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Athetosis

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81. Tardive Dyskinesia (Overview)

movements Voluntary Involuntary Pathologic movements Paralysis, paresis, hyperreflexia, and spasticity Akathisia, athetosis, ballismus, chorea, dystonia, myoclonus, stereotypy, tic, and tremor Classic disorders of the extrapyramidal system include a variety of involuntary movement disorders. Some of these movement disorders include dyskinesias such as akathisia, chorea, dystonia, myoclonus, stereotypy, tic, and tremor. The pathophysiology of extrapyramidal disorders has been disputed on the grounds

2014 eMedicine.com

82. Surgical Treatment of Tremor (Overview)

is speech impairment with dysarthria and hypophonia. The risk of speech abnormalities is 30% after unilateral thalamotomy and greater than 60% after bilateral thalamotomy. Other complications include memory loss, contralateral hemiparesis, and, more rarely, hemineglect, dystonia, hemiballismus, athetosis, and dyspraxia. Preoperative memory and language evaluation can help identify patients who are at greatest risk for postoperative cognitive and language dysfunction. In the largest series, the mortality

2014 eMedicine.com

83. Chorea in Adults (Treatment)

(7):853-7. . Gusella JF, MacDonald ME. Huntingtons disease: seeing the pathogenic process through a genetic lens. Trends Biochem Sci . July 2006. 31(pt 9):533-40. Nutting PA, Cole BR, Schimke RN. Benign, recessively inherited choreo-athetosis of early onset. J Med Genet . 1969 Dec. 6(4):408-10. . Fisher M, Sargent J, Drachman D. Familial inverted choreoathetosis. Neurology . 1979 Dec. 29(12):1627-31. . Wheeler PG, Dobyns WB, Plager DA, Ellis FD. Familial remitting chorea, nystagmus, and cataracts

2014 eMedicine.com

84. Chorea in Children (Treatment)

" Neoplastic See the list below: Primary and metastatic brain tumors Primary CNS lymphoma Nutritional See the list below: Vitamin B-12 deficiency in infants Toxins See the list below: Carbon monoxide Manganese Organophosphate poisoning Previous Next: Pathophysiology and General Principles in Treatment of Chorea Movement disorders (particularly chorea, athetosis, and dystonia) are thought to result from basal ganglia pathology. Connections of the basal ganglia can be categorized as follows: Input from (...) motor development, dysarthria, intention tremor, athetosis, and hypotonia. Severity is highly variable but choreic movements are typically continuous and not episodic. Intellectual function is typically normal. Intellectual impairment has been reported in one family in which affected individuals had intelligence quotient scores averaging 10 points lower than unaffected relatives. Functional neuroimaging showed decreased striatal FDG metabolism in one study. Routine imaging and EEG results are normal

2014 eMedicine.com

85. Cerebral Palsy (Treatment)

(AFO) in foot drop to prevent tripping over the toes in a patient with inadequate dorsiflexion. [ , ] If a patient has impaired mobility, a wheelchair and/or mobility aids such as a cane or walker may help. Seating adaptations should be included with a manual wheelchair to keep the back straight and protect the hips from excessive adduction or abduction. A power wheelchair may be needed for children with severe spasticity or athetosis; this device can be introduced to children who have the ability (...) augmentative communication devices if they have some motor control and adequate cognitive skills. Patients with athetoid cerebral palsy may benefit the most from speech therapy, because most of these individuals have normal intelligence, and communication is an obstacle that is secondary to the effect of athetosis on speech. Adequate communication is probably the most important goal for enhancing function in a patient with athetoid cerebral palsy. Many children with cerebral palsy have feeding difficulties

2014 eMedicine.com

86. Cerebral Palsy (Treatment)

: Management of Abnormal Movements Numerous medications, although often used off label for age and indication, may relieve the movement difficulties associated with cerebral palsy. These drugs target spasticity, dystonia, myoclonus, chorea, and athetosis. For example, baclofen, administered either orally or intrathecally, is often used for treating spasticity in these patients. Botulinum toxin with or without casting AbobotulinumtoxinA (Dysport) is the first botulinum toxin to gain FDA approval (...) , and barbiturates) have been useful in the management of myoclonus. Chorea and athetosis are often difficult to manage, although benzodiazepines, neuroleptics, and antiparkinsonian drugs (eg, levodopa) have been tried. Benzodiazepines and baclofen are commonly used to manage spasticity. Management by spasticity type A multidisciplinary panel conducted a systematic evaluation of published evidence of efficacy and safety of pharmacologic treatments for childhood spasticity due to cerebral palsy. [ ] The panel

