Case files

Question 1

Essential tremor: tremor worse or better with movement?

Answer 1

Worse with purposeful movement

Question 2

Parkinson’s: tremor worse or better with movement?

Answer 2

Improves with purposeful movement

Question 3

Treatment of essential tremor

Answer 3

Beta-blockers and primidone if not controlled with B-blockers

Question 4

How do the tremors of essential tremor and parkinson’s disease differ with respect to latency period?

Answer 4

PD tremor takes longer to start in a patient holding arms out in front of them (10 seconds) vs. ET (1-2 seconds)

Question 5

What is the genetic basis of Huntington disease?

Answer 5

Repeat CAG repeats in the huntingtin gene on chromosome 4

Question 6

Clinical manifestations of Huntington disease

Answer 6

Motor (chorea, poor coordination, gait problems), cognitive (poor executive function, dementia), and behavioral problems (disinhibition, anger)

Question 7

Management of chorea in HD

Answer 7

Haloperidol or tetrabenazine (dopamine-depleting agent)

Question 8

Most common cause of tardive dyskinesia?

Answer 8

Exposure to central dopamine blocking agents (e.g. antipsychotics; occurs in ~1/3 of patients receiving these drugs)

Question 9

Treatment for tardive dyskinesia?

Answer 9

Benzos, baclofen, or vitamin E; tetrabenazine is a good alternative (dopamine depleting but not dopamine blocking)

Question 10

When does tardive dyskinesia usually begin after starting dopamine blocking agents?

Answer 10

Months (in contrast to dystonia, which has a more acute onset and can occur within days of starting meds)