clin med 2test3: Movement Disorders ppt
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Questions and Answers

What is the most common cause of tremor?

  • Essential Tremor
  • Parkinson Disease
  • Enhanced Physiologic Tremor (correct)
  • Restless Leg Syndrome
  • What is the primary treatment for Essential Tremor?

  • Levodopa/Carbidopa
  • Propranolol & Primidone (correct)
  • Dopamine Agonists
  • Habit Reversal Training
  • What is the characteristic tremor of Parkinson Disease?

  • Resting tremor (correct)
  • Action tremor
  • Intention tremor
  • Kinetic tremor
  • What is the primary neurotransmitter involved in Parkinson Disease?

    <p>Dopamine</p> Signup and view all the answers

    What is the primary treatment for Tic Disorders?

    <p>Habit Reversal Training</p> Signup and view all the answers

    What is the pathophysiologic mechanism underlying Restless Leg Syndrome?

    <p>Disordered dopamine function</p> Signup and view all the answers

    What is a characteristic feature of Essential Tremor?

    <p>Action tremor</p> Signup and view all the answers

    Which of the following is a characteristic of Enhanced Physiologic Tremor?

    <p>Resolves once the cause is removed or absent</p> Signup and view all the answers

    What is the typical age of onset for Parkinson Disease?

    <p>Age 70</p> Signup and view all the answers

    Which of the following is a cardinal feature of Parkinson Disease?

    <p>Resting tremor</p> Signup and view all the answers

    What is the primary mechanism of action for Dopamine Agonists in the treatment of Parkinson Disease?

    <p>Mimicking dopamine action in the brain</p> Signup and view all the answers

    What is the typical duration of Tic Disorders?

    <p>At least 3 months</p> Signup and view all the answers

    Which of the following is a characteristic of Simple Tics?

    <p>Involuntary, sudden, and brief movements</p> Signup and view all the answers

    What is the primary treatment for Restless Leg Syndrome?

    <p>Dopamine Agonists</p> Signup and view all the answers

    Which of the following is a common feature of Essential Tremor?

    <p>Action tremor</p> Signup and view all the answers

    What is the primary reason for the worsening of Essential Tremor with stress, anxiety, and hyperthyroidism?

    <p>Increased norepinephrine release</p> Signup and view all the answers

    Which of the following is a potential side effect of dopamine agonists in the treatment of Parkinson Disease?

    <p>Freezing or off effects</p> Signup and view all the answers

    A patient with a 5-year history of intermittent, sudden, and brief movements of the face is most likely to have which of the following?

    <p>Tic Disorder</p> Signup and view all the answers

    Which of the following medications is used to treat Tic Disorders when function is impaired?

    <p>Fluphenazine</p> Signup and view all the answers

    Which of the following is a characteristic feature of Restless Leg Syndrome?

    <p>Worsening at night</p> Signup and view all the answers

    A patient with a 15-year history of bilateral action tremor, with a recent onset of cogwheel phenomenon, is most likely to have which of the following?

    <p>Parkinson Disease</p> Signup and view all the answers

    Study Notes

    Movement Disorders

    Enhanced Physiologic Tremor

    • Caused by stress, anxiety, excitement, muscle fatigue, fever, hypoglycemia, alcohol or opioid withdrawal, and certain medications
    • Short duration, resolves once cause is removed
    • Most common cause of tremor
    • Risk increases with advanced age
    • Affects males and females equally

    Essential Tremor

    Clinical Features

    • Longstanding, progressive
    • Kinetic action tremor, bilateral but can be asymmetric
    • Worsens with stress, anxiety, hyperthyroidism, caffeine, and certain medications
    • Improves with alcohol
    • At least 3 years' duration

    Diagnostic Criteria

    • Bilateral action tremor of hands and forearms, but not resting tremor
    • Absence of other neurologic signs, except for cogwheel phenomenon
    • May have tremor in other locations (head, voice, lower limbs)

    Management

    • Pharmacologic: 1st line is propranolol and primidone

    Parkinson Disease

    Epidemiology

    • Mean onset: age 70
    • Males > Females

    Pathophysiology

    • Neurodegenerative disorder
    • Genetic and environmental factors
    • Pathologic features: Lewy body formation, degeneration of dopaminergic neurons, particularly in substantia nigra
    • Dopamine depletion

    Clinical Features

    • Motor: cardinal features include resting tremor (uni>bilateral), bradykinesia, rigidity (cogwheel>lead pipe)
    • Stooped posture, masked facial expression, rigidity, shuffling, short-stepped gait