2014 eMedicine.com

87. Communication Disorders (Treatment)

, alcohol abuse, infection Hypokinetic Monopitch, reduced loudness, inappropriate silences Extrapyramidal Rigidity, reduced range and speed of movement Parkinson disease, drug induced Hyperkinetic Quick Sudden variations in loudness, harsh quality, hypernasal Extrapyramidal Quick, involuntary, random movements Chorea, myoclonus, Tourette syndrome Slow Unsteady rate and loudness Extrapyramidal Sustained, distorted, slow movements Athetosis, dyskinesia Tremors Rhythmic alterations in pitch and loudness (...) loudness, inappropriate silences Extrapyramidal Rigidity, reduced range and speed of movement Parkinson disease, drug induced Hyperkinetic Quick Sudden variations in loudness, harsh quality, hypernasal Extrapyramidal Quick, involuntary, random movements Chorea, myoclonus, Tourette syndrome Slow Unsteady rate and loudness Extrapyramidal Sustained, distorted, slow movements Athetosis, dyskinesia Tremors Rhythmic alterations in pitch and loudness Extrapyramidal Involuntary, purposeless movements Organic

2014 eMedicine.com

88. Multiple Sclerosis (Treatment)

(medial rectus); upper eyelid elevation; and pupillary constriction. [ ] In rare cases, these lesions may be highly selective and may cause weakness of a single muscle, which can lead to diagnostic confusion. The oculomotor nerve runs in close proximity to numerous midbrain structures; therefore, features of a third nerve palsy can be associated with other neurological deficits, including contralateral hemiparesis (Weber syndrome), contralateral tremors (or chorea, athetosis) (Benedict syndrome

2014 eMedicine.com

89. Neurological History and Physical Examination (Treatment)

with gravity eliminated 3 Movement against gravity 4 Movement against partial resistance 5 Full strength Involuntary movements Involuntary movements include fibrillations, fasciculations, asterixis, tics, myoclonus, dystonias, chorea, athetosis, hemiballismus, and seizures. Fibrillations are not visible to the naked eye except possibly those in the tongue. Fasciculations may be seen under the skin as quivering of the muscle. Although fasciculations are typically benign (particularly when they occur (...) dysphonia, and writer's cramp. In athetosis, the spasms have a slow writhing character and occur along the long axis of the limbs or the body itself; the patient may assume different and often peculiar postures. The term chorea means dance. Quasi-purposeful movements affect multiple joints with a distal preponderance. Hemiballismus is a violent flinging movement of half of the body. It is associated with lesions of the subthalamic nucleus (ie, body of Louis). Seizures may result in orofacial

2014 eMedicine.com

90. Neurological History and Physical Examination (Overview)

with gravity eliminated 3 Movement against gravity 4 Movement against partial resistance 5 Full strength Involuntary movements Involuntary movements include fibrillations, fasciculations, asterixis, tics, myoclonus, dystonias, chorea, athetosis, hemiballismus, and seizures. Fibrillations are not visible to the naked eye except possibly those in the tongue. Fasciculations may be seen under the skin as quivering of the muscle. Although fasciculations are typically benign (particularly when they occur (...) dysphonia, and writer's cramp. In athetosis, the spasms have a slow writhing character and occur along the long axis of the limbs or the body itself; the patient may assume different and often peculiar postures. The term chorea means dance. Quasi-purposeful movements affect multiple joints with a distal preponderance. Hemiballismus is a violent flinging movement of half of the body. It is associated with lesions of the subthalamic nucleus (ie, body of Louis). Seizures may result in orofacial

2014 eMedicine.com

91. Surgical Treatment of Tremor (Treatment)

is speech impairment with dysarthria and hypophonia. The risk of speech abnormalities is 30% after unilateral thalamotomy and greater than 60% after bilateral thalamotomy. Other complications include memory loss, contralateral hemiparesis, and, more rarely, hemineglect, dystonia, hemiballismus, athetosis, and dyspraxia. Preoperative memory and language evaluation can help identify patients who are at greatest risk for postoperative cognitive and language dysfunction. In the largest series, the mortality

2014 eMedicine.com

92. Surgical Treatment of Parkinson Disease (Treatment)

is speech impairment with dysarthria and hypophonia. The risk of speech abnormalities is 30% after unilateral thalamotomy and greater than 60% after bilateral thalamotomy. Other complications include memory loss, contralateral hemiparesis, and, more rarely, hemineglect, dystonia, hemiballismus, athetosis, and dyspraxia. Preoperative memory and language evaluation can help identify patients who are at greatest risk for postoperative cognitive and language dysfunction. In the largest series, the mortality

2014 eMedicine.com

93. Tardive Dyskinesia (Treatment)

movements Voluntary Involuntary Pathologic movements Paralysis, paresis, hyperreflexia, and spasticity Akathisia, athetosis, ballismus, chorea, dystonia, myoclonus, stereotypy, tic, and tremor Classic disorders of the extrapyramidal system include a variety of involuntary movement disorders. Some of these movement disorders include dyskinesias such as akathisia, chorea, dystonia, myoclonus, stereotypy, tic, and tremor. The pathophysiology of extrapyramidal disorders has been disputed on the grounds

2014 eMedicine.com

94. Multiple Sclerosis (Follow-up)

(medial rectus); upper eyelid elevation; and pupillary constriction. [ ] In rare cases, these lesions may be highly selective and may cause weakness of a single muscle, which can lead to diagnostic confusion. The oculomotor nerve runs in close proximity to numerous midbrain structures; therefore, features of a third nerve palsy can be associated with other neurological deficits, including contralateral hemiparesis (Weber syndrome), contralateral tremors (or chorea, athetosis) (Benedict syndrome

