Tremor Flashcards
Benign essential tremor
relatively common associated with older age fine tremor voluntary movements most notable in hands can cause head, jaw and vocal tremor
features of benign essential tremor
Fine tremor Symmetrical More prominent on voluntary movement Worse when tired, stressed or after caffeine Improved by alcohol Absent during sleep
differential diagnosis of tremor
Parkinson’s disease Multiple sclerosis Huntington’s Chorea Hyperthyroidism Fever Medications (e.g. antipsychotics)
management for tremor
propranolol (a non-selective beta blocker)
Primidone (a barbiturate anti-epileptic medication)
Parkinson’s disease
progressive reduction in dopamine in the basal ganglia leading to a disorder of movement.
asymmetrical (one side affected more than the other)
classic triad:
Resting tremor
Rigidity
Bradykinesia
presentation of Parkinson
older male facial masking stooped posture forward tilt reduced arm swing shuffling gait
unilateral tremor (4-6Hz occurs 4-6 times in a second) pill-rolling tremor. more pronounced when resting, improves with voluntary movement. worse if distracted.
cogwheel rigidity
resistance to a passive movement. take hand passively and flex/extend the elbow. tension in their arm- jerks.
bradykinesia
- handwriting gets smaller
- shuffling gait
- difficulty initiating movement
- difficulty turning around when standing, have to take lots of steps
- reduced facial movements and facial expression hypomimia.
Depression Sleep disturbance and insomnia Loss of the sense of smell (anosmia) Postural instability Cognitive impairment and memory problems
Parkinson tremor / Benign Essential Tremor comparisson
Parkinson asymmetrical 4-6 hertz worse at rest improves with intentional movement other parkinson features +Ve no change with alcohol
BET symmetrical 5-8 hertz improves at rest worse with intentional movements no other parkinson features improve with alcohol
Multiple System Atrophy
rare condition
neurones in multiple systems in the brain degenerate
affects the basal ganglia
parkinson presentation
autonomic dysfunction- postural hypotension, constipation, abnormal sweating, sexual dysfunction
cerebrall dysfunction (ataxia)
Dementia with Lewy Bodies
associated with Parkinsonism
progressive cognitive decline
hallucinations, delusions, disorder of REM sleep, fluctuating consciences
management of Parkinson
Levodopa- synthetic dopamine. Given in combination with a drug that stops it from being broken down before entering the brain (peripheral decarboxylase inhbitiors= carbidopa, benserazide)
- co benyldopa
- co careldopa
the side effect of Parkinson meds
dopamine levels too high
dyskinesia
excessive motor activty
Dystonia: This is where excessive muscle contraction leads to abnormal postures or exaggerated movements.
Chorea: These are abnormal involuntary movements that can be jerking and random.
Athetosis: These are involuntary twisting or writhing movements usually in the fingers, hands or feet.
other parkinson meds
COMT inhibitors
Dopamine Agonist (bromocryptine, pergolide, cabergoline)
Monoamine Oxidase-B-inhibitor (selegine, rasagline)
