Juvenile-HD

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Understanding Behaviour in HD-Dr. Jane Paulsen
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Unified HD Rating Scale (UHDRS) Motor Section
Westphal Variant
SECTION 1 - AT RISK
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Best Interest of Child?
Crystal Ball?
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Q&A On Risk of Inheriting JHD
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SECTION 2 - GENETIC TESTING
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SECTION 3 - JHD
Coping With The Early Years
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Family-HD Underestimated
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HD - What Kids Are Saying
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SECTION 4 - SYMPTOM RECOGNITION
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8 Fears of A Chronic Illness
Anxiety/Apathy/Irritability~HD
Anxiety, Fears & Phobias
Apathy-Physician's Guide
Ataxia
Attention-Perceptual/Unawareness Physician's Guide
Bed/Pressure Sores
Bed/Pressure Ulcer Guideline
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Bradykinesia
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Chorea
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Dehydration
Delirium
Denial of HD
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Depression-How To Help
Depression - Treatment Resistant Patient
Depression-Other Resources
-Read If Your Child Is On Antidepressant
Disgust - Impaired Recognition in HD
Dissociative disorders
Driving - Physician's Guide
Dyslexia
Dyslexia Resources
Dystonia
Dystonia/Rigidity & Spasticity Physician's Guide
Dystonia-Predominant Adult-Onset HD
Epileptic Seizures and Epilepsy
Epilepsy-Seizures~PG
-Seizures ~Special Populations
Falling~Safety
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Fevers, sweating & menstural cycles in HD
GERD (Stomach)
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Hand muscle reflexes in HD
Hypothalamus - A Personal Theory
Insomia ~Physician's Guide
Irritability~Temper Outburst Physician's Guide
Learning Disability
Mania/OCD~Physician's Guide
Mood Disorder Rate In HD
Myoclonus (Movements)
Nails-What To Look For
Night Terrors
Obsessive Compulsive OCD
Panic Disorder
Personality disorders
Pneumonia
Pneumonia-Advanced Stages
Pneumonia - Aspirated (Inhaled)
Prosody - Social Impairment
Sexuality~Physician's Guide
Skins Sensitivity
Sleep Disorders
Smoking-Physician's Guide
Spasticity
Stress
Tremors
Why Certain Symptoms Occur
Symptom & Treatment Resources
SECTION 5 - COMMUNICATION
Communication Resources
Communication Problems
Communication Strategies For HD~Jeff Searle
SECTION 6 - EATING/SWALLOWING/NUITRITION
Hints For Weight Loss in HD
HD & Diet~HSA Fact Sheet 7
Nutrients: Some Possible Deficiency Symptoms
Nutrition and HD~Anna Gaba (Recipes)
Nutrition Information In HD~Naomi Lundeen
Speech & Swallowing~Lynn Rhodes
Swallowing & Nutrition Physician's Guide To HD
Swallowing & Nuitrition Resources
Swallowing Warning Signs
5 Swallowing Problems
Taste changes in HD
Weight Gain
Resources-Drinks/Shakes
-Feeding Tubes~Advanced Stages of HD
-Feeding Tube~Jean Miller
-Feeding Tubes: One More Word ~Jean Miller
-Feeding Tubes & Baby Foods
-Feeding Tube~Dental Care
