Resting (Static) Tremors
These tremors are most prominent at rest, and may decrease or disappear with voluntary movement. Illustrated is the common, relatively slow, fine, pill-rolling tremor of parkinsonism, about 5 per second.
These tremors appear when the affected part is actively maintaining a posture. Examples include the fine, rapid tremor of hyperthyroidism, the tremors of anxiety and fatigue, and benign essential (and sometimes familial) tremor. Tremor may worsen somewhat with intention.
Intention tremors, absent at rest, appear with activity and often get worse as the target is neared. Causes include disorders of cerebellar pathways, as in multiple sclerosis.
Oral-facial dyskinesias are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. The limbs and trunk are involved less often. These movements may be a late complication of psychotropic drugs such as phenothiazines, and have then been termed tardive (late) dyskinesias. They also occur in long-standing psychoses, in some elderly individuals, and in some edentulous persons.
Tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Causes include Tourette's syndrome and drugs such as phenothiazines and amphetamines.
Athetoid movements are slower and more twisting and writhing than choreiform movements, and have a larger amplitude. They most commonly involve the face and the distal extremities. Athetosis is often associated with spasticity. Causes include cerebral palsy.
Choreiform movements are brief, rapid, jerky, irregular, and unpredictable. They occur at rest or interrupt normal coordinated movements. Unlike tics, they seldom repeat themselves. The face, head, lower arms, and hands are often involved. Causes include Sydenham's chorea (with rheumatic fever) and Huntington's disease.
Dystonic movements are somewhat similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result. Causes include drugs such as phenothiazines, primary torsion dystonia and, as illustrated, spasmodic torticollis.
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