Tremor and movement disorders Flashcards
Examples of hyperkinetic movement disorders
Tremor Tics Chorea Myoclonus Dystonia
What is tremor?
Rhythmic sinusoidal oscillation of a body part, usually due to alternate activation of agonist and antagonist muscles
How is tremor classified?
Position (resting, posture, movement)
Distribution (Which body part)
Frequency
Amplitude
What does examination of the patient with tremor involve?
Examine at rest, on posture and during movement
Ask patient to write something and copy a spiral
Complete physical and neuro exam
What investigations should be carried out in young patients (
TFT, copper and coeuruloplasmin
How is dystonia defined?
Involuntary sustained muscle contraction
Which gene is responsible for torsion dystonia and what are it’s clinical features?
DYT1
Starts before 28
Starts in a limb usually leg
Majority progress over 5-10 years to become generalised
Often FH
What is the surgical treatment of choice for dystonia?
Deep brain stimulation
What is the treatment of choice for focal dystonia
Injection of botox
For patients who do not respond to botox what is the next step?
Surgery- Improvement in pain and function reported, benefit weeks to months after operation, trials still ongoing
What is chorea?
Brief irregular purposeless movements which flit and flow from one body part to another
What are Tics?
Involuntary stereotyped movements or vocalisations
What is myoclonus?
Brief electric shock like jerks, hiccups or hypnic jerks (when falling asleep) are common
Clinical features of huntingtons
Behavioural disturbance
dementia
Movement disorder, usually chorea
What is the inheritance pattern of Huntington’s?
Autosomal dominant