-Feeding Tube Instructions~Jean Miller
-Feeding Tube Resources
SECTION 7 - THERAPIES
Finding a Therapist - Behavoir
What Is A Physiotherapist?
Physical Therapy In HD
Speech-Language Therapy
Therapy Descriptions
Therapy Resources- Easter Seal
Therapy Resources
SECTION 8 - MEDICATIONS
HD Treatments
Medications-Movement Disorders
Medication/Emergency Info Forms
Cutting Prescriptions
Drugs-Look 'Em Up
-Adolescents Under 25
-Antidepressant Adverse Effects
-Anti-psychotic
-Anxiety-Antidepressant
A-Z Mental Health Drugs
-Creatine
-EPA~Fish Oil
-Haldol/Haloperidol - Clinical Sheet
-Haldol~Clinician Description
-Haldol & HD
-Haldol/HD Patient Experiences
-Haldol~ Patient Handout
-Mood Stabilizers: ASK 3 Questions
-Neuroleptic Malignant Synd WARNING
-Olanzipine-Risperidone/blood tests
-Celexa/Luvox/Paxil/Prozac/Zoloft
-Psychiatric Drugs & Children
Sertraline ~Zoloft
-Spasticity Meds/Treatments
-SSRI Medications
-Tardive Dyskinesia WARNING
-Weight Gain Medications
-Sites/Help the Medicine Go Down
-Vitamin & Mineral Deficiencies
SECTION 9 - SURGERIES
Surgery-Movement Disorders
o Surgery Resources
SECTION 10 - PROCEDURES
Clinic Visits-How To Prepare
CT Scans, MRI's etc.
Swallowing Tests
Tests Commonly Used
o Procedures Resources
SECTION 11- ALCOHOL/DRUGS
Alcohol-Parent's Guide
Alcohol-Talking To Your Child
Drugs-What To Do?
Drugs-Talking To Your Child
Disciplining-Ages 0-13 & Up
SECTION 12- SUICIDE
Straight Talk On Suicide
Teen Suicide-You Need To Know
o Suicide Resources
SECTION 13 - DIVORCE
Divorce & Child Stress
Tips For Divorcing Parents
SECTION 14 - DISABILITY ISSUES
Guides To Disability Issues
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Caring for a Seriously Ill Child
Child Long Term Illness
Disability-Special Education Plan
IFSP Early Intervention Process
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Wishes Can Come True-Children's Wish Foundations
Special Needs Resources
Special Needs Camp - About
Special Needs Camp - Finding One
SECTION 15 - ASSISTIVE TECHNOLOGY
Child Assistive Technology
Adaptive Equipment Resources
Products
SECTION 16 - EMOTIONAL ISSUES
Signs of Unhealthy Self-Esteem
Emotional Behavior Links
o Emotional Support Resources
SECTION 17 - GRIEF
Helping Child Deal With Death
o Grief Addtional Resources
SECTION 18 - ADD/ADHD
ADD & Teens
Conduct Disorders
FAQS & Related Info
Understanding AD/HD
What Is AD/HD?
Research Articles
Resources
SECTION 19 - HD SUPPORT GROUPS
HD Support Groups
National Youth Association
SECTION 20 - HD LINKS
HD Links
Related Resources
Tips For Friends
SECTION 21 - BENEFITS/INSURNACE
HD Disability
Benefits Check UP - See What You Can Get
Medical Insurance Bureau's Facts On You!
Medicare-Medicaid
Medicare Rights-Home Health & Hospice
Medicare Rights Center Resources
No Insurance? Try This!
Prescription Drug Cards Part I
Prescription Drug Cards Part II
Social Security-Children With Disabilities
SECTION 22 - ARTICLES/JHD
JHD and ADD
SECTION 23 - CAREGIVING
Articles-Resources
Caregiver Self-Assessment
Caregiver's Handbook
"First Shift With A Person With HD"
Getting Respite Care/Help At Home
Helpful Forms-Info
Home Emergency Preparations
Symptom Management
Ten Tips
Useful Tools
SECTION 24 - BIO
Our Personal Experience
Coping At The End
Kelly E. Miller
Song & Verse
Letter From My Heart
GUESTBOOK
Tremors

