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1 Professor Tim Anderson Neurologist University of Otago Christchurch 11:00-11:55 WS #91: Shakes Jerks and Spasms - Recognition and Differential Diagnosis 12:05-13:00 WS #102: Shakes Jerks and Spasms - Recognition and Differential Diagnosis (Repeated)
2 Shakes, Jerks and Spasms Recognition and differential diagnosis Tim Anderson Christchurch
3 Phenomenology hyperkinetic disorders tremor jerks spasms stereotypy akithisia hypokinetic disorders bradykinesia rigidity postural instability
4 Types of Movement Disorders Tremor Jerks Spasms
5 Types of Movement Disorders Tremor Jerks Spasms
6 Tremor rhythmical oscillation of a body part tremor frequency is not relevant diagnosis of cause is on the basis of: the type of tremor the associated features
7 Tremor - Classification Rest Action Postural Kinetic (tremor during movement) Simple kinetic (non goal directed) Intention (goal directed) Task specific isometric
8 Tremor types (Rest) Rest Tremor The only true rest tremor is Parkinsonian
9 Parkinson s Disease Bradykinesia (slowness)
10 Parkinson s Disease
11 Tremor Types (postural) Rest tremor ActionTremor Postural Kinetic Postural Tremor Essential tremor Enhanced Physiological Drugs hyperthyroidism brainstem/red nucleus Wilson's disease Tremor present on sustained posture
12 Tremor Types (intention) Rest Action Postural Kinetic Simple kinetic (non goal directed) Intention (goal directed) Task specific isometric Intention Tremor Brainstem disease, or Cerebellar disease Multiple sclerosis Cerebellar degeneration Tremor during target-directed movements
13 Tremor Syndromes Additional data from a medical history and the results of a neurologic examination can be combined into one of the following clinical syndromes: enhanced physiologic tremor classical essential tremor (ET) primary orthostatic tremor task- and position-specific tremors dystonic tremor cerebellar tremor palatal tremor tremor in Parkinson's disease Holmes' tremor drug-induced and toxic tremor tremor in peripheral neuropathies psychogenic tremor.
14 Classical Essential Tremor
15 Essential Tremor 50% hereditary (no specific gene established) 50% alcohol responsive always involves the hands (postural) symmetrically then head, tongue, voice (rarely jaw or legs) head tremor usually side-to-side no other neurologic features note! can get "cogwheeling" at wrists (due to superimposed tremor) Louis EL. Lancet Neurology 2005; 4:100-10
16 Tremor Syndromes Additional data from a medical history and the results of a neurologic examination can be combined into one of the following clinical syndromes: enhanced physiologic tremor classical essential tremor (ET) primary orthostatic tremor task- and position-specific tremors dystonic tremor cerebellar tremor palatal tremor tremor in Parkinson's disease Holmes' tremor drug-induced and toxic tremor tremor in peripheral neuropathies psychogenic tremor.
17 primary orthostatic tremor Treatment: clonazepam, L-dopa, gabapentin
18 Tremor Syndromes Additional data from a medical history and the results of a neurologic examination can be combined into one of the following clinical syndromes: enhanced physiologic tremor classical essential tremor (ET) primary orthostatic tremor task- and position-specific tremors dystonic tremor cerebellar tremor palatal tremor tremor in Parkinson's disease Holmes' tremor drug-induced and toxic tremor tremor in peripheral neuropathies psychogenic tremor.
19 task and position-specific tremors e.g. vocal tremor and writing tremor
20 Tremor Syndromes Additional data from a medical history and the results of a neurologic examination can be combined into one of the following clinical syndromes: enhanced physiologic tremor classical essential tremor (ET) primary orthostatic tremor task- and position-specific tremors dystonic tremor cerebellar tremor palatal tremor tremor in Parkinson's disease Holmes' tremor drug-induced and toxic tremor tremor in peripheral neuropathies psychogenic tremor.
21 Tremor Syndromes Additional data from a medical history and the results of a neurologic examination can be combined into one of the following clinical syndromes: enhanced physiologic tremor classical essential tremor (ET) primary orthostatic tremor task- and position-specific tremors dystonic tremor cerebellar tremor palatal tremor tremor in Parkinson's disease Holmes' tremor drug-induced and toxic tremor tremor in peripheral neuropathies psychogenic tremor.
22 Types of Movement Disorders Tremor Jerks Spasms
23 Types of Jerk Chorea continuous flow of brief jerky movements which flit from one part of the body to the next in random fashion
24 Chorea continuous flow of brief jerky movements which flit from one part of the body to the next in random fashion
25 Types of Jerk Chorea Huntington s disease Sydenham s chorea Drugs Levodopa Antipsychotics Anticholinergics Stroke Treatment Tetrabenazine 12.5mg od max 50mg tds
26 athetosis from stroke
27 Chorea from L-dopa Jerks chorea myoclonus tics continuous flow of brief jerky movements which flit from one part of the body to the next in random fashion
28 Types of Jerk Chorea Myoclonus rapid shock-like muscle jerks, often repetitive, sometimes rhythmic
29 Myoclonus rapid shock-like muscle jerks, often repetitive, sometimes rhythmic
30 Types of Jerk Chorea Myoclonus Can be due to many brain and spinal cord disorders After cardiac arrest drugs Treatment 1. clonazepam 0.25mg od 2mg tds 2. sodium valproate 200mg od 500mg tds 3. levetiracetam 500mg 1000mg bd
31 Types of Jerk Chorea Myoclonus Tics repetitive, stereotyped jerks which can be mimicked voluntarily, and briefly held in check
32 Types of Jerk Chorea Myoclonus Tics Predilection around face/head Single (simple) or multiple Common in childhood transient Tourettes Syndrome Start in childhood Multiple motor tics Sonic tics Improves in adulthood
33 Types of Jerk Chorea Myoclonus Tics Treatment (if necessary) tetrabenazine clonidine haloperidol dopamine agonists
34 Types of Movement Disorders Tremor Jerks Spasms = Dystonia
35 Dystonia (spasms) "sustained contraction of voluntary muscles causing twisting and repetitive movements or abnormal posture Treatment: anticholinergics, botulinum toxin
36 Dystonia - classification Focal spasmodic torticollis (cervical dystonia) blepharospasm oromandibular dystonia spasmodic dysphonia (laryngeal dystonia) dystonic writers cramp limb dystonia Segmental Meige syndrome cranio-cervical dystonia Generalised idiopathic torsion dystonia Hemidystonia post stroke Other structural lesions
37 focal and segmental dystonia
38 Hemidystonia and generalised dystonia
39 stereotypies Huntington s disease Intellectually impaired
Professor Tim Anderson
Professor Tim Anderson Neurologist University of Otago Christchurch 11:00-11:55 WS #91: Shakes Jerks and Spasms - Recognition and Differential Diagnosis 12:05-13:00 WS #102: Shakes Jerks and Spasms - Recognition
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