overview of movement disorders: part 2 - hyperkinesias
TRANSCRIPT
OUTLINEOUTLINE• Part 1a - General Overview
– Definitions, Listing of categories, How to examine a pt, Comparative prevalence rates, Advances in genetics
• Part 1b – Hypokinetic disorders – Phenomenology – videotapes
• Part 2 – Hyperkinetic disorders– Tables to help identify the hyperkinesias– Phenomenology - videotapes
• Part 1a - General Overview – Definitions, Listing of categories, How to
examine a pt, Comparative prevalence rates, Advances in genetics
• Part 1b – Hypokinetic disorders – Phenomenology – videotapes
• Part 2 – Hyperkinetic disorders– Tables to help identify the hyperkinesias– Phenomenology - videotapes
LIST OF MOVEMENT DISORDERSLIST OF MOVEMENT DISORDERSII. HYPERKINESIAS
A. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
L. Jumpy stumps
M. Moving toes/fingers
N. Myoclonus
O. Myokymia
P. Myorhythmia
Q. Paroxysmal dyskinesias
R. Restless legs/PLMS
S. Stereotypies
T. Tics
U. Tremor
A Guide (set of tables) to Help Recognize and Identify the
Hyperkinetic Category
A Guide (set of tables) to Help Recognize and Identify the
Hyperkinetic Category
Level A: Immediate Impressions1. Rhythmic vs. Arrhythmic2. Sustained vs. Non-sustained3. Paroxysmal vs. Continual vs. Continuous4. Sleep vs. AwakeLevel B: More Prolonged Observations1. At Rest vs. with Action vs. Overflow2. Patterned vs. Non-patterned3. Combinations of varieties of movements
Level A: Immediate Impressions1. Rhythmic vs. Arrhythmic2. Sustained vs. Non-sustained3. Paroxysmal vs. Continual vs. Continuous4. Sleep vs. AwakeLevel B: More Prolonged Observations1. At Rest vs. with Action vs. Overflow2. Patterned vs. Non-patterned3. Combinations of varieties of movements
RECOGNIZING THE DYSKINESIASRECOGNIZING THE DYSKINESIAS
Level C: Requiring Longer Observation• Speed: slow vs. fast• Amplitude: ballistic vs. not ballistic• Force: powerful vs. easy to overcome• Suppressibility• Vocalizations• Self-mutilation• Complexity of movements• Sensory component• Ocular movements
Level C: Requiring Longer Observation• Speed: slow vs. fast• Amplitude: ballistic vs. not ballistic• Force: powerful vs. easy to overcome• Suppressibility• Vocalizations• Self-mutilation• Complexity of movements• Sensory component• Ocular movements
RECOGNIZING THE DYSKINESIASRECOGNIZING THE DYSKINESIAS
Level A: Immediate Impressions1. Rhythmic vs. Arrhythmic2. Sustained vs. Non-sustained3. Paroxysmal vs. Continual vs. Continuous4. Sleep vs. AwakeLevel B: More Prolonged Observations1. At Rest vs. with Action vs. Overflow2. Patterned vs. Non-patterned3. Combinations of varieties of movements
Level A: Immediate Impressions1. Rhythmic vs. Arrhythmic2. Sustained vs. Non-sustained3. Paroxysmal vs. Continual vs. Continuous4. Sleep vs. AwakeLevel B: More Prolonged Observations1. At Rest vs. with Action vs. Overflow2. Patterned vs. Non-patterned3. Combinations of varieties of movements
RECOGNIZING THE DYSKINESIASRECOGNIZING THE DYSKINESIAS
RHYTHMIC VS Irregular VSTremor Cortical myoclonus
resting Minipolymyoclonuspostural Dystonic tremorsaction Epilepsia partialis continuaintention Moving toes/fingers