INDEX Page

Tremor 
 
Tremors are not normally associated with JHD
 
Definitions

Tremor is a rhythmic, involuntary back-and-forth oscillation of part of the body. Tremor in children may be caused by familial essential tremor, focal epilepsy, or a psychogenic movement disorder. Tremor is often seen with ataxia, dystonia, or myoclonus. Physiologic tremor is the normal shaking that occurs when people attempt to exert large forces or lift heavy objects. If a child has weakness, this type of tremor may be accentuated. Ataxia may lead to tremor when the inaccurate movements are corrected and then repeatedly over corrected.

Tremor may occur...

  • While at rest
  • While maintaining a fixed arm position or posture (postural tremor)
  • With movement or kinetic, action, or intention tremor

Tremor may occur in the hands, feet, back, neck, face, voice, or other parts of the body. The frequency of the tremor may be described by the number of cycles per second, or Hertz (Hz). Tremor may appear suddenly, or worsen gradually over months or years. Many types of tremor disappear during sleep, only to return the next day upon awakening. Tremor is often associated with other neurological disorders; therefore, it is important to look for the cause of tremor.

In familial essential tremor, the onset may occur at any age. Once started, this type of tremor often continues or become slowly worse with time. Some family members may notice that the tremor improves briefly after drinking alcohol. This type of tremor is usually postural, and may be particularly evident while the child attempts to eat or drink from an open cup.

Examination

The child is examined to determine which body parts are affected, as well as the frequency and amplitude of the tremor. The tremor is examined while the child is at rest, while holding a posture against gravity (e.g., as with the arms outstretched), and while reaching for targets. Tremor may be accentuated by attempting to drink from a nearly full cup of water. It may be difficult to distinguish myoclonic or dystonic tremor from "true" tremor. Frequently, the distinction depends upon whether or not other symptoms are present, such as dystonic posturing or stimulus sensitivity. The child's strength must be assessed, as enhanced physiologic tremor may become more apparent if there is muscle weakness. Family history of tremor is important, as several types of tremor, myoclonus, or dystonia may be inherited. It is also important to look for medications or toxins that are known to cause tremor.

Etiology

Benign:
Enhanced physiologic tremor, shaking/shuddering spells (although these may be a precursor to essential tremor), spasmus nutans.

Static (fixed) injury:
Stroke (particularly in the midbrain or cerebellum), multiple sclerosis

Degenerative:
juvenile parkinsonism, Wilson's disease, Huntington's disease, Tay-Sachs disease

Chemical/metabolic:
hyperthyroidism, hyper-adrenaline state (including anxiety or pheochromocytoma), hypomagnesemia, hypocalcemia, hypoglycemia, hepatic encephalopathy

Drug-induced:
valproate, lithium, thyroid hormone, tricyclic antidepressants, stimulants (cocaine, amphetamine, caffeine, thyroxine, bronchodilators), neuroleptics, cyclosporin, toluene, mercury, thallium, amiodarone, nicotine, lead, manganese, arsenic, cyanide, naphthalene, ethanol, lindane

Other causes of tremor:
peripheral neuropathy, cerebellar disease or malformation, psychogenic tremor, familial essential tremor

Workup

The workup of tremor depends upon the specific type of tremor and its possible cause. Any medications that may worsen tremor should be avoided, if possible. If the tremor had sudden onset, an MRI of the head may be able to show a stroke, multiple sclerosis, or other lesion.

Electroencephalogram (EEG), which measures electrical activity in the brain, is important if there is a suspicion that the tremor is due to focal seizures. If there has been gradual onset, it is important to check electrolytes, including glucose, calcium and magnesium, thyroid function, copper in the urine (for Wilson's disease), and possibly the amount of adrenaline metabolites (for pheochromocytoma). If parkinsonian features are present, a trial of L-DOPA may be helpful. Rarely, an EMG may help to determine if the tremor is more likely to be due to dystonia or myoclonus. Tests for myoclonus, including EEG with back-averaging and SEP, may help to confirm the presence of dystonia or myoclonus. If there is a family history of tremor, it may be helpful to try the use of alcohol. This is often tried with an adult family member, rather than the child. If the tremor improves with alcohol, this suggests that it will also improve with other medications, including the dopamine agonist primidone.

Often, mild tremor does not require treatment. If there is a specific illness such as Parkinson's or Wilson's disease, tremor will improve with appropriate therapy for the underlying condition. Otherwise, symptoms may often be treated with propranolol, primidone, or benzodiazepines (i.e., clonazepam, diazepam, lorazepam). In all cases, the child should start with a very small dose. The dose should be increased gradually in order to avoid side effects. If the tremor is felt to by psychogenic, then psychotherapy may be helpful in determining and avoiding any psychiatric triggers for the movement.

Source:  We Move.  Visit their website at www.wemove.org/kidsmove/
Kids Move is WE MOVE's  Web site devoted to pediatric movement disorders. Healthcare professionals and parents  may access up-to-date information about the recognition, assessment, treatment, and avenues of support that are  available for individuals concerned with childhood movement disorders