Tremor Flashcards
what is a tremor
rhythmic sinosoidal oscillation of a body part
what are tics
involuntary stereotyped movements or vocalisations
what is chorea
brief irregular purposeless movements which flit and flow from one body part to another - kind of like dancing
what is myoclonus
brief electric shock like jerks
what is dystonia
abnormal posture of the affected body part
classification of tremors
position - at rest, on posture or during movement
distribution - body part affected
frequency - measured in Hz
amplitude - fine or coarse
resting tremor found in
PD
drug induced parkinsonism
psychogenic tumour
postural tremor found in
essential tremor
enhanced psychological tremor
tremor associated with neuropathy
kinetic tremor found in
cerebellar disease
wilsons disease
head tremor found in
dystonia
cerebellar disease
jaw tremor found in
dystonia
PD
palatal tremor found in
ataxia
symptomatic
essential tremor
ix for tremor
possible thyroid function test in px under 45
guided by presentation
what is a dystonic tremor
treatment
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
what is dystonia and what does it lead to
disorder of movement - involuntary sustained muscle contraction which leads to twisting and repetitive movement or abnormal posturing
when does primary dystonia come on and what is the distribution
<28
focal
when does dystonia plus come on and the types and the distribution of each
> 28
DRD - segmental
myoclonic dystonia - multifocal
what is the secondary dystonia like and the distribution
symptomatic
generalised
3 physiological changes seen in primary dystonia
loss or reduction in reciprocal inhibition
alterations in brain plasticity
alterations in sensory function
the DYT1 gene causes what kind of dystonia
torsion
torsion dystonia when
where
progress
FH
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
indications for surgery in cervical dystonia
not responded to botox
causes of chorea
inherited - huntingtons, wilsons AI - SLE, anti phospholipid, coeliac infectious - HIV drugs - dopamine receptor blocking drugs, levodopa, OCP, anti convulsants paroxysmal chorea - PD metabolic - thyroid
paroxysmal chorea
PD
examination in corea
examine at rest with arms outstretched and while walking
ix in chorea
brain imaging, blood for acanthocytes, ds DNA, anti phospholipid ABs
treatment for chorea
treat underlying cause
teabenazine or dopamine receptor blocking drugs
Tics classicfication
motor (movement) or vocal (sound)
motor tics can be simple or complex
vocal tics can be simple or complex
primary or secondary
young onset of tics
adult onset
young onset - usually primary tics
adult onset rare and usually secondary
ix for chorea
usually none
possible copper studies, blood for acanthocythosis, ASO titre, uric acid, genetic testing for HD, brain imaging
primary tic disorder
simple
chronic
adult onset - tourettism
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
tourette syndrome
M:F
genetics
M>F
A dom in some families
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
treatment of tourette syndrome
symptomatic - clonidine, tetrabenazine and cognitive behavioural therapy
types of myoclonus
primary
myoclonus with epilepsy
progressive myclonic epilepsy and ataxia
symptomatic myoclonus with encephalopathy
liver failure renal failure drug intoxication toxins post hypoxia
progressive encephalomyelitis with rigidity
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
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]
