Thread by @MedinaRiojaMD

In November 29, the World Movement Disorders day is celebrated.

#MoveDisorder #Neuro #Teaching #EndNeurophobia

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That is a great reason for a small tweetorial on how to approach phenomenology, the key element of this branch in Neurology. 🧠

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But first, what is phenomenology?
That is a term that refers to the description of the movement. Instead of trying inmmediately to put a label on what you see, first I suggest start by watching and describing. 🤔

#Noticing

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A careful description is crucial in the approach of these conditions and will eventually lead to a proper classification of the patient's signs and symptoms.

#Maupassant had it clear!

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Next I will present you 10 things not to forget when doing a proper semiology in cases that seem complicated.
I find them very useful. 🧐

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1⃣ Which part is involved?
🦵💪😶

2⃣ What is the extend of the movement or it's distribution?

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3⃣ The pattern
- Rhytmic?
- Regular?
- Uniform?
- Recurrent?

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4⃣ Course?
- Speed
- Frequency

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5⃣ Amplitude?
-Force of the movement.

6⃣ Relantionship with:
- Posture
- Rest
- Voluntary activity/exertion
- Involuntary activity
- Time of the day

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7⃣ The response to heat and cold

8⃣ The relationship to emotional tension and excitement:
- Worse?
- Better?

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9⃣ Are the movements suppressible by attention or the use of sensory tricks?

🔟Are they present during sleep?
- RBD and other parasomnias

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One example:
Man with bilateral 💪 movement, it goes from 👐and extends to the elbows, it is rhytmic, regular and uniform. Medium speed (6-8 Hz?) and amplitude. It is absent during rest and present when hands are held outstretched.

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It is worse when patient is nervous and it may be reduced with alcohol ingestion. Absent during sleep.

Espirals below

Diagnosis: Essential tremor.

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One final lesson...
First observe, then describe and finally analyze, after all the clues have been gathered, classification and approach will come easier.

Thanks and hope you have enjoyed!

Sources:
1.- Pract Neurol. 2019 Oct;19(5):427-430.
doi: 10.1136/practneurol-2018-002176
2.- Pract Neurol. 2017 Dec;17(6):456-463.
doi: 10.1136/practneurol-2017-001719
3.- Dejong's The Neurologic Examination. Eighth Edition. 2020.