Orthostatic TremorDystonic tremorDystonic myorhythmiaMyoclonus, segmentalMyoclonus, oscillatoryMyorhythmiaPeriodic limb movements in sleepSome stereotypiesClassic Tardive Dyskinesia (T. stereotypy)
RHYTHMIC VS Irregular VSTremor Cortical myoclonus
resting Minipolymyoclonuspostural Dystonic tremorsaction Epilepsia partialis continuaintention Moving toes/fingers
Orthostatic TremorDystonic tremorDystonic myorhythmiaMyoclonus, segmentalMyoclonus, oscillatoryMyorhythmiaPeriodic limb movements in sleepSome stereotypiesClassic Tardive Dyskinesia (T. stereotypy)
RHYTHMIC vs. ARRHYTHMIC MOVEMENTSRHYTHMIC vs. ARRHYTHMIC MOVEMENTSARRHYTHMICAkathitic movementsAthetosisBallismChoreaDystoniaHemifacial spasmHyperekplexiaArrhythmic myoclonusSome stereotypiesTics
ARRHYTHMICAkathitic movementsAthetosisBallismChoreaDystoniaHemifacial spasmHyperekplexiaArrhythmic myoclonusSome stereotypiesTics
Sustained VS Non-sustained• Stiff-person • Rigidity All others• Dystonia• Oculogyric crisis• Paroxysmal dystonia• Dystonic tics• Sandifer syndrome• Neuromyotonia• Congenital torticollis• Orthopedic torticollis
Sustained VS Non-sustained• Stiff-person • Rigidity All others• Dystonia• Oculogyric crisis• Paroxysmal dystonia• Dystonic tics• Sandifer syndrome• Neuromyotonia• Congenital torticollis• Orthopedic torticollis
LEVEL A - #2LEVEL A - #2
LEVEL A - #3LEVEL A - #3PAROXYSMAL VS.TicsPKDPNKDPEDEpisodic ataxiaEpisodic tremorHypnogenic dystoniaParoxysmal dystonia in Self-Stimulatory BehaviorSome stereotypiesAkathitic movementsSome jumpy stumps
CONTINUAL VS.BallismChoreaDystonic movementsMyoclonus, arrhythmicSome stereotypiesAkathitic moaning
CONTINUOUSAbdominal dyskinesiasAthetosisTremorsDystonic posturesMinipolymyoclonusMyoclonus, rhythmicTardive stereotypyMyokymiaTic statusSome jumpy stumps Moving toes/fingersMyorhythmia
infancy
LEVEL A - #4 LEVEL A - #4 APPEARS ONLY DURING SLEEP
PERSISTS DURING SLEEP
DIMINISHES DURING SLEEP
Hypnogenic dyskinesias
Secondary palatal myoclonusOcular myoclonusSpinal myoclonus
Primary palatal
myoclonus
Periodic limb movements in sleep
Oculofaciomastica-tory myorhythmia
Severe dystoniaSevere tics
Peripheral MovDisordMoving toes/fingers
All others
REM Sleep Behavior Disorder
MyokymiaNeuromyotonia
(Isaacs syndrome)
Level A: Immediate Impressions1. Rhythmic vs. Arrhythmic2. Sustained vs. Non-sustained3. Paroxysmal vs. Continual or Continuous4. Sleep vs. AwakeLevel B: More Prolonged Observations1. At Rest vs. with Action vs. Overflow2. Patterned vs. Non-patterned3. Combinations of varieties of movements
Level A: Immediate Impressions1. Rhythmic vs. Arrhythmic2. Sustained vs. Non-sustained3. Paroxysmal vs. Continual or Continuous4. Sleep vs. AwakeLevel B: More Prolonged Observations1. At Rest vs. with Action vs. Overflow2. Patterned vs. Non-patterned3. Combinations of varieties of movements
RECOGNIZING THE DYSKINESIASRECOGNIZING THE DYSKINESIAS
LEVEL B - #1LEVEL B - #1AT REST ONLY (disappears with action)Akathitic movements Restless legsParadoxical dystonia Orthostatic tremor (only onResting tremor standing) & other posture-
