Jerks/ twitches resident survival guide

Jerks/ twitches Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts

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. The most common hyperkinetic disorder is essential tremor, while the most common hypokinetic disorder 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.

• Head trauma
• Toxins
• Metabolic
• Vascular

Common Causes

• Parkinson's disease
• Huntington chorea
• Lewy Body Dementia
• Tardive Dyskinesia

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Abnormal movements according thee American Academy of Neurology guidelines:

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 treatmentof 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 treatmentof 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 specifictreatment 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.
• 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.
• Inquire about ethnicity and family history of movement disorders as these aspects may guide into the diagnosis.
• 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.
• 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.
• 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.
• Perform genetic testing as the initial diagnostic step in possible genetic diseases that require confirmation, such as Huntington's disease.

Don'ts

• Do not order imaging or laboratory tests to diagnose clinical disorders, such as Parkinson's disease and essential tremor.
• 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.