Movement Disorders

Question 1

Chorea

Answer 1

Involuntary, irregular, non-rhythmic movement that seems to flow from one body part to another

Indicates Huntington disease or Hemiballismus

Question 2

Akathisia

Answer 2

Sense of inner general restlessness reduced by mooving about

Question 3

Asterixis

Answer 3

Brief flap of outstretched limb, transient inhibition of the muscles of posture

Question 4

Ataxia

Answer 4

Unstady or swaying motion

Question 5

Tics vs. Tremors

Answer 5

Tics are repetitive and non-rhythmic, usually sudden

Tremors are repetitive and rhythmic and can occur at rest, postural, or intention

Question 6

Hyperkinetic Disorders

Answer 6

Essential Tremor
Restless Leg Syndrome
Dystonia
Tourette Syndrome
Huntington disease

Question 7

Hypokinetic disorders

Answer 7

Parkinson disease
Progressive supranuclear palsy
multisystem atrophy

Question 8

Movement Disorder Tips

Answer 8

important to ascertain which category the movement disorder falls into by obtaining a careful history incuding family history.

This includes the age at onset, the regions of the body affected, progression of symptoms, the quality of movements and dysfunction, the factors that make symptoms better or worse, and the timing

Question 9

Diagnostics in Movement Disorders

Answer 9

CBC, CMP, Thyroid, drug / tox screen, infection workup, CT

Rule out epilepsy, metabolic / medication causes, brain tumor / head injury, infections, stroke

Question 10

Referral Criteria

Answer 10

Diagnosis is unclear
Patient does not respond to treatment
Condition is worsening
New onset Parkinson / Huntington
Focal acute neuro symptoms or underlying medical cause

Question 11

Essential Tremor

Answer 11

benign, chronic neurologic condition that involves symmetric, rhythmic trembling of the upper extremities, head, or voice even at rest. Alcohol may reduce symptoms but is not a treatment.

Oscillations are present throughout voluntary movement and are accentuated as the hand approaches a given target. Emotional stress will also increase the symptoms, whereas alcohol or rest will diminish them

Question 12

Essential Tremor Treatment

Answer 12

Medications generally reduce amplitude but not frequency of tremors

Blockers - Propranolol, start low and increase up as needed
Anti-convulsants - Gabapentin / toprimate if beta-blockers are ineffective
Combo may help if either is only partly effective

Benzos may work but have serious risks