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• Tremor


  Rhythmic oscillations; synchronous contraction of agonist/antagonist muscles
• Types of tremor


  • Resting tremor
  • Postural tremor
  • Kinetic tremor
  • Intentional tremor
• Resting tremor


  • Tremor of the hand while patient is sitting quietly (Parkinson's)
• Postural tremor


  • Tremor when maintaining the hand in a certain posture (e.g. holding a cup)
• Benign essential tremor


  • Familial (AD), worse with anxiety & better with alcohol. Treated with propranolol.
• Kinetic tremor


  • Tremor when doing something (e.g. pouring water/writing)
• Intentional tremor


  • Tremor increases as the patient approaches the target. Dysmetria. Use finger to nose test. Indicative of a cerebellar lesion.
• Chorea


  Irregular, fidgety, random, semi-purposive movements
• Huntington's disease


  • Autosomal dominant
  • Symptoms begin in middle age; progressive chorea, personality change, dementia, death
  • Loss of neurons in basal ganglia→depletion of GABA & acetylcholine but sparing dopamine
  • No treatment. Symptomatic relief & genetic counseling
• Sydenham's chorea


  • Post-streptococcal in children; history of enlarged tonsils followed by fidgety movements
• Tics


  Stereotyped movements/sounds; can be controlled voluntarily for some time
• Dystonia


  Abnormal muscle contraction leading to abnormal posture of a body part
• Types of dystonia


  • Primary dystonia
  • Secondary dystonia
• Primary dystonia


  • Young onset: generalized primary torsion dystonia - DYT1 gene mutation (chrom9)
  • Adult onset: task specific (Writer's cramp, musician's dystonia)
  • Focal: Torticollis, Blepharospasm
• Secondary dystonia


  • Brain injury/Drugs (dopamine depleting)/post encephalitic
  • Heredodegenerative: Parkinsonian syndromes, Wilson's, Huntington's
• Botulinum toxin


  The most useful treatment for dystonia
• Myoclonus


  Sudden electric jerk-like movements of a part of the body or the whole body
• Myoclonus


  • Whole body may flex→patient falls down
  • Jerk of one or both limbs together → clonic contraction that can't be suppressed
• Dyskinesia


  Extra unwanted movements; e.g. tardive dyskinesia due to neuroleptics
• Ballismus


  Sudden vigorous forceful movements usually involving a whole limb, due to stroke in the subthalamic nucleus