2014 eMedicine.com

95. Neurological History and Physical Examination (Follow-up)

with gravity eliminated 3 Movement against gravity 4 Movement against partial resistance 5 Full strength Involuntary movements Involuntary movements include fibrillations, fasciculations, asterixis, tics, myoclonus, dystonias, chorea, athetosis, hemiballismus, and seizures. Fibrillations are not visible to the naked eye except possibly those in the tongue. Fasciculations may be seen under the skin as quivering of the muscle. Although fasciculations are typically benign (particularly when they occur (...) dysphonia, and writer's cramp. In athetosis, the spasms have a slow writhing character and occur along the long axis of the limbs or the body itself; the patient may assume different and often peculiar postures. The term chorea means dance. Quasi-purposeful movements affect multiple joints with a distal preponderance. Hemiballismus is a violent flinging movement of half of the body. It is associated with lesions of the subthalamic nucleus (ie, body of Louis). Seizures may result in orofacial

2014 eMedicine.com

96. Chorea in Adults (Follow-up)

, recessively inherited choreo-athetosis of early onset. J Med Genet . 1969 Dec. 6(4):408-10. . Fisher M, Sargent J, Drachman D. Familial inverted choreoathetosis. Neurology . 1979 Dec. 29(12):1627-31. . Wheeler PG, Dobyns WB, Plager DA, Ellis FD. Familial remitting chorea, nystagmus, and cataracts. Am J Med Genet . 1993 Dec 1. 47(8):1215-7. . Evans BK, Jankovic J. Tuberous sclerosis and chorea. Ann Neurol . 1983 Jan. 13(1):106-7. . Ross CA, Margolis RL, Rosenblatt A, et al. Huntington disease

2014 eMedicine.com

97. Chorea in Children (Follow-up)

" Neoplastic See the list below: Primary and metastatic brain tumors Primary CNS lymphoma Nutritional See the list below: Vitamin B-12 deficiency in infants Toxins See the list below: Carbon monoxide Manganese Organophosphate poisoning Previous Next: Pathophysiology and General Principles in Treatment of Chorea Movement disorders (particularly chorea, athetosis, and dystonia) are thought to result from basal ganglia pathology. Connections of the basal ganglia can be categorized as follows: Input from (...) motor development, dysarthria, intention tremor, athetosis, and hypotonia. Severity is highly variable but choreic movements are typically continuous and not episodic. Intellectual function is typically normal. Intellectual impairment has been reported in one family in which affected individuals had intelligence quotient scores averaging 10 points lower than unaffected relatives. Functional neuroimaging showed decreased striatal FDG metabolism in one study. Routine imaging and EEG results are normal

2014 eMedicine.com

98. Cerebral Palsy (Follow-up)

(AFO) in foot drop to prevent tripping over the toes in a patient with inadequate dorsiflexion. [ , ] If a patient has impaired mobility, a wheelchair and/or mobility aids such as a cane or walker may help. Seating adaptations should be included with a manual wheelchair to keep the back straight and protect the hips from excessive adduction or abduction. A power wheelchair may be needed for children with severe spasticity or athetosis; this device can be introduced to children who have the ability (...) augmentative communication devices if they have some motor control and adequate cognitive skills. Patients with athetoid cerebral palsy may benefit the most from speech therapy, because most of these individuals have normal intelligence, and communication is an obstacle that is secondary to the effect of athetosis on speech. Adequate communication is probably the most important goal for enhancing function in a patient with athetoid cerebral palsy. Many children with cerebral palsy have feeding difficulties

2014 eMedicine.com

99. Cerebral Palsy (Follow-up)

: Management of Abnormal Movements Numerous medications, although often used off label for age and indication, may relieve the movement difficulties associated with cerebral palsy. These drugs target spasticity, dystonia, myoclonus, chorea, and athetosis. For example, baclofen, administered either orally or intrathecally, is often used for treating spasticity in these patients. Botulinum toxin with or without casting AbobotulinumtoxinA (Dysport) is the first botulinum toxin to gain FDA approval (...) , and barbiturates) have been useful in the management of myoclonus. Chorea and athetosis are often difficult to manage, although benzodiazepines, neuroleptics, and antiparkinsonian drugs (eg, levodopa) have been tried. Benzodiazepines and baclofen are commonly used to manage spasticity. Management by spasticity type A multidisciplinary panel conducted a systematic evaluation of published evidence of efficacy and safety of pharmacologic treatments for childhood spasticity due to cerebral palsy. [ ] The panel

2014 eMedicine.com

100. Surgical Treatment of Tremor (Diagnosis)

is speech impairment with dysarthria and hypophonia. The risk of speech abnormalities is 30% after unilateral thalamotomy and greater than 60% after bilateral thalamotomy. Other complications include memory loss, contralateral hemiparesis, and, more rarely, hemineglect, dystonia, hemiballismus, athetosis, and dyspraxia. Preoperative memory and language evaluation can help identify patients who are at greatest risk for postoperative cognitive and language dysfunction. In the largest series, the mortality

2014 eMedicine.com

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