specific tremorsWITH ACTION ONLYAtaxia; Tremor: postural, action, intentionAction dystonia, myoclonus; Task-specific tremor, dystoniaAT REST AND CONTINUES WITH ACTIONAbdominal dyskinesias, Athetosis, Ballism, Chorea, Dystonia at rest, Jumpy stumps, Minipolymyoclonus, Moving toes/fingers, Myoclonus at rest, Myokymia, Pseudodystonias, Tics
AT REST ONLY (disappears with action)Akathitic movements Restless legsParadoxical dystonia Orthostatic tremor (only onResting tremor standing) & other posture-
specific tremorsWITH ACTION ONLYAtaxia; Tremor: postural, action, intentionAction dystonia, myoclonus; Task-specific tremor, dystoniaAT REST AND CONTINUES WITH ACTIONAbdominal dyskinesias, Athetosis, Ballism, Chorea, Dystonia at rest, Jumpy stumps, Minipolymyoclonus, Moving toes/fingers, Myoclonus at rest, Myokymia, Pseudodystonias, Tics
LEVEL B - #2LEVEL B - #2PATTERNED
(i.e., same muscle groups)Abdominal dyskinesiasDystoniaHemifacial spasmMoving toes/fingersSegmental myoclonusMyorhythmiaMyokymiaMost stereotypiesTardive dyskinesia movementsTremor
PATTERNED(i.e., same muscle groups)Abdominal dyskinesiasDystoniaHemifacial spasmMoving toes/fingersSegmental myoclonusMyorhythmiaMyokymiaMost stereotypiesTardive dyskinesia movementsTremor
NON-PATTERNEDAll othersNON-PATTERNEDAll others
LEVEL B - #3LEVEL B - #3COMBINATIONS OF VARIETIES OF
MOVEMENTS (etiologies)Psychogenic movements Tardive syndromesWilson disease Huntington diseaseNeuroacanthocytosis Hered spastic paraplegiasSome dystonias (e.g. parkinsonism, myoclonus)Neurodegenerations with Brain Iron Accumulation Multiple system atrophy (MSA); PSP; FXTASSome spinocerebellar ataxias, esp. SCA-3, FriedreichDentatorubral-pallidoluysian atrophy (DRPLA)Ataxia-telangiectasia (A-T); Lesch-Nyhan syndrome
COMBINATIONS OF VARIETIES OF MOVEMENTS (etiologies)
Psychogenic movements Tardive syndromesWilson disease Huntington diseaseNeuroacanthocytosis Hered spastic paraplegiasSome dystonias (e.g. parkinsonism, myoclonus)Neurodegenerations with Brain Iron Accumulation Multiple system atrophy (MSA); PSP; FXTASSome spinocerebellar ataxias, esp. SCA-3, FriedreichDentatorubral-pallidoluysian atrophy (DRPLA)Ataxia-telangiectasia (A-T); Lesch-Nyhan syndrome
Level C: Requiring Longer Observation• Speed: slow vs. fast• Amplitude: ballistic vs. not ballistic• Force: powerful vs. easy to overcome• Suppressibility• Vocalizations• Self-mutilation• Complexity of movements• Sensory component• Ocular movements
Level C: Requiring Longer Observation• Speed: slow vs. fast• Amplitude: ballistic vs. not ballistic• Force: powerful vs. easy to overcome• Suppressibility• Vocalizations• Self-mutilation• Complexity of movements• Sensory component• Ocular movements
RECOGNIZING THE DYSKINESIASRECOGNIZING THE DYSKINESIAS
LEVEL C - #1LEVEL C - #1SPEED: FAST VS. SLOWSPEED: FAST VS. SLOW
FASTEST INTERMEDIATE SLOWESTminipolymyoclonus chorea athetosis
myoclonus ballism moving toes/fingers
hyperekplexia jumpy stumps myorhythmia
startle tremors akathiticmovements
hemifacial spasm (HFS) tardive stereotypy hemifacial spasm
HFS can be either myoclonic (fastest) or tonic (slowest) Note: tics and dystonic movements can be of all speeds
LEVEL C - #2 AMPLITUDE:LEVEL C - #2 AMPLITUDE:
LARGE MEDIUM VERY SMALLballism chorea and minipolymyoclonus
all others
