Jerks/ twitches resident survival guide: Difference between revisions
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*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 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> | ||
*Always ask for exacerbating and relieving factors; for example, involuntary movements that present in frequent, brief attacks that are induced by sudden movements (such as rising from a chair) suggest the diagnosis of paroxysmal kinesigenic dyskinesia.<ref name="pmid26214782">{{cite journal |vauthors=Hao SS, Feng YH, Zhang GB, Wang AP, Wang F, Wang P |title=Neuropathophysiology of paroxysmal, systemic, and other related movement disorders |journal=Eur Rev Med Pharmacol Sci |volume=19 |issue=13 |pages=2452–60 |date=July 2015 |pmid=26214782 |doi= |url=}}</ref><ref name="pmid11346027">{{cite journal |vauthors=Bhatia KP |title=Familial (idiopathic) paroxysmal dyskinesias: an update |journal=Semin Neurol |volume=21 |issue=1 |pages=69–74 |date=2001 |pmid=11346027 |doi=10.1055/s-2001-13121 |url=}}</ref> | *Always ask for exacerbating and relieving factors; for example, involuntary movements that present in frequent, brief attacks that are induced by sudden movements (such as rising from a chair) suggest the diagnosis of paroxysmal kinesigenic dyskinesia.<ref name="pmid26214782">{{cite journal |vauthors=Hao SS, Feng YH, Zhang GB, Wang AP, Wang F, Wang P |title=Neuropathophysiology of paroxysmal, systemic, and other related movement disorders |journal=Eur Rev Med Pharmacol Sci |volume=19 |issue=13 |pages=2452–60 |date=July 2015 |pmid=26214782 |doi= |url=}}</ref><ref name="pmid11346027">{{cite journal |vauthors=Bhatia KP |title=Familial (idiopathic) paroxysmal dyskinesias: an update |journal=Semin Neurol |volume=21 |issue=1 |pages=69–74 |date=2001 |pmid=11346027 |doi=10.1055/s-2001-13121 |url=}}</ref> | ||
*Inquire about ethnicity and family history of movement disorders as these aspects may guide into the diagnosis.<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> | |||
*Ask the patient's partner for the nature, pattern, and description of the movement disorder, since many times, these movements are hampered by the fact that patients frequently try to mask their abnormal movements by incorporating them into voluntary movements.<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> | *Ask the patient's partner for the nature, pattern, and description of the movement disorder, since many times, these movements are hampered by the fact that patients frequently try to mask their abnormal movements by incorporating them into voluntary movements.<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> | ||
*Perform a systematic approach when encountering a patient with more than one type of movement disorder (mixed). | *Perform a systematic approach when encountering a patient with more than one type of movement disorder (mixed). | ||
*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> | *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> | ||
*Have in mind the possibility of adverse drug effects medication whenever patients present with a mixed movement disorder; the most common are dopamine D2 receptor-blocking agents such as neuroleptics.<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> | *Have in mind the possibility of adverse drug effects medication whenever patients present with a mixed movement disorder; the most common are dopamine D2 receptor-blocking agents such as neuroleptics.<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> | ||
*Perform genetic testing as the initial diagnostic step in possible genetic diseases that require confirmation, such as Huntington's disease.<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> | |||
==Don'ts== | ==Don'ts== | ||
Revision as of 04:49, 26 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
Management of movement disorders will vary depending on the underlying cause, among the treatment strategies, there is physical therapy, medical therapy, botulin toxin injection, and deep brain stimulation.
- To view the specific treatment of myoclonus click here.
- To view the specific treatment of tics click here.
- To view the specific treatment of essential tremors click here.
- To view the specific treatment of Parkinson's disease click here.
- To view the specific treatment of progressive supranuclear palsy (PSP) click here.
- To view the specific treatment of multiple system atrophy (MSA) click here.
- To view the specific treatment of Lewy body dementia (LBD) click here.
- To view the specific treatment of Tourette's disorder click here.
- To view the specific treatment of Huntington's disease click here.
- To view the specific treatment of ataxia-telangiectasia click here.
- To view the specific treatment of tardive dyskinesia click here.
- To view the specific treatment of Friedreich's ataxia click here.
