Essential Tremor, Huntington's Restless Leg Syndrome

Question 1

Risk Factors for Essential Tremor

Answer 1

Age and Genetics

Question 2

Pathophysiology involved

Answer 2

Synchronous or Alternating contractions of antagonist muscles

Question 3

Classic Presentation of Essential Tremors (what body parts, what type of activity)

Answer 3

Bilateral hand + forearm tremor

Head Tremor

Question 4

Alleviating factors for Essential Tremors

Answer 4

Alcohol is a common alleviating factor that should be avoided

Question 5

What is the important first step to rule out other causes of Essential Tremors

Answer 5

Brain MRI: Helps rule out other structural causes that may cause essential tremor

Question 6

Labs/Imaging done for Essential Tremors and why?

Answer 6

Labs:

Chemistry panel + Liver Enzymes –> rules out Wilsons disease

Question 7

Treatment for Essential Tremor

Answer 7

1st Line: Propranolol (Beta blocker)

Primidone –> Anticonvulsant

Question 8

What is the genetic pattern with Huntingtons disease

Answer 8

Autosomal dominant

Question 9

What is the genetic abnormality

Answer 9

Tri-nucleic repeat forming the “HIT” protein

Seen on the HD gene on chromosome 4

Question 10

What is the typical age of onset of Huntingtons

Answer 10

32-38

Question 11

What are clues in family history that can lead to Huntingtons disease

Answer 11

1. Dementia (short-term memory clue)

2. Family hx of Multiple suicides

Question 12

What are personality and behavioral changes that are seen in Huntingtons

Answer 12

Changes in mood, depression, OCD, thoughts of suicide

Question 13

What are the abnormal movements seen in Huntingtons

Answer 13

Ballism - rapid, violent movments

Chorea

Question 14

What cognitive changes occur in Huntingtons

Answer 14

1. Short-term memory loss

2. Anhedonia- lack of pleasure in things or lack of interest

Question 15

Definitive diagnosis for Huntingtons

Answer 15

Genetic testing for CAG/Tri-nucleic repeats

Question 16

What other test can be considered for Huntingtons

Answer 16

MRI- can detect any widening of the bicaudal diameter showing atrophy

Question 17

Treatment for Huntingtons. What types or supportive treatments are offered and why

Answer 17

Supportive Treatments

Benzo’s (Diazapam) –> For Ballism and Chorea movements

Question 18

What is the diagnostic criteria needed to diagnose Restless Leg syndrome

Answer 18

1. Urge to move legs due to a uncomfortable sensation
2. Symptoms get begin or get worse during rest
3. Symptoms improve during movement
4. Symptoms worsen at night
5. No other condition can attribute to symptoms (like cramping or habitual tapping)

Question 19

What labs can be tested to diagnose Restless leg syndrome?

Answer 19

Ferritin levels- since low iron is a associated with RLS

Question 20

Classic signs and symptoms of Restless leg syndrome?

Answer 20

BILATERAL Lower leg discomfort that is alleviated by movement

Question 21

What are aggravating/alleviating factors of RLS?

How is the sensation described

Answer 21

• Aggravating factor- Rest
• Alleviating factor- moving

Description: Creepy, crawling, pulling, aching, itching, stretching

Question 22

What are non-pharmacologic treatments

Answer 22

1. Exercise
2. Leg massage
3. Heating pads