jumpy stumps would be ballistic, but a short stump keeps the amplitude relatively small
LARGE MEDIUM VERY SMALLballism chorea and minipolymyoclonus
all others
jumpy stumps would be ballistic, but a short stump keeps the amplitude relatively small
LEVEL C - #3 FORCE :LEVEL C - #3 FORCE :
POWERFUL MEDIUM MILDStiff-person dystonia all othersJumpy stumpsFixed postures of dystonia
POWERFUL MEDIUM MILDStiff-person dystonia all othersJumpy stumpsFixed postures of dystonia
LEVEL C - #4 SUPPRESSIBILITY:LEVEL C - #4 SUPPRESSIBILITY:stereotypies > tics, akathitic movements > chorea >
ballism > dystonia > tremor Not suppressible: hemifacial spasm, myoclonus,
minipolymyoclonus, hyperekplexia, myorhythmia, moving toes
LEVEL C - #5 VOCALIZATIONS:phonic tics: simple or complexakathitic moaningHuntington diseaseneuroacanthocytosiscranial dystonia
stereotypies > tics, akathitic movements > chorea > ballism > dystonia > tremor
Not suppressible: hemifacial spasm, myoclonus, minipolymyoclonus, hyperekplexia, myorhythmia, moving toes
LEVEL C - #5 VOCALIZATIONS:phonic tics: simple or complexakathitic moaningHuntington diseaseneuroacanthocytosiscranial dystonia
LEVEL C - #6 SELF MUTILATION:LEVEL C - #6 SELF MUTILATION:Lesch-Nyhan syndrome, neuroacanthocytosis, Tourette syndrome, psychogenic movement disorders[These are etiologies]LEVEL C - #7 COMPLEX MOVEMENTS:Tics, akathitic movements, compulsions, stereotypies, psychogenic movements(Note: each of the above can also consist of simple
movements)
LEVEL C - #8 SENSORY COMPONENT:Akathisia, moving digits/painful limbs, restless legs, tics
Lesch-Nyhan syndrome, neuroacanthocytosis, Tourette syndrome, psychogenic movement disorders[These are etiologies]LEVEL C - #7 COMPLEX MOVEMENTS:Tics, akathitic movements, compulsions, stereotypies, psychogenic movements(Note: each of the above can also consist of simple
movements)
LEVEL C - #8 SENSORY COMPONENT:Akathisia, moving digits/painful limbs, restless legs, tics
LEVEL C - #9 OCULAR MOVEMENTS LEVEL C - #9 OCULAR MOVEMENTS
Ocular ticsOculogyric crisesOpsoclonusOcular myoclonusOcular myorhythmiaOcular dysmetriaNystagmusSquare wave jerks
Ocular ticsOculogyric crisesOpsoclonusOcular myoclonusOcular myorhythmiaOcular dysmetriaNystagmusSquare wave jerks
OUTLINEOUTLINE• Part 1a - General Overview
– Definitions, Listing of categories, How to examine a pt, Comparative prevalence rates, Advances in genetics
• Part 1b – Hypokinetic disorders – Phenomenology – videotapes
• Part 2 – Hyperkinetic disorders– Tables to help identify the hyperkinesias– Phenomenology - videotapes
• Part 1a - General Overview – Definitions, Listing of categories, How to
examine a pt, Comparative prevalence rates, Advances in genetics
• Part 1b – Hypokinetic disorders – Phenomenology – videotapes
• Part 2 – Hyperkinetic disorders– Tables to help identify the hyperkinesias– Phenomenology - videotapes
LIST OF MOVEMENT DISORDERSLIST OF MOVEMENT DISORDERSII. HYPERKINESIAS
A. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
L. Jumpy stumps
M. Moving toes/fingers
N. Myoclonus
O. Myokymia
P. Myorhythmia
Q. Paroxysmal dyskinesias
R. Restless legs/PLMS
S. Stereotypies
T. Tics
U. Tremor
