Table of contents
- 1. Restless Leg Syndrome
- 2. Tics
- 3. Chorea
.
Restless Leg Syndrome
- Definition:
- deep, ill-defined discomfort or dysesthesia usually involving the legs that occurs when a person is trying to fall asleep (i.e. crawling sensation).
- Coupled with urge to move, and movement reduces or eliminates the sensation.
- Typically occurs during middle age (rarely start in 20s).
- Often familial, restless legs syndrome may worsen over time.
- Treatment:
- Dopamine agonists or opiates can alleviate symptoms.
- Dopamine agonists
- Pramipexole
- Ropinirole
Periodic Limb Movements
- Recurrent, patterned leg jerks and tonic spasms that sometimes resemble a flexion reflex, usually occur every 20 seconds during early-stage sleep, and generally resolve deeper in the sleep cycle.
- May disturb the sleeping partner and also awaken the patient
- Leads to inadequate or fragmented sleep + daytime drowsiness.
- Diagnosis:
- Confirmed by polysomnography.
- Workup
- Check ferritin (can be ass'd w/ iron deficiency)
- Treatment
- Just like restless leg syndrome, can result from dopaminergic deficiency
- Treated with dopamine agonists, such as pramipexole or ropinirole.
Tics
Source: MKSAP 17
- Tourette Syndrome
- Ticks:
- Repetitive
- Stereotyped
- Suppressible
- Typically preceded by an abnormal sensation (premonitory urge)
- Typically patients can suppress the movements, but eventually sensation builds up to the point that they have to move.
- Types:
- Vocal (clearing throat)
- Compex Motor (shoudler elevation + neck rolling)
- Typically have co-morbid OCD disorder.
- Can wax/wane, old tics can be replaced by new ones over time, but typically some movements present on exam.
Chorea
- Random, diffuse, and nonsuppressible involuntary abnormal movements.
- Corea is
- NOT focal
- NOT suppressible
- NOT stereotyped
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