TREMOR

TREMOR

1. Rhythmic movement, the shuttle, of involuntary body parts with relatively fixed frequency & Amplitududo held within a certain time.
2. Incurred due to synchronous or alternating stimulation of antagonistic muscles
3. The mechanism involves N. central oscillator and perifir, but not yet clearly known pathophysiology.
4. Conditions intrunsic neuron membrane thalamus and inferior olive tend to take charge spontaneous and recurrent (oscillasi)
5. Harmalin (beta-carboline) can cause tremor ok membangkatkan Oscillasi spontaneous and synchronous in N. Olive spread to surrounding areas.

ETIOLOGY OF TREMOR

  

DIAGNOSIS OF APPEALS

• Cortical myoclonus is changing so fast and rhythmic movements: EMG and EEG examination can help Dx. Cortical myoclonus.
• Clonus: the relevant muscles are passively stretched clonus increased.
• Epilepsy partialis continua: EEG can help Dx. Epilepsy.

ESSENTIAL TREMOR

1. Tremor is most commonly found in adults
2. Often bilateral limb and hand
3. Can asymmetry, and spread to the body or head
4. Etio: Unknown, suspected hereditary appearance at the age of 65 years.
5. Tx.: Clozapine, Propranolol, Primidone, Gabapentin, Topiramate.

PARKINSON TREMOR

• Tremor at rest on the hand, can be to the lips, tongue and jaw
• Tremor in the legs, typical only in Parkinson's
• Oscillator central in the GPI and STN, related to cholinergic nerve antikolinrgik ok beneficial drugs, cholinesterase inhibitors are being exacerbated.
• Tx.: L-dopa, DA agonists, anticholinergics and Clozapine.

CEREBELLAR TREMOR

1. There are two forms: Postural and Kinetic (Intention Tremor)
2. Postural, associated with head & body
3. Kinetic, associated with voluntary movement
4. Etio: Can ok Multiple sclerosis, Wilson's disease, brain injury, Degen.
5. Tx.: Clonazepam, carbamazepin.

DRUG AND TOXINS

• Toxins and drugs increase physiological tremor and tremor causes
• Tx. stop the influx of drugs and toxins
• A variety of drugs and toxins that cause tremor:

List of dariugs and toxic substances that may induce a tremor
Dariugs	Toxins
Sympathicomimetics •         Adarienaline •         Bronchodilators •         Theophylline •         Caffeine	Alcohol Cocaine Nicotine Lead
Dopamine antagonists •         Neuroleptics •         Reserpine •         Tetrabenazine •         Metoclopramide	Mercury CO Manganese Arsenic

Dariugs	Toxins
Antidepressants •         Tricyclic antidepressants •         Selective serotonin reuptake inhibitors •         Lithium	Cyanide Toluene DDT
Steroids •         Progesterone •         Anti-estrogens (Tamoxiphen) •         Adarienocorticoids	Dioxin
Other •         Valproic acid •         Flunarizine, cinnarizine •         Amiodarone •         Mexiletine, procainamide •         Calcitonin •         Thyroid hormone •         Cytostatics •         Cylosporin A