LIST OF MOVEMENT DISORDERSLIST OF MOVEMENT DISORDERSII. HYPERKINESIAS
A. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
L. Jumpy stumps
M. Moving toes/fingers
N. Myoclonus
O. Myokymia
P. Myorhythmia
Q. Paroxysmal dyskinesias
R. Restless legs
S. Stereotypies
T. Tics
U. Tremor
Faciobrachial Dystonic Seizures
Faciobrachial Dystonic Seizures
• Could be mistaken for segmental dystonia• Are due to an autoimmune encephalitis
caused by the Lgi1 antibody against the voltage gated potassium channel
• Excellent response to corticosteroids• Poor response to anticonvulsants
• Could be mistaken for segmental dystonia• Are due to an autoimmune encephalitis
caused by the Lgi1 antibody against the voltage gated potassium channel
• Excellent response to corticosteroids• Poor response to anticonvulsants
leucine-rich glioma inactivated 1 protein that is part of the Voltage-Gated Potassium Channel complex
Faciobrachial seizures of Lgi1 Antibody limbic encephalitis: video
Faciobrachial seizures of Lgi1 Antibody limbic encephalitis: video
LIST OF MOVEMENT DISORDERSLIST OF MOVEMENT DISORDERSII. HYPERKINESIAS
A. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
L. Jumpy stumps
M. Moving toes/fingers
N. Myoclonus
O. Myokymia
P. Myorhythmia
Q. Paroxysmal dyskinesias
R. Restless legs
S. Stereotypies
T. Tics
U. Tremor
LIST OF MOVEMENT DISORDERSLIST OF MOVEMENT DISORDERSII. HYPERKINESIAS
A. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
II. HYPERKINESIASA. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
L. Jumpy stumps
M. Moving toes/fingers
N. Myoclonus
O. Myokymia
P. Myorhythmia
Q. Paroxysmal dyskinesias
R. Restless legs
S. Stereotypies
T. Tics
U. Tremor
65 yo RHM, with celiac dz. Intermittent twitching of L toes began 8 years ago. 3yrs ago, they involved the whole L foot and then the L calf. Mvts became jerky and were worse when moving the leg or walking, but they also occur when sitting and even lying. The amplitude increased in the last year, interfering with gait and caused several falls. Exam revealed stiffness and jerky mvts of the L leg when he moves it and when it is stimulated. The movement pattern posed a phenomenological challenge. I wondered if this could be cortical myoclonus and decided to admit him for EEG monitoring and also observe him during sleep. EEG showed continual sharp spikes in the paracentral cortex over the leg area, present when the patient was awake and asleep. Discharges preceded involuntary movements at a fixed interval as demonstrated by bipolar surface EMG leads.
Epilepsia PartialisContinua
LIST OF MOVEMENT DISORDERSLIST OF MOVEMENT DISORDERSII. HYPERKINESIAS
A. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
II. HYPERKINESIASA. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
L. Jumpy stumps
M. Moving toes/fingers
N. Myoclonus
O. Myokymia
P. Myorhythmia
Q. Paroxysmal dyskinesias
R. Restless legs
S. Stereotypies
T. Tics
U. Tremor
LIST OF MOVEMENT DISORDERSLIST OF MOVEMENT DISORDERSII. HYPERKINESIAS
A. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
II. HYPERKINESIASA. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
L. Jumpy stumps
M. Moving toes/fingers
N. Myoclonus
O. