Jerks/ twitches resident survival guide: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
Shown below is an [[algorithm]] summarizing the [[diagnosis]] of [[Movement disorders|Abnormal movements]] according thee American Academy of Neurology guidelines:<ref name="FlemmingJones2015">{{cite journal|last1=Flemming|first1=Kelly D|last2=Jones|first2=Lyell K|year=2015|doi=10.1093/med/9780190244927.001.0001}}</ref><ref name="Abdovan de Warrenburg2010">{{cite journal|last1=Abdo|first1=Wilson F.|last2=van de Warrenburg|first2=Bart P. C.|last3=Burn|first3=David J.|last4=Quinn|first4=Niall P.|last5=Bloem|first5=Bastiaan R.|title=The clinical approach to movement disorders|journal=Nature Reviews Neurology|volume=6|issue=1|year=2010|pages=29–37|issn=1759-4758|doi=10.1038/nrneurol.2009.196}}</ref><br><br> | Shown below is an [[algorithm]] summarizing the [[diagnosis]] of [[Movement disorders|Abnormal movements]] according thee American Academy of Neurology guidelines:<ref name="FlemmingJones2015">{{cite journal|last1=Flemming|first1=Kelly D|last2=Jones|first2=Lyell K|year=2015|doi=10.1093/med/9780190244927.001.0001}}</ref><ref name="Abdovan de Warrenburg2010">{{cite journal|last1=Abdo|first1=Wilson F.|last2=van de Warrenburg|first2=Bart P. C.|last3=Burn|first3=David J.|last4=Quinn|first4=Niall P.|last5=Bloem|first5=Bastiaan R.|title=The clinical approach to movement disorders|journal=Nature Reviews Neurology|volume=6|issue=1|year=2010|pages=29–37|issn=1759-4758|doi=10.1038/nrneurol.2009.196}}</ref><ref name="KojovicCordivari2011">{{cite journal|last1=Kojovic|first1=Maja|last2=Cordivari|first2=Carla|last3=Bhatia|first3=Kailash|title=Myoclonic disorders: a practical approach for diagnosis and treatment|journal=Therapeutic Advances in Neurological Disorders|volume=4|issue=1|year=2011|pages=47–62|issn=1756-2856|doi=10.1177/1756285610395653}}</ref><br><br> | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} | ||
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{{Family tree | A01 | | A02 | | A03 | | | A04 | | | | A05 | | | | | |`|-|-| A06 |-|-|'| | |A01=Sudden, brief, shock-like involuntary movements|A02=Randomly flowing movements, which are, individually, jerky in nature|A03= ‘Stereotyped’ character of the recurrent movements|A04=Involuntary, rhythmic and sinusoidal alternating movements of one or more body parts|A05=Involuntary abnormal co-contraction of antagonistic muscles, which may cause sustained abnormal postures or twisting and repetitive movements |A06=Parkinsonism }} | {{Family tree | A01 | | A02 | | A03 | | | A04 | | | | A05 | | | | | |`|-|-| A06 |-|-|'| | |A01=Sudden, brief, shock-like involuntary movements|A02=Randomly flowing movements, which are, individually, jerky in nature|A03= ‘Stereotyped’ character of the recurrent movements|A04=Involuntary, rhythmic and sinusoidal alternating movements of one or more body parts|A05=Involuntary abnormal co-contraction of antagonistic muscles, which may cause sustained abnormal postures or twisting and repetitive movements |A06=Parkinsonism }} | ||
{{Family tree | |!| | | |!| | | |!| | | | |!| | | | | |!| | | | | | | | | | |!| }} | {{Family tree | |!| | | |!| | | |!| | | | |!| | | | | |!| | | | | | | | | | |!| }} | ||
{{Family tree | A01 | | A02 | | A03 | | | A04 | | | | A05 | | | | | | | | A06 | | | | | |A01=Myoclonus |A02=Chorea |A03=Tics |A04=Tremor |A05=Dystonia |A06= • Parkinson's disease<br> • Juvenile parkinsonism<br> • Infectious<br> • Drugs<br> • Toxins<br> • Vascular<br> • Trauma<br> • Metabolic<br> • Corticobasal degeneration (CBD)<br> • Progressive Supranuclear Palsy (PSP)<br> • Multiple System Atrophy (MSA)<br> • Lewy Body Dementia (LBD)}} | {{Family tree | A01 | | A02 | | A03 | | | A04 | | | | A05 | | | | | | | | | A06 | | | | | |A01=Myoclonus |A02=Chorea |A03=Tics |A04=Tremor |A05=Dystonia |A06= • Parkinson's disease<br> • Juvenile parkinsonism<br> • Infectious<br> • Drugs<br> • Toxins<br> • Vascular<br> • Trauma<br> • Metabolic<br> • Corticobasal degeneration (CBD)<br> • Progressive Supranuclear Palsy (PSP)<br> • Multiple System Atrophy (MSA)<br> • Lewy Body Dementia (LBD)}} | ||
{{Family tree | |!| | | |!| | | |!| | | | |!| | | | | |!| | | | | | | | | | |!| }} | |||
{{Family tree | A01 | | A02 | | A03 | | | A04 | | | | A05 | | | | | | | | | | | | | |A01=• Storage diseases<br> • Friedriech's ataxia<br> • Ataxia-telangectasia<br> • Prion diseases<br> • CNS infections<br> • Hashimoto encephalopaty<br> • Hypertiroidism<br> • Electrolyte imbalances<br> • Metabolic imbalances |A02=Huntington's disease |A03=Nervous tics |A04=Essential tremor |A05=Dystonia }} | |||
