parkinson's tremor

[indytravl]

hi,

can anyone give info on neurophysiological pathway of Parkinson's hand tremor please?

pt was tested by neuropsych. the doc was concerned about a psychogenic contribution to his tremor since he was failing almost all of the symptom validity testing (he allows a few in demented pts). on motor tasks for cerbral laterality differences, the tremor on the resting hand disappears when he uses the one hand during these. PD is resting tremor that will imiprove with engagement but does this control "spillover" & improve the hand that is actually still resting & NOT engaged?

thanks

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[indytravl]

hello?
PLEASE help ....

 

[TopSecret]

The basal ganglia is a complicated structure. It's probably best to consult a textbook.

It would also help to have additional history. Age, gender, comorbidities, social history (boxing?), family history, etc.

For those under 40 I usually screen for Wilson's as early treatment could halt progression. So check for Kayser-Fleischer rings and do a 24 hour urine for copper and ceruloplasmin in addition to LFT's. In the elderly Lewy Body dementia should be considered. Serotonin syndrome and extrapyramidal side effects from medications such as from SSRI's, TCA's, neuroleptics, antiemetics and so forth should be excluded, too. Those are fairly common causes. You might also want to screen for hyperthyroidism by checking TSH. A brain MRI might also show a vascular cause if it was sudden in onset but insurance might balk at the expense.