    Diagnosis

    • Cardinal features: bradykinesia + resting tremor or rigidity
    • MRI brain if atypical presentation

    Pharmacologic Management

    • Levodopa/carbidopa
    • Side effects: motor fluctuations, "freezing" or "off effects"
    • Dopamine agonists: early (family history of tics, obsessive compulsive disorder)

    Tourette Syndrome

    Pathophysiology

    • Genetic predisposition
    • CNS dis-inhibition of motor and limbic system

    Clinical Features

    • Tics: involuntary, sudden, brief, intermittent movements (motor) or utterances (vocal or phonic)
    • Increase: stress
    • Decrease: distraction, focus
    • Simple or complex
    • Transient remissions
    • Do not occur during sleep

    Prognosis

    • 33-50% of cases resolve by age 18
    • Tic types: simple (twitching, blinking, sniffing, grunting), complex (touching, slapping, clapping)

    Evaluation

    • Clinical diagnosis
    • Onset before age 18
    • At least 3 months duration
    • Treatment: habit reversal training, Rx when function impaired, dopamine agonists (fluphenazine, pimozide), antagonists (tetrabenazine)

    Restless Leg Syndrome

    General Information

    • More common in Caucasians
    • Pathophysiology: likely involves disordered dopamine function, associated with iron metabolism abnormality
    • Primary RLS: genetic, several loci with AD pattern of inheritance, variable penetrance
    • Mean age of onset: 27 years old
    • Secondary RLS: associated with pregnancy, anemia, ferritin deficiency, uremia, peripheral neuropathy, spinal cord disease

    Clinical Features

    • Urge to move legs, usually caused or accompanied by unpleasant sensation in the leg
    • Symptoms begin or worsen with rest
    • Diagnosis: sleep laboratory assessment, positive response to dopaminergic therapy

    Evaluation

    • History and physical exam
    • Rule out secondary RLS: check ferritin level

    Movement Disorders

    Enhanced Physiologic Tremor

    • Caused by stress, anxiety, excitement, muscle fatigue, fever, hypoglycemia, alcohol or opioid withdrawal, and certain medications
    • Short duration, resolves once cause is removed
    • Most common cause of tremor
    • Risk increases with advanced age
    • Affects males and females equally

    Essential Tremor

    Clinical Features

    • Longstanding, progressive
    • Kinetic action tremor, bilateral but can be asymmetric
    • Worsens with stress, anxiety, hyperthyroidism, caffeine, and certain medications
    • Improves with alcohol
    • At least 3 years' duration

    Diagnostic Criteria

    • Bilateral action tremor of hands and forearms, but not resting tremor
    • Absence of other neurologic signs, except for cogwheel phenomenon
    • May have tremor in other locations (head, voice, lower limbs)

    Management

    • Pharmacologic: 1st line is propranolol and primidone

    Parkinson Disease

    Epidemiology

    • Mean onset: age 70
    • Males > Females

    Pathophysiology

    • Neurodegenerative disorder
    • Genetic and environmental factors
    • Pathologic features: Lewy body formation, degeneration of dopaminergic neurons, particularly in substantia nigra
    • Dopamine depletion

    Clinical Features

    • Motor: cardinal features include resting tremor (uni>bilateral), bradykinesia, rigidity (cogwheel>lead pipe)
    • Stooped posture, masked facial expression, rigidity, shuffling, short-stepped gait

    Diagnosis

    • Cardinal features: bradykinesia + resting tremor or rigidity
    • MRI brain if atypical presentation

    Pharmacologic Management

    • Levodopa/carbidopa
    • Side effects: motor fluctuations, "freezing" or "off effects"
    • Dopamine agonists: early (family history of tics, obsessive compulsive disorder)

    Tourette Syndrome

    Pathophysiology

    • Genetic predisposition
    • CNS dis-inhibition of motor and limbic system

    Clinical Features

    • Tics: involuntary, sudden, brief, intermittent movements (motor) or utterances (vocal or phonic)
    • Increase: stress
    • Decrease: distraction, focus
    • Simple or complex
    • Transient remissions
    • Do not occur during sleep

    Prognosis

    • 33-50% of cases resolve by age 18
    • Tic types: simple (twitching, blinking, sniffing, grunting), complex (touching, slapping, clapping)