{{familytree/end}}<br><br> | {{familytree/end}}<br><br> | ||
==Treatment== | ==Treatment== | ||
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==Do's== | ==Do's== | ||
* | *Perform a physical examination with finger or foot tapping. | ||
==Don'ts== | ==Don'ts== | ||
* | *Do not order imaging tests to diagnose clinical disorders, such as Parkinson's disease and essential tremor. | ||
==References== | ==References== | ||
{{Reflist|2}} {{WikiDoc Help Menu}} {{WikiDoc Sources}} | {{Reflist|2}} {{WikiDoc Help Menu}} {{WikiDoc Sources}} | ||
Revision as of 05:14, 12 November 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo, M.D.
Synonyms and Keywords: jerks, twitches, abnormal movements, movement disorders, movement disorders approach
Overview
Movement disorders are common conditions. The clinical presentation of movement disorders is complex and often has variation from person to person. Therefore, finding the correct diagnosis may be challenging. A focused physical examination and history are imperative, and many times the only required resource to establish the diagnosis. Movement disorders may be divided into hyperkinetic and hypokinetic, and this can be evaluated by performing a finger or foot tapping. Among the hyperkinetic disorders, you may classify them as jerky and non-jerky, while hypokinetic may vary in velocity, but in the end, are classified as a whole. The most common hyperkinetic disorder is essential tremor, while the most common hypokinetic one is Parkinson's disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Diagnosis
Shown below is an algorithm summarizing the diagnosis of Abnormal movements according thee American Academy of Neurology guidelines:[1][2][3]
| Patient with movement disorders | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Perform physical examination | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Perform finger or foot tapping | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Increased alternating movements | Progressive fatiguing and decrement of repetitive alternating movements | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hyperkinetic/non-rigid | Rigid | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Jerky | Non-jerky | Akinetic | Hypokinetic | Bradykinetic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Sudden, brief, shock-like involuntary movements | Randomly flowing movements, which are, individually, jerky in nature | ‘Stereotyped’ character of the recurrent movements | Involuntary, rhythmic and sinusoidal alternating movements of one or more body parts | Involuntary abnormal co-contraction of antagonistic muscles, which may cause sustained abnormal postures or twisting and repetitive movements | Parkinsonism | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Myoclonus | Chorea | Tics | Tremor | Dystonia | • Parkinson's disease • Juvenile parkinsonism • Infectious • Drugs • Toxins • Vascular • Trauma • Metabolic • Corticobasal degeneration (CBD) • Progressive Supranuclear Palsy (PSP) • Multiple System Atrophy (MSA) • Lewy Body Dementia (LBD) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| • Storage diseases • Friedriech's ataxia • Ataxia-telangectasia • Prion diseases • CNS infections • Hashimoto encephalopaty • Hypertiroidism • Electrolyte imbalances • Metabolic imbalances | Huntington's disease | Nervous tics | Essential tremor | Dystonia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Do's
- Perform a physical examination with finger or foot tapping.
Don'ts
- Do not order imaging tests to diagnose clinical disorders, such as Parkinson's disease and essential tremor.
References
- ↑ Flemming, Kelly D; Jones, Lyell K (2015). doi:10.1093/med/9780190244927.001.0001. Missing or empty
|title=(help) - ↑ Abdo, Wilson F.; van de Warrenburg, Bart P. C.; Burn, David J.; Quinn, Niall P.; Bloem, Bastiaan R. (2010). "The clinical approach to movement disorders". Nature Reviews Neurology. 6 (1): 29–37. doi:10.1038/nrneurol.2009.196. ISSN 1759-4758.
- ↑ Kojovic, Maja; Cordivari, Carla; Bhatia, Kailash (2011). "Myoclonic disorders: a practical approach for diagnosis and treatment". Therapeutic Advances in Neurological Disorders. 4 (1): 47–62. doi:10.1177/1756285610395653. ISSN 1756-2856.