Essential Tremor Flashcards

1
Q

define a tremor

A

involuntary, rhythmic, oscillatory movement of a body part

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2
Q

what is a resting tremor activation

A

presence in absence of voluntary muscle contration

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3
Q

types of action tremor activation behaviours

A

Postural: present while voluntarily maintaining a posture against gravity
Kinetic: present during movement
Isometric: result of muscular contraction against a rigid stationary object
Task specific: occurs only when performing a specific task

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4
Q

Normal, fine tremor in hands while maintaining posture or executing an action
Can be exacerbated by stress, anxiety, hypoglycemia, hypothermia, medications (salbutamol, caffeine)

A

physiologic tremor

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5
Q

common causes of cerebellar tremor include

A

stroke, MS, TBI

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6
Q

what type of tremor is based on situation/ anxiety

A

psychogenic tremor

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7
Q

Rapid lower limb tremor when moving from supine or seated to standing
Tremor ceases upon walking

A

orthostatic tremor

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8
Q

orthostatic tremor
1. occurs mainly when sitting from standing
2. stops upon walking
3. common causes are stroke, MS, TBI
4. is only present with lack of movement

A

2

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9
Q

A kinetic tremor with or without postural tremor

A

essential tremor

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10
Q

a simple ET is defined as (4)

A

Isolated tremor sx of bilateral upper limb action tremor
Of at least 3 yrs duration
w/ without tremor in other locations (head, voice, lower limbs)
An absence of other neurological signs like dystonia, ataxia, or parkinsonism

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11
Q

ET plus is defined as

A

A tremor with characteristics of ET
Additional neurological signs like impared tandem gait, questionable dystonic posturing, rest tremor, memory impairment or other mild neurologic signs of unknown significance that do not suffice to make an additional sx classification or diagnosis

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12
Q

essential tremors see the __________ involved in generation + propagation of abnormal oscillatory activity

A

inferior olivary nucleus and cerebellum

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13
Q

in pts diagnosed with tremors, there may be ______ neuronal damage and abnormalities of ______ recepotsr

A

cerebellar
GABA receptors

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14
Q

in pts diagnosed with tremors, there are decreased CSF concentrations of ____________
and increased concs of __________

A

decreased GABA, glycine, serine
increased glutamate, NE

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15
Q

what are the genetics of ET

A

autosomal dominant
replicated with gene that encodes LINGO1
associated with several single nucleotide polymorphisms

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16
Q

T or F: genetic testing is not recommended for ET

A

T

17
Q

what is the most common MDO

A

ET

18
Q

the epidemiology of ET has a ________ distribution

A

bimodal
15-20yrs, 50-70ysr

19
Q

T or F: not many ET pts seek care or recieve emdication

A

T

20
Q

what assessments of the tremor may be done?

A

Physiologic- ex- EMG
Clinical: handwriting, spiral drawing
Function: maze tests, water cup holding
Impact: functional measures, QoL

21
Q

are there any biomarkers for ET

A

no

22
Q

what must be ruled out in ET assessment

A

drug withdrawal, hypothermia, hypoglycemia, pheochromocytoma, thyrotoxicosis, Wilson’s disease

23
Q

which 3 medications are the biggest culprits for ET

A

beta agonists
lithium
thyroid preps

24
Q

what is the anatomical distribution of ET

A

hands 85-95%, head (can occur later in disease, 35-45%), voice (15-20%), legs (10-15%)

25
Q

ET resolves with ________ in 50-70% of pst

A

alcohol

26
Q

alcohol resolves ET with peak effect in _________ after ingestion, may result in rebound after ______hrs

A

in 45-90min
rebound after 3hrs

27
Q

ET is a progressive disease, with greater amplitude in

A

hands

28
Q

T or F: there is a cure for ET

A

F- only sx manageent

29
Q

what devices may be used for ET

A

Wrist weights (hands), weighted utensils, plate guards, modified mouse/ keyboard

should be assessed by physio for proper weight + avoid further damage

30
Q

what are 2 level A tx for ET

A

propranolol
primidone

31
Q

propranolol SEs

A

bradycardia, bronchospasm, dizziness, ED

32
Q

primidone SEs

A

severe fatigue, some malaise and dizziness

33
Q

primidone SE of fatigue is due to

A

phenobarbital metabolite

34
Q

T or F: primidone levels should be monitored for efficacy

A

F- only for toxicity sometimes

35
Q

when should level B meds for ET be used

A

If CI for level A, need additional tx, or level A drugs can not be increased

36
Q

what are the 4 level B tx for ET

A

primidone + propranolol
alprazolam
gabapentin
topiramate

37
Q

what are 2 level C tx for ET

A

clonazepam, botox

38
Q

surgery for ET is indicated for

A

medically intractable tremor

39
Q

3 types of surgery for ET

A

deep brain stimulation
thalamotomy
thermoablation with guided ultrasound