Other Movement Disorders

Question 1

define tremor

Answer 1

involuntary, rhythmic, oscillating movements

Question 2

is tremor hyperkinetic or hypokinetic

Answer 2

hyperkinetic

Question 3

what kind of tremor occurs when the body is relaxed and supported by gravity

Answer 3

rest tremor

Question 4

name the two types of action tremors

Answer 4

kinetic and postural

Question 5

what kind of tremor would be seen in someone trying to complete a finger-to-nose test?

Answer 5

intention tremor (type of kinetic)

Question 6

what kind of tremor is seen with someone that occurs when the walk forward?

Answer 6

task-specific tremor

Question 7

what descriptors are important in determining phenomenology of a tremor (5 things)

Answer 7

location
laterality
frequency
amplitude
situation in which it occurs

Question 8

what is an essential tremor?

Answer 8

postural + kinetic

Question 9

are men or women more likely to develop head tremors?

Answer 9

women

Question 10

epidemiology of essential tremor

Answer 10

bimodal age onset
5% of population
no gender preference

Question 11

what tremor improves with alcohol

Answer 11

essential tremor

Question 12

does essential tremor have increased mortality?

Answer 12

no, but 2-4 times the risk of developing parkinson’s

Question 13

treatment of essential temor

Answer 13

reduce caffeine
sleep
propanolol 40mg BID (can titrate up to 320mg)
Primadone 12.5- 25mg (can titrate up to 250mg)

Question 14

define dystonia

Answer 14

sustained of intermittent muscle contractions causing twitching postures, repetitive movements, or both.

Question 15

difference between the movements in dystonia vs chorea or myoclonus

Answer 15

longer in duration, patterned

Question 16

treatment of dystonia

Answer 16

chemodenervation, oral medications (dopaminergics, anticholinergics, dopamine depleting, muscle relaxants), and deep brain stimulation

Question 17

define tic

Answer 17

brief, stereotyped movement or vocalization

Question 18

3 key features of a tic

Answer 18

urge
relief
suppressible

Question 19

when does a tic not always warrant a work up

Answer 19

in children- can be transient

Question 20

define Tourette’s

Answer 20

multiple motor tics
at least one vocal tic
starts before age 21
occurs at least daily for at least one year

Question 21

list of drugs we have to know for hyperkinetic movement disorders (from the neuro section drug list, just an FYI)

Answer 21

Ropinirole
Levodopa
Risperidone
Olanzepine
Propranolol

Question 22

Rx treatment for tics

Answer 22

risperidone

olanzepine

Question 23

in restless leg syndrome what does U.R.G.E. stand for

Answer 23

urge
rest (makes worse)
getting active (makes better)
evening (makes worse)

Question 24

what are the physical exam findings with restless leg syndrome

Answer 24

none, it is normal

Question 25

what are the common secondary causes of restless leg syndrome

Answer 25

pregnancy, iron deficiency, peripheral neuropathy, ESRD, chronic lung disease, gastric surgery, parkinson’s

Question 26

what is the primary cause of restless leg syndrome

Answer 26

unknown,
more common in elderly
genetic probably (3-5 times higher risk with a 1st degree relative)

Question 27

treatment of restless leg syndrome

Answer 27

iron
dopamine agonist
off-label drugs (gabapentin, levodopa, pregabalin, opiates, benzos, topiramate)

Question 28

what is wilson’s disease

Answer 28

rare, autosomal recessive disorder
50% present with movement disorder
50% present with liver disease
fatal if untreated