6. Tremors, Myoclonus, Focal Dystonias, & Tics

Question 0

This refers to a tremor that is present when the limbs & trunk are actively maintained in certain positions and that may persist throughout active movement

Answer 0

Postural/ action tremor

Question 1

Defined as a more or less involuntary & rhythmic oscillatory movement produced by alternating or irregularly synchronous contractions of reciprocally innervated muscles

Answer 1

Tremor

Question 2

This is the most common type of tremor & is of lower frequency than physiologic tremor & is unassociated with other neurologic changes

Answer 2

Essential tremor

Question 3

What is the identifying feature of essential tremors?

Answer 3

Its appearance or marked enhancement with attempts to maintain a static limb posture

Question 4

This is a coarse, rhythmic tremor with a frequency of 3-5 Hz. Electromyographically, it is characterized by bursts of activity that alternate between opposing muscle groups. It occurs when the limb is in an attitude of repose & is suppressed by willed movement.

Answer 4

Parkinsonian/rest tremor

Question 5

This is a strong familial episodic tremor disorder of the chin & lower lip that begins with childhood & may worsen with age

Answer 5

Geniospasm

Question 6

This is a rare but striking tremor isolated to the legs that is remarkable by its occurrence only during quiet standing & its cessation almost immediately on walking. An important accompanying feature is the sensation of severe imbalance, which causes the patient to assume a widened stance while standing.

Answer 6

Primary orthostatic tremor

Question 7

These tremors are usually restricted to a single limb, are gross in nature, are less regular than the common static or action tremors, & diminish in amplitude or disappear if the patient is distracted

Answer 7

Psychogenic tremor

Question 8

A tremor that reflects the rhythmic activation of the tensor veli palatini muscles & imparts a repetitive audible click, which ceases during sleep. It has no known pathologic basis.

Answer 8

Essential palatal tremor

Question 9

A type of tremor caused by a diverse group of brainstem lesions that interrupt the central tegmental tracts. In contrast to all other tremors, it persists during sleep & is sometimes associated with oscillopsia & unilateral or bilateral cerebellar signs.

Answer 9

Symptomatic palatal tremor

Question 10

A phenomenon in which contraction of the masseters occurs concurrently with pendular ocular convergence, which has been observed in Whipple disease

Answer 10

Oculomasticatory myorhythmia

Question 11

Refers to a series of rhythmic, monophasic (unidirectional) contractions & relaxations of a group of muscles

Answer 11

Clonus

Question 12

Specifies the very rapid, shock-like contractions of a group of muscles, irregular in rhythm & amplitude, &, with few exceptions, asynchronous & asymmetrical in distribution

Answer 12

Myoclonus

Question 13

Myoclonus that occurs singly or are repeated in a restricted group of muscles, such as those of an arm or leg

Answer 13

Segmental myoclonus/ myoclonus simplex

Question 14

Widespread, lightning-like, arrhythmic contractions

Answer 14

Myoclonus multiplex/ polymyoclonus

Question 15

A special type of rhythmic epileptic activity in which one group of muscles - usually of the face, arm, or leg - is continuously (day & night)involved in a series of rhythmic monophasic contractions

Answer 15

Epilepsia partialis continua

Question 16

What is the difference between clonus & tremors?

Answer 16

Clonus are unidirectional while tremors are bidirectional

Question 17

So-called startle disease, wherein the aberrant gene is known to be in the alpha1-subunit of the inhibitory glycine receptor GLRA1

Answer 17

Hyperexplexia/ hyperekplexia

Question 18

Treatment for startle disorders?

Answer 18

Clonazepam

Question 19

The most common type of focal dystonia, limited to neck muscles, wherein the spasms may be more pronounced on one side, with rotation or partial extension of the head

Answer 19

Idiopathic cervical dystonia/ torticollis

Question 20

Type of focal dystonia wherein the posterior or anterior neck muscles are involved predominantly and the head may become hyperextended

Answer 20

Retrocollic spasm/ retrocollis

Question 21

Type of focal dystonia wherein the posterior or anterior neck muscles are involved predominantly and the head may become inclined forward

Answer 21

Procollic spasm/ anterocollis

Question 22

Spasms of the orbicularis oculi causing forced closure of the eyelids

Answer 22

Blepharospasm

Question 23

Contraction of the muscles of the mouth & jaw, which may cause forceful closure or opening of the jaw or retraction or pursing of the lips

Answer 23

Oromandibular dystonia

Question 24

Spasms of the laryngeal muscles, imparting a high-pitched strained quality to the voice

Answer 24

Spasmodic dysphonia

Question 25

By far the most effective treatment for spasmodic torticollis

Answer 25

Botulinum toxin

Question 26

The most effective treatment for blepharospasm

Answer 26

Botulinum toxin

Question 27

The most common type of oromandibular/facial/lingual spasm characterized by forceful opening of the jaw, retraction of the lips, spasm of the platysma, & protrusion of the tongue; or the jaw may be clamped shut & the lips may purse

Answer 27

Meige/Brueghel syndrome

Question 28

A form of focal dystonia that affects only the jaw muscles

Answer 28

Masticatory spasm of Romberg

Question 29

Refers to striking, repetitive, stereotyped, almost rhythmic mouth & tongue movements that follow exposure to an offending drug and that, once stablished, persists for months or years

Answer 29

Tardive dyskinesia

Question 30

The rarest & most severe tic syndrome distinguished by multiplicity of tics & the combination of motor & vocal tics

Answer 30

Tourette syndrome

Question 31

First-line treatment for Tourette syndrome

Answer 31

Alpha2-adrenergic agonists clonidine & guanfacine

Question 32

An inner feeling of restlessness, an inability to sit still, & a compulsion to move about

Answer 32

Akathisia