Tremor Flashcards

1
Q

what is a tremor

A

rhythmic sinosoidal oscillation of a body part

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2
Q

what are tics

A

involuntary stereotyped movements or vocalisations

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3
Q

what is chorea

A

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

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4
Q

what is myoclonus

A

brief electric shock like jerks

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5
Q

what is dystonia

A

abnormal posture of the affected body part

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6
Q

classification of tremors

A

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

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7
Q

resting tremor found in

A

PD
drug induced parkinsonism
psychogenic tumour

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8
Q

postural tremor found in

A

essential tremor
enhanced psychological tremor
tremor associated with neuropathy

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9
Q

kinetic tremor found in

A

cerebellar disease

wilsons disease

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10
Q

head tremor found in

A

dystonia

cerebellar disease

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11
Q

jaw tremor found in

A

dystonia

PD

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12
Q

palatal tremor found in

A

ataxia
symptomatic
essential tremor

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13
Q

ix for tremor

A

possible thyroid function test in px under 45

guided by presentation

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14
Q

what is a dystonic tremor

treatment

A

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

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15
Q

what is dystonia and what does it lead to

A

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

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16
Q

when does primary dystonia come on and what is the distribution

17
Q

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

A

> 28

DRD - segmental
myoclonic dystonia - multifocal

18
Q

what is the secondary dystonia like and the distribution

A

symptomatic

generalised

19
Q

3 physiological changes seen in primary dystonia

A

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

20
Q

the DYT1 gene causes what kind of dystonia

21
Q

torsion dystonia when
where
progress
FH

A

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

22
Q

indications for surgery in cervical dystonia

A

not responded to botox

23
Q

causes of chorea

A
inherited - huntingtons, wilsons 
AI - SLE, anti phospholipid, coeliac 
infectious - HIV
drugs - dopamine receptor blocking drugs, levodopa, OCP, anti convulsants 
paroxysmal chorea - PD
metabolic - thyroid
24
Q

paroxysmal chorea

25
examination in corea
examine at rest with arms outstretched and while walking
26
ix in chorea
brain imaging, blood for acanthocytes, ds DNA, anti phospholipid ABs
27
treatment for chorea
treat underlying cause | teabenazine or dopamine receptor blocking drugs
28
Tics classicfication
motor (movement) or vocal (sound) motor tics can be simple or complex vocal tics can be simple or complex primary or secondary
29
young onset of tics | adult onset
young onset - usually primary tics | adult onset rare and usually secondary
30
ix for chorea
usually none | possible copper studies, blood for acanthocythosis, ASO titre, uric acid, genetic testing for HD, brain imaging
31
primary tic disorder
simple chronic adult onset - tourettism
32
secondary tics causes
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
33
tourette syndrome M:F genetics
M>F | A dom in some families
34
dx for tourette syndrome
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
35
treatment of tourette syndrome
symptomatic - clonidine, tetrabenazine and cognitive behavioural therapy
36
types of myoclonus
primary myoclonus with epilepsy progressive myclonic epilepsy and ataxia
37
symptomatic myoclonus with encephalopathy
``` liver failure renal failure drug intoxication toxins post hypoxia ``` progressive encephalomyelitis with rigidity
38
symptomatic myoclonus without encephalopathy
plus dementia - alzheimer's, lewy bodies plus parkinsonism focal/segmental - spinal cord, root, plexus injury other - whipple disease, coeliac, paraneoplastic, drugs
39
what is juvenile myoclonus epilepsy precipitants symptoms worse when ECG treatment
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]