Jerks/ twitches resident survival guide: Difference between revisions
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{{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 | |!| | | |!| | | |!| | | | |!| | | | | |!| | | | | | | | | | | }} | ||
{{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<br> • Familial benign chorea<br> • Familial inverse choreoatetosis<br> • CNS infections<br> • Electrolyte imbalances<br> • Metabolic imbalances |A03=• Transient tic disorder |A04=• Essential tremor |A05=• Blepharospasm<br> • Cervical dystonia<br> • Oromandibular dystonia<br> • Writer's Cramp (hand dystonia)<br> • Paroxismal dystonia}} | {{Family tree | A01 | | A02 | | A03 | | | A04 | | | | A05 | | | | | | | | | | | | | |A01=• tardive dyskinesia<br> • 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<br> • Familial benign chorea<br> • Familial inverse choreoatetosis<br> • CNS infections<br> • Electrolyte imbalances<br> • Metabolic imbalances |A03=• Transient tic disorder<br> • Torette's disorder<br> • Chronic vocal or motor tic disorder<br> • Tic disorder not otherwise specified |A04=• Essential tremor<br> • Postural tremor<br> • Action tremor<br> • Resting tremor<br> • Pyschogenic tremor<br> • Physiologic tremor|A05=• Blepharospasm<br> • Tardive dystonia<br> • Cervical dystonia<br> • Oromandibular dystonia<br> • Writer's Cramp (hand dystonia)<br> • Paroxismal 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. | *Perform a physical examination with finger or foot tapping.<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> | ||
*Perform a urine toxicology test to look for drug-induced movement disorders such as tardive dystonia, postural tremor, parkinsonism, etc.<ref name="ChoukseyPandey2020">{{cite journal|last1=Chouksey|first1=Anjali|last2=Pandey|first2=Sanjay|title=Clinical Spectrum of Drug-Induced Movement Disorders: A Study of 97 Patients|journal=Tremor and Other Hyperkinetic Movements|volume=10|issue=1|year=2020|issn=2160-8288|doi=10.5334/tohm.554}}</ref> | |||
==Don'ts== | ==Don'ts== |
Revision as of 14:51, 13 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) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
• tardive dyskinesia • Storage diseases • Friedriech's ataxia • Ataxia-telangectasia • Prion diseases • CNS infections • Hashimoto encephalopaty • Hypertiroidism • Electrolyte imbalances • Metabolic imbalances | • Huntington's disease • Familial benign chorea • Familial inverse choreoatetosis • CNS infections • Electrolyte imbalances • Metabolic imbalances | • Transient tic disorder • Torette's disorder • Chronic vocal or motor tic disorder • Tic disorder not otherwise specified | • Essential tremor • Postural tremor • Action tremor • Resting tremor • Pyschogenic tremor • Physiologic tremor | • Blepharospasm • Tardive dystonia • Cervical dystonia • Oromandibular dystonia • Writer's Cramp (hand dystonia) • Paroxismal dystonia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Do's
- Perform a physical examination with finger or foot tapping.[1]
- Perform a urine toxicology test to look for drug-induced movement disorders such as tardive dystonia, postural tremor, parkinsonism, etc.[4]
Don'ts
- Do not order imaging tests to diagnose clinical disorders, such as Parkinson's disease and essential tremor.
References
- ↑ 1.0 1.1 Flemming, Kelly D; Jones, Lyell K (2015). doi:10.1093/med/9780190244927.001.0001. Missing or empty
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(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.
- ↑ Chouksey, Anjali; Pandey, Sanjay (2020). "Clinical Spectrum of Drug-Induced Movement Disorders: A Study of 97 Patients". Tremor and Other Hyperkinetic Movements. 10 (1). doi:10.5334/tohm.554. ISSN 2160-8288.