Movement Disorders

Question 1

describe what a tremor is

Answer 1

rhythmic wave like oscillations of a body part

Question 2

what are the 3 main types of tremor found

Answer 2

resting tremor
postural tremor
intention tremor

Question 3

describe the features of a resting tremor and what conditions it’s associated with

Answer 3

occurs when muscle is relaxed
slow, asymmetrical, goes away with movement
associated with Parkinsons

Question 4

describe the features of a postural tremor and what conditions its associated with

Answer 4

absent on rest, present on maintained posture eg holding arms out
causes are anxiety, alcohol withdrawal, thyrotoxicosis, B agonists, lithium, valproate and tricyclics

Question 5

describe the features of an intention tremor and what conditions its associated with

Answer 5

task orientated and worsens throughout range of movement
assessed by asking patients to touch their nose and then clinicians finger
causes are MS, stroke, haemorrhage or Wilsons disease

Question 6

what is dystonia

Answer 6

involuntary sustained muscle spasms that result in abnormal posturing and repetitive movements in context of associated tremor

Question 7

how can dystonia be classified

Answer 7

focal or generalised

also acute

Question 8

outline some examples of focal dystonia

Answer 8

cervical neck - torticollis
eyes - blepharospasm and forced eye closure
clenching of jaw

Question 9

what conditions cause focal dystonias

Answer 9

myasthenia gravis
TMG dysfunction
muscle strain
limb dystonia

Question 10

how does generalised dystonia present

Answer 10

occurs all over the body, starts in one limb and spread

Question 11

what causes generalised dystonia

Answer 11

genetic conditions - primary torsion dystonia

drug induced dystonia - levodopa, anti-psychotics, metoclopramide, cyclizine

Question 12

what drugs are used to manage dystonia

Answer 12

anti-spasmodics such as Baclofen
anti-cholinergics such as procyclidine
botox injections can be used for focal dystonia

Question 13

what is chorea

Answer 13

non-rhythmical irregular purposeless movements that flow from one body part to another

Question 14

give some examples of chorea

Answer 14

facial grimacing
writhing of shoulders
rapid movement of fingers

Question 15

like some causes of chorea

Answer 15

infection - HIV
neuro - Parkinsons and Huntingtons
metabolic - thyrotoxicosis, sodium or magnesium disturbance
drugs - anti-psychotics, anticonvulsants, levodopa

Question 16

what is a tic

Answer 16

involuntary movement or vocalisation that the individual is unable to suppress, doing so causes discomfort and will only go away once completing the tic

Question 17

what are the features of a tic

Answer 17

saying inappropriate phrases or gestures
coping movements of others
coughing, hurting themselves

Question 18

what is the main primary tic disorder

Answer 18

Tourettes syndrome - always starts in childhood

Question 19

what are some secondary tic disorders

Answer 19

autism, huntingtons, haemochromatosis, wilsons disease

Question 20

describe a myoclonus

Answer 20

sudden involuntary focal or generalised jerks

Question 21

myoclonus can be physiological true/false

Answer 21

true - small number or during sleep is very normal

Question 22

list some causes for myoclonus

Answer 22

benign essential myoclonus 
stroke, head injury, SOL 
CJD - dementia, ataxia and myoclonus 
anti-convulsants, alcohol withdrawal 
liver and renal failure