Tremors

Question 1

what is a tremor

Answer 1

agonist-antagonist contraction
leads to rhythmic back-and-forth movements in a region

Question 2

what features are used to class tremors

Answer 2

region affected (may be multiple)
when is it present (resting, during movement etc)
amplitude - fine (low amplitude) or coarse (high amplitude)
frequency (in Hz)

Question 3

clinical examination for tremors

Answer 3

hands resting in lap, arms supinated - tremor present=resting
hands outstretched - tremor present=postural
during action - draw spiral, write a sentence, mime an action
finger-nose testing - intention tremor appears on approach to target, may also see past pointing (dysmetria)
during walking - tremor and loss of arm swing indicates Parkinsons

Question 4

what is a physiological tremor

Answer 4

often due to overactivity of sympathetic nervous system
occurs with anxiety, caffeine, beta-2 agonists, hyperthyroidism
fine, high frequency tremor (fast)
symmetrical, in upper limbs

Question 5

treatment of physiological tremor

Answer 5

treat underlying cause (reduce caffeine, treat hyperthyroidism, beta-blockers)

Question 6

what is an essential tremor

Answer 6

bilateral symmetrical arm tremor, typically woth movement
may also develop head and vocal tremor
typically emerges or worsens on action
amplitude and frequency can vary (often 8-10Hz)

Question 7

treatment/management of essential tremor

Answer 7

alcohol can reduce/mask tremor (patients can develop problematic drinking patterns)
treatment - beta-blockers, primodone, deep brain stimulation surgery
management - supportive measure (adapted cutlery)

Question 8

features of Parkinsons tremor

Answer 8

slow, coarse, ‘pill-rolling’ in hands
most prominent at rest, reduces/disappears upon movement, increases with stress
present during walking (with reduced arm swing)
typically asymmetrical

Question 9

drugs that can induce tremor

Answer 9

beta-agonists
theophylline
sodium valporate
thyroxine
lithium
tricyclic antidepressants
recreational drugs (eg amphetamines)
alcohol
caffeine

Question 10

metabolic/endocrine causes of tremor

Answer 10

hyperthyroidism
hypoglycaemia
alcohol withdrawl
advanced renal failure
advanced hepatic failure
hyperparathyroidism

Question 11

describe an intention tremor

Answer 11

sign of cerebellar dysfunction
absent at rest, appears when approaching target
increasingly coarse amplitude when approaching target
more pronounced if arm is fully outstretched
look for dysmetria (past-pointing)
treatment - rehabilitation measures can help depending on cause of cerebellar disease