Do's
- Perform a physical examination with finger or foot tapping.[1]
- Always ask for exacerbating and relieving factors; for example, involuntary movements that present in frequent, brief attacks that are induced by sudden movements (such as rising from a chair) suggest the diagnosis of paroxysmal kinesigenic dyskinesia.[4][5]
- Inquire about ethnicity and family history of movement disorders as these aspects may guide into the diagnosis.[2]
- Ask the patient's partner for the nature, pattern, and description of the movement disorder, since many times, these movements are hampered by the fact that patients frequently try to mask their abnormal movements by incorporating them into voluntary movements.[2]
- Perform a systematic approach when encountering a patient with more than one type of movement disorder (mixed).
- Perform a urine toxicology test to look for drug-induced movement disorders such as tardive dystonia, postural tremor, parkinsonism, etc.[6]
- Have in mind the possibility of adverse drug effects medication whenever patients present with a mixed movement disorder; the most common are dopamine D2 receptor-blocking agents such as neuroleptics.[2]
- Perform genetic testing as the initial diagnostic step in possible genetic diseases that require confirmation, such as Huntington's disease.[2]
Don'ts
- Do not order imaging or laboratory tests to diagnose clinical disorders, such as Parkinson's disease and essential tremor.[7][8]
- Do not apply deep brain stimulation therapy for Parkinson's disease if any of the following are present: cognitive disturbances (Mattis score ≥130), major comorbidities, major depression (Beck depression score II <25), or other psychiatric contraindications, or neurosurgical contraindications.[9][10]
References
- ↑ 1.0 1.1 Flemming, Kelly D; Jones, Lyell K (2015). doi:10.1093/med/9780190244927.001.0001. Missing or empty
|title=(help) - ↑ 2.0 2.1 2.2 2.3 2.4 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.
- ↑ Hao SS, Feng YH, Zhang GB, Wang AP, Wang F, Wang P (July 2015). "Neuropathophysiology of paroxysmal, systemic, and other related movement disorders". Eur Rev Med Pharmacol Sci. 19 (13): 2452–60. PMID 26214782.
- ↑ Bhatia KP (2001). "Familial (idiopathic) paroxysmal dyskinesias: an update". Semin Neurol. 21 (1): 69–74. doi:10.1055/s-2001-13121. PMID 11346027.
- ↑ 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.
- ↑ Piccini P, Whone A (May 2004). "Functional brain imaging in the differential diagnosis of Parkinson's disease". Lancet Neurol. 3 (5): 284–90. doi:10.1016/S1474-4422(04)00736-7. PMID 15099543.
- ↑ Seppi K, Schocke MF (August 2005). "An update on conventional and advanced magnetic resonance imaging techniques in the differential diagnosis of neurodegenerative parkinsonism". Curr Opin Neurol. 18 (4): 370–5. doi:10.1097/01.wco.0000173141.74137.63. PMID 16003111.
- ↑ Paschen, Steffen; Deuschl, Günther (2018). "Patient Evaluation and Selection for Movement Disorders Surgery: The Changing Spectrum of Indications". 33: 80–93. doi:10.1159/000480910. ISSN 0079-6492.
- ↑ Deuschl, Günther; Schade-Brittinger, Carmen; Krack, Paul; Volkmann, Jens; Schäfer, Helmut; Bötzel, Kai; Daniels, Christine; Deutschländer, Angela; Dillmann, Ulrich; Eisner, Wilhelm; Gruber, Doreen; Hamel, Wolfgang; Herzog, Jan; Hilker, Rüdiger; Klebe, Stephan; Kloß, Manja; Koy, Jan; Krause, Martin; Kupsch, Andreas; Lorenz, Delia; Lorenzl, Stefan; Mehdorn, H. Maximilian; Moringlane, Jean Richard; Oertel, Wolfgang; Pinsker, Marcus O.; Reichmann, Heinz; Reuß, Alexander; Schneider, Gerd Helge; Schnitzler, Alfons; Steude, Ulrich; Sturm, Volker; Timmermann, Lars; Tronnier, Volker; Trottenberg, Thomas; Wojtecki, Lars; Wolf, Elisabeth; Poewe, Werner; Voges, Jürgen (2006). "A Randomized Trial of Deep-Brain Stimulation for Parkinson's Disease". New England Journal of Medicine. 355 (9): 896–908. doi:10.1056/NEJMoa060281. ISSN 0028-4793.