CM- Neuro -10- Movement Disorders
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| What are tremors | rhythmic oscillation of the body usually in distal body parts
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| What are the major metabolic causes of tremors | uremia and liver failure
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| what are the major endocrine causes of tremors | hypoglycemia, pheochromocytoma, thyrotoxicosis
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| What are the common drugs that are associated with tremors | Caffeine, Theophylline, Amphetamines, Alcohol, Lithium, Beta-Agonists, Bronchodilators, tricyclics, Valproic Acid, Amiodarone, Nifedipine
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| What is an action tremor/intention tremor | tremor provoked by movement usually indicates brain stem disorder or cerebellar disease
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| What is a resting tremor and what is it common in | tremor that is present in absence of voluntary muscle activity usually seen in Parkinson's
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| What is a postural tremor | tremor that occurs while trying to maintain posture, physiologic tremor and drug induced
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| What disease is associated with chorea (choreoathetosis movements) jerking | Huntington's Disease
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| What type of tremor or movement disorder is characterized by involuntary jerky nonrhythmic semi purposeful movements that occur predominantly in the limbs but can be in head, neck, lips, tongue | tardive dyskinesia
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| What type of movement is seen in senile chorea | buccolingual dyskinesia
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| What type of movement disorder can the following drugs induce- Phenytoin, L-Dopa, Psychotropic's | Drug induced Chorea
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| What type of movement disorder is marked by large flinging ballistic movements of the arms and legs | Hemiballismus- associated with Lacunar CVA, subthalamic basal ganglia disorders
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| What are the following characterized as? Spasmodic torticollis, segmental and generalized dystonia | focal dystonias
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| What type of movement disorder are the following characterized as? Oculogyric crisis, torticollis, tongue protrusion and opisthotonos | Acute Dystonic Reaction
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| What is the tx for acute dystonic reaction and paroxysmal dystonia | botulinum toxin
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| Which is more common Parkinson's' tremor or essential tremor | Essential tremor affects any age usually >60, affect both sexes, no racial predilection
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| What are something's that can reduce the essential tremors a pt experiences | alcohol and beta-blockers
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| Your pt has what you think is an essential tremor just to be careful what intoxication should you rule out | manganese or organic solvents can case essential like tremors
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| What type of inheritance is seen with essential tremor | autosomal dominant
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| what conditions can worsen essential tremors | emotion, hunger, and fatigue
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| How do essential tremors typically start | in one upper limb then involves other legs are less likely to be affected
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| what activities of daily living are affected most by essential tremors | hand writing, holding up a glass small manual dexterity tasks
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| What is the biggest difference between essential tremor and Parkinson's disease | essential tremor is tremor with action while Parkinson's exhibits a tremor at rest
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| One of your differentials of essential tremor is hyperthyroidism how would you rule this out | look for other s/sx of hyperthyroidism they will have increased appetite, weight loss, increased sweating, exophthalmos and lid lag, tachycardia, abnormal thyroid function tests
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| One of the differentials of essential tremors is cerebellar disease how would you rule this out | look for other s/sx of cerebellar disease such as tremor increases with intensity as target is approached, slow rate of tremor, broad ataxic gait, movements are clumsy, get brain imaging, hypotonia, past pointing
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| What questions would you want to ask a pt with suspected essential tremor | what makes it go away- alcohol, sleep. What makes it worse- Anxiety; Family hx
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| What tests should you order in suspected essential tremor pt | get thyroid tests, CT/MRI scans to rule hyperthyroidism and Cerebellar disease or tumor
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| What is the tx for essential tremor | most just need reassurance that they don't have Parkinson's but if activities of daily living are impacted beta blockers are effective
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| What is often the first line therapy for essential tremors especially in younger pts | Beta Blocker such as propanolol, Primidone is now being used as first line as well
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| What are some second line therapies for essential tremors | Anticonvulsants such as gabapentin and topiramate
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| When would surgery be considered as tx option for essential tremors | when all other tx has failed and the tremors are debilitating (surgery involves deep brain stimulation or thalamotomy)
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| what are the guidelines for starting propanolol to tx essential tremors | start low and go slow
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| What are the contraindications for using propranolol to tx essential tremors | hypersensitivity to tx, sinus bradycardia, heart block > 1st degree, sick sinus syndrome, overt heart failure, asthma
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| What type of drug is primidone that is used sometimes to tx essential tremors | antiepileptic drug start low and go slow with elderly
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| T/F clonazepam is ineffective at tx essential tremors | F it is effective but should be reserved for after Beta-Blocker or primidone
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| What is a common cause of restless leg syndrome | Iron deficiency
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| What are tx for restless leg syndrome | Iron supplements if serum iron is low, Sinemet, dopamine agonists (pergolide, ropinirole) and Gabapentin can all be used
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