Hyperkinetic Movement Disorders

Question 1

Resting tremor

Answer 1

Occurs when body part is completely supported against gravity
Completely at rest
Subsides with action
Ex: hand resting in lap
Almost exclusively due to parkinsonism

Question 2

2 types of action tremor

Answer 2

Postural and kinetic

Action tremors occur during voluntary muscle contraction

Question 3

Postural tremor

Answer 3

Voluntarily maintaining limb against gravity

Ex: extending arms in front of body

Question 4

Kinetic tremor

Answer 4

Voluntarily making movement

Ex: while drinking from a cup

Question 5

Intention tremor

Answer 5

Subtype of kinetic tremor
Increases at the end of goal directed movement
We use this to imply a cerebellar lesion
Should have other cerebellar signs
Ex: finger to nose test issues

Question 6

4 common causes of tremor

Answer 6

Physiological tremor and enhanced physiological tremor
Cerebellar tremor
Essential tremor
Parkinson’s disease

Question 7

Physiological tremor

Answer 7

Normal phenomenon
Generally invisible to the naked eye
Certain conditions may enhance it so it becomes visible
Enhanced is not associated with an underlying neurological condition so you need to check for reversible systemic causes

Question 8

Cerebellar tremor

Answer 8

Due to underlying cerebellar disease and present in the company of ataxia
Phenomenology is intention tremor

Question 9

Essential tremor

Answer 9

Can commence at any age
Also called familiar tremor
Phenomenology: postural and kinetic tremor, bilateral upper extremities, vocal cords/face/lower limbs
Not a sinister disease (doesnt progress or cause death)
Alcohol makes it better

Question 10

Isolated head tremor

Answer 10

Not essential tremor

Likely cervical dystonia

Question 11

2 first line treatment medications for essential tremor

Answer 11

Propanolol (caution with asthma, hypotension, bradycardia, depression)
Primidone (can get a severe adverse reaction)

Question 12

2nd and 3rd line treatments for essential tremor

Answer 12

2nd: gabapentin, topiramate, clonazepam, alprazolam
3rd: deep brain stimulation, thalamotomy

Question 13

Sensory trick

Answer 13

A way to overcome dystonia that some people find

Ex: touching your jaw with dystonia from Wilson’s disease

Question 14

What to test for if a patient is presenting with young onset PD (before 40)?

Answer 14

Wilson’s disease

Treat with copper chelation, not levadopa

Question 15

Tourette syndrome

Answer 15

Primary tic disorder
Characterized by multiple motor tics (2 or more) and at least one vocal tic, of at least 1 year duration
Onset before 18
Not due to meds, drugs, or another medical condition