Movement Disorders

Easy first question: Hyperkinetic diseases: [blank_start]Excessive/unwanted movement[blank_end] Example: [blank_start]Tremor[blank_end] Hypokinetic diseases: [blank_start]Lack of movement[blank_end] Example: [blank_start]Parkinsonism[blank_end]

Match the Dyskinesia to its definition: [blank_start]Tremor[blank_end] - Rhythmic sinusoidal oscillation of a body part [blank_start]Tic[blank_end] - An involuntary stereotyped movement or vocalisation (can occur singularly) [blank_start]Chorea[blank_end] - Brief irregular purposeless movements which move from one body part to another [blank_start]Myoclonus[blank_end] - Brief electric shock like jerks in groups of muscles [blank_start]Dystonia[blank_end] - Twisting and repetitive movements or an abnormal fixed posture in the affected body part

What is the most common form of dyskinesia? [blank_start]Tremor[blank_end]

Resting tremor is a condition whereby a tremor occurs when muscles are at rest. This type of tremor typically affects the [blank_start]hands/fingers[blank_end] and is the tremor most commonly associated with [blank_start]Parkinson's[blank_end] disease

Which type of tremor is the most common generally? [blank_start]Essential[blank_end] tremor

Essential tremor is considered to be a type of [blank_start]postural[blank_end] tremor, which is a tremor that occur upon sustained muscle tone (e.g. holding arms out horizontally)

Patients with an essential tremor are commonly misdiagnosed as having Parkinson's disease. This is not the case as essential tremor is considered to be a [blank_start]postural[blank_end] tremor whereas parkinson's features only [blank_start]resting[blank_end] tremors

Which of the following conditions is associated with a kinetic tremor? (tremor exacerbated by purposeful movements)

Wilson's disease a genetic disorder in which [blank_start]copper[blank_end] builds up in the body, resulting in jaundice, vomiting and a kinetic tremor.

Apart from a resting tremor typically in the hands, Parkinson's disease patients can also experience a [blank_start]Jaw[blank_end] tremor

In the approach to a patient with a tremor, why might you want to test a young patient (<45) for copper and caeruloplasmin? To test for [blank_start]Wilson's[blank_end] Disease

What are the two first line treatments for essential tremor? (only prescribe one at a time)

Propranolol - [blank_start]Beta Blocker[blank_end] Primidone - [blank_start]Anticonvulsant[blank_end]

Primary tic disorders almost always start in childhood - adult onset of tics is rare and almost always due to a secondary cause

[blank_start]Huntington's[blank_end] Disease is the most common inherited cause of Chorea

Medications for Chorea in Huntington's Disease: [blank_start]Haloperidol[blank_end] - Antipsychotic medication [blank_start]Tetrabenazine[blank_end] - Blocks Dopamine transport into synaptic vesicles in CNS

[blank_start]Haloperidol[blank_end] has side effects such as night sedation and weight gain which can be beneficial to Huntington's Disease patients. [blank_start]Tetrabenazine[blank_end] does not have these side effects, however is more likely to cause depression.

A 27 year old woman presents to her GP, describing that every so often at night as she is falling asleep she is suddenly awoken by a brief jerk and a feeling that she is falling. This woman is most likely suffering from [blank_start]hypnic[blank_end] jerks

Hypnic jerks are often associated with a feeling of falling, and are categorised as a type of [blank_start]myoclonus[blank_end]

A 17 year old boy presents to his GP complaining of involuntary movements. This started around the age of 14 as brief twitches of his muscles in the mornings, but now consists of more forceful jerks occurring both in the mornings and before bed. He describes that the jerks are typically worse after he's been on a night out drinking alcohol, or when he is very tired. What condition is he suffering from? [blank_start]Juvenile Myoclonic Epilepsy[blank_end]

Juvenile Myoclonic Epilepsy (JME) is normally treated with which medication?

Hiccups are a form of [blank_start]myoclonus[blank_end]