370.2 🩺 國考版

370.2.1 高頻考點

370.2.1.1 Tremor Types

  • Rest: PD
  • Postural: ET, physiological
  • Kinetic/intention: cerebellar
  • Task-specific: writing
  • Holmes (rubral): combination

370.2.1.2 Essential Tremor

  • Bilateral postural/kinetic
  • Improves with alcohol
  • AD inheritance often
  • Treatment: propranolol, primidone, topiramate, DBS, FUS thalamotomy

370.2.1.3 Parkinson Tremor

  • Asymmetric rest tremor (pill-rolling)
  • 4-6 Hz
  • See Ch379

370.2.1.4 Cerebellar Tremor

  • Intention (worsens near target)
  • Other cerebellar signs

370.2.1.5 Dystonia

  • Sustained, twisting, posturing
  • Focal: blepharospasm, cervical, writer’s cramp
  • Generalized: DYT1
  • DRD: childhood, diurnal, levodopa response
  • Treatment: BTX (focal), trihexyphenidyl, levodopa trial, DBS

370.2.1.6 Huntington Disease

  • AD, CAG ≥ 40 in HTT
  • Anticipation (longer in offspring)
  • Onset 30-50s
  • Chorea + cognitive + psychiatric
  • Caudate atrophy (“box-car”)
  • VMAT-2 for chorea (tetrabenazine, deutetrabenazine, valbenazine)

370.2.1.7 Sydenham Chorea

  • Post-strep
  • Major Jones criterion for rheumatic fever

370.2.1.8 Tourette Syndrome

  • Childhood onset
  • Motor + vocal tics > 1 year
  • Comorbid OCD, ADHD
  • CBIT, α2 agonists, antipsychotics

370.2.1.9 Tardive Dyskinesia

  • After chronic antipsychotic
  • Oro-facial-lingual
  • VMAT-2 inhibitors: valbenazine, deutetrabenazine

370.2.1.10 Myoclonus Causes

  • Post-anoxic (Lance-Adams)
  • Epilepsy (JME)
  • CJD
  • SSPE
  • Asterixis (negative myoclonus): hepatic encephalopathy

370.2.1.11 RLS

  • Iron if ferritin < 75
  • α2ÎŽ ligands first-line now (gabapentin, pregabalin)
  • Dopamine agonists alternative (augmentation concern)

370.2.2 Specific Drugs

370.2.2.1 VMAT-2 Inhibitors (Vesicular Monoamine Transporter)

  • Tetrabenazine (Xenazine) — HD chorea
  • Deutetrabenazine (Austedo) — HD chorea, TD; FDA 2017
  • Valbenazine (Ingrezza) — TD; FDA 2017
  • Side effects: depression (BBW), parkinsonism, akathisia, QT

370.2.2.2 Botulinum Toxin Indications

  • Cervical dystonia
  • Blepharospasm
  • Hemifacial spasm
  • Writer’s cramp (selected)
  • Spasmodic dysphonia
  • Spasticity (post-stroke, MS)
  • Migraine (BTX-A, PREEMPT for chronic migraine)

370.2.2.3 Dopa-Responsive Dystonia (DRD)

  • Childhood onset
  • Diurnal worsening (worse evening)
  • Dramatic response to low-dose levodopa
  • Trial in all early-onset dystonia
  • GCH1, TH, SPR mutations