What are the abnormal movements seen in Huntingtons
Ballism - rapid, violent movments
Chorea
What cognitive changes occur in Huntingtons
- Short-term memory loss
2. Anhedonia- lack of pleasure in things or lack of interest
Definitive diagnosis for Huntingtons
Genetic testing for CAG/Tri-nucleic repeats
What other test can be considered for Huntingtons
MRI- can detect any widening of the bicaudal diameter showing atrophy
Treatment for Huntingtons. What types or supportive treatments are offered and why
Supportive Treatments
Benzo’s (Diazapam) –> For Ballism and Chorea movements
What is the diagnostic criteria needed to diagnose Restless Leg syndrome
- Urge to move legs due to a uncomfortable sensation
- Symptoms get begin or get worse during rest
- Symptoms improve during movement
- Symptoms worsen at night
- No other condition can attribute to symptoms (like cramping or habitual tapping)
What labs can be tested to diagnose Restless leg syndrome?
Ferritin levels- since low iron is a associated with RLS
Classic signs and symptoms of Restless leg syndrome?
BILATERAL Lower leg discomfort that is alleviated by movement
What are aggravating/alleviating factors of RLS?
How is the sensation described
- Aggravating factor- Rest
- Alleviating factor- moving
Description: Creepy, crawling, pulling, aching, itching, stretching
What are non-pharmacologic treatments
- Exercise
- Leg massage
- Heating pads
