trigger - movement Flashcards
Exacerbated by extreme temps and hunger
essential tremor
also exacerbated by emotion and fatigue
improved by alcohol
Essential tremor
has to be present for 3 years in order to dx
essential tremor:
Isolated tremor consisting of bilateral UE action without other motor abnormalities
3y in duration
W or w/o tremors in other locations
Absence of other neurologic signs
worsened with caffeiene
enhanced physiologic tremor
restless leg syndrome too!
treatment for intermittent ET
1st-line: Propranolol and Primidone (slower onset)
2nd-line: xanax or klonopin
tx for persistent ET
1st-line: propanolol or primidone daily. or both! (combo)
2nd-line: gabapentin, pregabalin, topiramate.
2nd-line: Neurologist for botox A or surgical intervention via deep brain stim or thalamotomy
caused by damage to the pons, midbrain, thalamus or cerebellum.
intention/kinetic tremor
only treatment is to refer to neuro for surgery
intention tremor
WORSE by attempting voluntary movement
dystonia
Involuntary contraction of both agonist and antagonist muscles
dystonia
MC 30-50
torticollis
T or F: blepharospasms can be bilateral or unilateral
false: they are unilateral, synchronus and symmetric
irregular and involuntary voice breaks, pt feels like they have to yell
spasmodic dysphonia
how to treat adults with generalized dystonias
all pts = trial of carbidopa/levodopa
1st-line: Clonazepam (GABA)
Second-line: Baclofen (GABA agonist) or trihexyphenidyl (anticholinergic which increases dopamine release)
Alternative second-line: VMAT2 inhibitor (-benazine and off-label use)
Last resort: DBS
what is the tx for generalized dystonias in children
- trihexyphenadyls
- baclofen or BZDs
Treated w NSAIDS and soft cervical collar
infantile torticollis
MC in:
white women
preggo
fmhx
middle aged/older
restless leg syndrome
MC with iron deficiency anemia
restless leg
risks include alcoholism, DM, amyloidosis, motor neuron disease
restless leg
worsened by antihistamines, metoclopramide, antipsychotics and antidepressants
restless leg syndrome
also worse w caffeine and sleep deprivation
when do you initiate pharm for restless leg and what are the pharm options for tx!
> or equal to 3 nights/week
- gabapentin, pregablin or gebapentin encarbamil(ER) (ER is given when they have sx throughout hte daytime.)
- Pramipexole, ropinrole, rotigotine patch
risk of impulse control disorder and augmentation
dopamine agonists (pramipexole, ropinirole, rotigotine)
what drug requires drug holidayrs
dopamine agonists (pramipexole, ropinirole, rotigotine) becuase of risk of augmentation
what are the indication for treating tourettes and what do you treat them with.
Affecting ADLs, and daily life in general.
Causes pain, discomfort, or injury
FDA approved: Haldol, primozide, aripiprazole
Non-FDA approved: VMAT2 inhibitor (tetrabenazine), clonidine, guanfacine
hypotonia w hyperreflexia
huntingtons disease
presents w Wt loss and cachexia
huntingtons dz
Slowly progressing disease characterized by tremor, bradykinesia, rigidity, and postural instability
parkinsons disease
lewy bodies and decreased dopamine producing neurons
parkinsons
leads to high acetylcholine and low dopamine
alleviated by voluntary movemen
tremors in parkinsons
tapping over the bridge of the nose and produces sustained blink
what is the name of this test and who is it positive in
myerson sign
+ in parkinsons
what is the treatment for a young patient with a tremor in parkinsons
benzotropine and trihenxyphenidyl
what is the treatment for mild parkinsons symptoms
amantadine
seligiline, rasagiline, safanamide
what is the treatment for moderate parkinsons symptoms
dopamine agonists (pamiprexole, roperinole, rotigotine) for younger
carbidopa/levodopa for older
for severe parkinsons what is indicated
carbidopa/levodopa
+/- etacapone or tolcapone
how do you treat dementia in parkinsons
what about psychosis
Ach inhibitors and memantine
atypical antipsycotics (quetipine)
which part of the cerebellum is asociated with ataxia of gait, balance and, ocular
midline cerebellar lesions
What kind of ataxia is associated with Dysdiadochokinesis, dysmetria, limb ataxia, tremor, speech
hemispheric cerebeller lesions
assocaited with loss of hand/eye coordinaiton, nystagmus, and unclear speech
motor/cerebellar ataxia
also with:
Imbalance and coordination
Ataxic gait (drunk)
Unclear (scanning) speech
Nystagmus => visual blurring
Loss of hand coordination
Intention tremor
abnormal vibratory sense, stomping gait and positive romberg
sensory/proprioceptive ataxia
deviation of gait to affected side, nystagmus, NV, dizziness
vestibular ataxia
what do dopamine agonists treat
moderate parkinsons disease
restless leg syndrome
these are pamiprexole, ropinirole, and rotigotine
SE of viral infection and syncope
ropinirole
Syncope
Somnolence
Dizziness
Fatigue
N/V
Viral infection
Dyskinesias
DDI with cipro, estrogens, and CNS depressants
ropinirole
Alcohol
Dopamine antagonists
CNS depressants
Estrogens
Cipro
dopamine agonist w SE of hypotension
rotogotine
DDI is anti-HTN
inhibits release of dopamine, noradrenaline and seratonin
VMAT2 inhibitors
tetrabenazine
hepatically metabolized
tetrabenazine
ropinirole
amantadine
entacapone
when are VMAT2 inhibitors used
2nd line for tourettes
non FDA approved for generalized dystonias in adults
CI in active SI, uncontrolled depression or MAOI use in 14d
tetrabenazine (VMAT2’s)
can cause NMS
tetrabenazine
DDI with tramadol
amantadine
SE of disturbance of cardiac rhythm
amantadine
also:
Restlessness
Confusion
Skin rashes
Edema
Disturbances of cardiac rhythm
CI in melanoma and narrow angle glaucoma
carbidopa/levodopa
avoid this med on a high protiein diet
carbidopa/levodopa
