Tremor

Question 1

what is a tremor

Answer 1

rhythmic sinosoidal oscillation of a body part

Question 2

what are tics

Answer 2

involuntary stereotyped movements or vocalisations

Question 3

what is chorea

Answer 3

brief irregular purposeless movements which flit and flow from one body part to another - kind of like dancing

Question 4

what is myoclonus

Answer 4

brief electric shock like jerks

Question 5

what is dystonia

Answer 5

abnormal posture of the affected body part

Question 6

classification of tremors

Answer 6

position - at rest, on posture or during movement
distribution - body part affected
frequency - measured in Hz
amplitude - fine or coarse

Question 7

resting tremor found in

Answer 7

PD
drug induced parkinsonism
psychogenic tumour

Question 8

postural tremor found in

Answer 8

essential tremor
enhanced psychological tremor
tremor associated with neuropathy

Question 9

kinetic tremor found in

Answer 9

cerebellar disease

wilsons disease

Question 10

head tremor found in

Answer 10

dystonia

cerebellar disease

Question 11

jaw tremor found in

Answer 11

dystonia

PD

Question 12

palatal tremor found in

Answer 12

ataxia
symptomatic
essential tremor

Question 13

ix for tremor

Answer 13

possible thyroid function test in px under 45

guided by presentation

Question 14

what is a dystonic tremor

treatment

Answer 14

tremor produced by dystonic muscle contraction
tremor associated with dystonia - tremor occurring in conjunction with dystonia

propanolol, primidone
2nd line atenolol, gabapentin, satolol, alpraxolom, toprimate, clonazepam, nadolol, nimodipine

severe - deep brain stimulation

Question 15

what is dystonia and what does it lead to

Answer 15

disorder of movement - involuntary sustained muscle contraction which leads to twisting and repetitive movement or abnormal posturing

Question 16

when does primary dystonia come on and what is the distribution

Answer 16

<28

focal

Question 17

when does dystonia plus come on and the types and the distribution of each

Answer 17

> 28

DRD - segmental
myoclonic dystonia - multifocal

Question 18

what is the secondary dystonia like and the distribution

Answer 18

symptomatic

generalised

Question 19

3 physiological changes seen in primary dystonia

Answer 19

loss or reduction in reciprocal inhibition
alterations in brain plasticity
alterations in sensory function

Question 20

the DYT1 gene causes what kind of dystonia

Answer 20

torsion

Question 21

torsion dystonia when
where
progress
FH

Answer 21

before 28, usually in childhood

starts in a limb, usually legs, trunk and neck affected in minority, head/face is very rare

majority progress over 5-10 years to become generalised/multifocal

FH present but gene not highly penetrable

Question 22

indications for surgery in cervical dystonia

Answer 22

not responded to botox

Question 23

causes of chorea

Answer 23

inherited - huntingtons, wilsons 
AI - SLE, anti phospholipid, coeliac 
infectious - HIV
drugs - dopamine receptor blocking drugs, levodopa, OCP, anti convulsants 
paroxysmal chorea - PD
metabolic - thyroid

Question 24

paroxysmal chorea

Answer 24

PD

Question 25

examination in corea

Answer 25

examine at rest with arms outstretched and while walking

Question 26

ix in chorea

Answer 26

brain imaging, blood for acanthocytes, ds DNA, anti phospholipid ABs

Question 27

treatment for chorea

Answer 27

treat underlying cause

teabenazine or dopamine receptor blocking drugs

Question 28

Tics classicfication

Answer 28

motor (movement) or vocal (sound)
motor tics can be simple or complex
vocal tics can be simple or complex

primary or secondary

Question 29

young onset of tics

adult onset

Answer 29

young onset - usually primary tics

adult onset rare and usually secondary

Question 30

ix for chorea

Answer 30

usually none

possible copper studies, blood for acanthocythosis, ASO titre, uric acid, genetic testing for HD, brain imaging

Question 31

primary tic disorder

Answer 31

simple
chronic
adult onset - tourettism

Question 32

secondary tics causes

Answer 32

neurodegenerative - huntingtons, wilsons, retts

developmental - downs, autism, fragile x syndrome

structural - basal ganglia lesions, post encephalopathy

infection - sydenhams

drugs and toxins - CO poisoning, amphetamines, cocaine, anti convulsants

Question 33

tourette syndrome
M:F
genetics

Answer 33

M>F

A dom in some families

Question 34

dx for tourette syndrome

Answer 34

both multiple motor tics and one or more vocal tics must be present

the tics must occur at multiple times a day, nearly every day or intermittently for more than 1 year with no longer 3 month interval tic free

age of onset <18

exclusion of obvious secondary causes

Question 35

treatment of tourette syndrome

Answer 35

symptomatic - clonidine, tetrabenazine and cognitive behavioural therapy

Question 36

types of myoclonus

Answer 36

primary
myoclonus with epilepsy
progressive myclonic epilepsy and ataxia

Question 37

symptomatic myoclonus with encephalopathy

Answer 37

liver failure
renal failure
drug intoxication 
toxins
post hypoxia 

progressive encephalomyelitis with rigidity

Question 38

symptomatic myoclonus without encephalopathy

Answer 38

plus dementia - alzheimer’s, lewy bodies

plus parkinsonism

focal/segmental - spinal cord, root, plexus injury

other - whipple disease, coeliac, paraneoplastic, drugs

Question 39

what is juvenile myoclonus epilepsy

precipitants

symptoms worse when

ECG

treatment

Answer 39

onset in teenage years of myoclonic jerks and generalised seizures

alcohol and sleep deprivation

worse in the morning

3-5Hz poly spike and wave pattern

sodium valproate and levitiracetam [carbamazepine can aggravate the epilepsy syndrome]