TREMOR, CHOREA AND TICS

LAYOUT

• Tremor
• Chorea
• Tics
• Reflection
• Questions

TREMOR

INVOLVING OSCILLATIONS OF 1 OR MORE PARTS OF THE BODY.

3 CLASSIFICATIONS

RESTING

• Patient is relaxed and limb is not moving
• Causes include:
• Parkinson's or Parkinsonism
• Multiple sclerosis
• Other extrapyramidal diseases

POSTURAL

• When body is held in fixed position against gravity
• Encompasses wide range of tremors!
• [Exaggerated] physiological tremor, essential tremor
• Anxiety states, drug or alcohol abuse
• Neurological disease

INTENTION

• A form of kinetic tremor
• During voluntary active movement
• Usually the upper limb but can affect lower limbs
• Tremor worsens as person moves closer to target
• Associated with cerebellar disease

MANAGEMENT

Depends on patient,
how debilitating the tremor is,
cause of tremor

BETA-BLOCKERS

Commonly used
Especially effective in anxiety and thyrotoxicosis

PRIMIDONE

Most commonly used
Side effects and contraindications are especially problematic in elderly

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CHOREA

SECONDARY OR ACQUIRED

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• Syndenham's chorea - rheumatic fever
• Autoimmune e.g. Lupus
• Antidopaminergic medications - for schizophrenia, bipolar, n&v

HUNTINGTON'S DISEASE

TETRABENAZINE

SIDE EFFECTS

INTERACTIONS

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TICS

Vocal
Motor
Both!
Childhood onset
Association - ADHD, OCD

RULE OUT SECONDARY CAUSES

• HD
• Encephalitis, CVA, hyperthyroid, autoimmune
• Schizophrenia
• Drugs

NON-PHARMACOLOGICAL

MODERATE TO SEVERE TICS

• Managed pharmacologically
• Patient referred to specialist - neuro/mental health

HALOPERIDOL

Antipsychotic
Only licensed medication for tics
Extra-pyramidal features common

PIMOZIDE

Comorbidities may dictate treatment choice.

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REFLECTION

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