    Evaluation

    • Clinical diagnosis
    • Onset before age 18
    • At least 3 months duration
    • Treatment: habit reversal training, Rx when function impaired, dopamine agonists (fluphenazine, pimozide), antagonists (tetrabenazine)

    Restless Leg Syndrome

    General Information

    • More common in Caucasians
    • Pathophysiology: likely involves disordered dopamine function, associated with iron metabolism abnormality
    • Primary RLS: genetic, several loci with AD pattern of inheritance, variable penetrance
    • Mean age of onset: 27 years old
    • Secondary RLS: associated with pregnancy, anemia, ferritin deficiency, uremia, peripheral neuropathy, spinal cord disease

    Clinical Features

    • Urge to move legs, usually caused or accompanied by unpleasant sensation in the leg
    • Symptoms begin or worsen with rest
    • Diagnosis: sleep laboratory assessment, positive response to dopaminergic therapy

    Evaluation

    • History and physical exam
    • Rule out secondary RLS: check ferritin level

    Movement Disorders

    Enhanced Physiologic Tremor

    • Caused by stress, anxiety, excitement, muscle fatigue, fever, hypoglycemia, alcohol or opioid withdrawal, and certain medications
    • Short duration, resolves once cause is removed
    • Most common cause of tremor
    • Risk increases with advanced age
    • Affects males and females equally

    Essential Tremor

    Clinical Features

    • Longstanding, progressive
    • Kinetic action tremor, bilateral but can be asymmetric
    • Worsens with stress, anxiety, hyperthyroidism, caffeine, and certain medications
    • Improves with alcohol
    • At least 3 years' duration

    Diagnostic Criteria

    • Bilateral action tremor of hands and forearms, but not resting tremor
    • Absence of other neurologic signs, except for cogwheel phenomenon
    • May have tremor in other locations (head, voice, lower limbs)

    Management

    • Pharmacologic: 1st line is propranolol and primidone

    Parkinson Disease

    Epidemiology

    • Mean onset: age 70
    • Males > Females

    Pathophysiology

    • Neurodegenerative disorder
    • Genetic and environmental factors
    • Pathologic features: Lewy body formation, degeneration of dopaminergic neurons, particularly in substantia nigra
    • Dopamine depletion

    Clinical Features

    • Motor: cardinal features include resting tremor (uni>bilateral), bradykinesia, rigidity (cogwheel>lead pipe)
    • Stooped posture, masked facial expression, rigidity, shuffling, short-stepped gait

    Diagnosis

    • Cardinal features: bradykinesia + resting tremor or rigidity
    • MRI brain if atypical presentation

    Pharmacologic Management

    • Levodopa/carbidopa
    • Side effects: motor fluctuations, "freezing" or "off effects"
    • Dopamine agonists: early (family history of tics, obsessive compulsive disorder)

    Tourette Syndrome

    Pathophysiology

    • Genetic predisposition
    • CNS dis-inhibition of motor and limbic system

    Clinical Features

    • Tics: involuntary, sudden, brief, intermittent movements (motor) or utterances (vocal or phonic)
    • Increase: stress
    • Decrease: distraction, focus
    • Simple or complex
    • Transient remissions
    • Do not occur during sleep

    Prognosis

    • 33-50% of cases resolve by age 18
    • Tic types: simple (twitching, blinking, sniffing, grunting), complex (touching, slapping, clapping)

    Evaluation

    • Clinical diagnosis
    • Onset before age 18
    • At least 3 months duration
    • Treatment: habit reversal training, Rx when function impaired, dopamine agonists (fluphenazine, pimozide), antagonists (tetrabenazine)

    Restless Leg Syndrome

    General Information

    • More common in Caucasians
    • Pathophysiology: likely involves disordered dopamine function, associated with iron metabolism abnormality
    • Primary RLS: genetic, several loci with AD pattern of inheritance, variable penetrance
    • Mean age of onset: 27 years old
    • Secondary RLS: associated with pregnancy, anemia, ferritin deficiency, uremia, peripheral neuropathy, spinal cord disease

    Clinical Features

    • Urge to move legs, usually caused or accompanied by unpleasant sensation in the leg
    • Symptoms begin or worsen with rest
    • Diagnosis: sleep laboratory assessment, positive response to dopaminergic therapy

    Evaluation

    • History and physical exam
    • Rule out secondary RLS: check ferritin level

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    Description

    This quiz covers the causes, epidemiology, and clinical features of Enhanced Physiologic Tremor, a common movement disorder. Learn about the factors that contribute to this condition and how it differs from Essential Tremor.

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