Movement disorders Flashcards
Tremor
contraction of antagonistic muscles
most common movement disorder
Types of tremor
resting-
come and go depending on pt’s stress level
better during movement
action-
- postural- body part held against gravity
- kinetic- voluntary movement of limb
- intention- worst with goal-directed movement
- isometric- occur during muscle contraction against stationary objects
Action tremor types
- postural- body part held against gravity
- kinetic- voluntary movement of limb
- intention- worst with goal-directed movement
- isometric- occur during muscle contraction against stationary objects
Benign essential tremor (familial tremor)
increase with age
inherited- autosomal dominant disorder
Essential tremor is usually ____ tremor
postural- action tremor
with “essential” action (ex writing)
Essential tremor affect what limbs?
hands, forearms, head, voice- “essential” body parts
Essential tremor- exacerbating and relieving ?
stress exacerbates
alcohol relieves
Essential tremor workup
not needed- maybe TSH
clinical dx
Essential tremor tx- intermittent
propranol (BP med- a beta blocker)
s/e- hypotension, dizziness, light headedness
alcohol
Essential tremor tx- persistent
1. propranol (BP med- a beta blocker) s/e- hypotension, dizziness, light headedness 2. primidone 3. second line choice: - gabapentin, topirimate, nimodipine
Essential tremor- prognosis
slow, gradual progression
Physiological tremor characteristics
occurs in all people- not neurological disease
in all voluntary muscle groups
not visible to eye
Physiological tremors are heightened by
fear/anxiety hypoglycemia exhaustion hyperthyroidism caffeine alcohol benzodiazepine withdrawal stimulants fever
Parkinsonism tremor characteristics
rest tremor
pill-rolling
starts in 1 hand
Parkinsonism tremor is associated with
bradykinesia and rigidity
Cerebellar tremor characteristics
uni or bi
manifests as intention tremor
finger to nose test, heel to shin
worsens approaching target
Cerebellar tremor causes
MS
CVA
Brainstem tumor
Drug induced tremors
long list- epinephrine prozac caffeine thyroid hormone
Orthostatic tremors
legs and or trunk after standing
unsteadiness
not visible
responds to klonopin (sedative)
Psychogenic tremor (functional tremor)
not neurological looks like others sudden onset and remission stops with distraction increases with stress
Primary writing tremor
action
limited to one hand
Restless leg syndrome (RLS) aka
Willis-ekbom disease (Wed)
uncomfortable urge to move legs when relaxed
“tingling”, creeping/crawling sensation, cramping, electric
relieved with movement
during sleep= PLMS (periodic limb movements of sleep)
Restless leg syndrome risk factors
Diabetes IDA ESRD (end stage renal disease) RA PD neuropathy myelopathy
RLS pathophysiology
iron deficiency anemia most common treatable cause (have decreased iron stores)
secondary to peripheral neuropathy, uremia, pregnancy
RLS tx
- iron replacement
- avoid antidepressants, sedating antihistamines- makes you relax
RLS- intermittent symptoms tx
- levodopa- “on demand”
s/e: nausea, dizziness, somnolence - benzodiazepines (klonopin)
Dopamine agonists- RLS
mirapex
s/e: ortho hypotension, nausea, dizziness
requip
s/e: hypotension, drowsiness, dizziness, nausea, fatigue
neupro- patch
s/e: hypotension, edema, drowsiness, dizziness, dyskinesia
Alpha-2 delta calcium channel ligands- RLS
gabapentin
s/e: dizziness, drowsiness, fatigue
lyrica
s/e: somnolence, ataxia, edema
Huntington disease
inherited (autosomal dominant) and fatal progressive neurodegenerative disorder characterized by chorea, psychiatric disturbances and dementia
Huntington disease- clinical representation
chorea- “choreography= dance” rapid involuntary movements
- can cause dysarthria, dysphagia, and involuntary vocalization
- common cause of death= dysphagia and aspiration
weight loss/cachexia
dementia
psychiatric symptoms
- increased risk of suicide
abnormal eye movements
Huntington disease dx
clinical, family hx
genetic testing- confirm
Huntington disease tx
no cure, can’t halt
Huntington disease meds- help with chorea
xenazine
= dopamine-depleting agent
s/e: drowsiness, sedation, depression, etc.
Huntington disease meds- neuroleptics (depresses nerve functions- tranquilizer)
- chorea and psych = antipsychotic zyprexa haldol clozapine
-psych
TCAs (tricyclic antidepressants) and SSRIs (selective serotonin reuptake inhibitor)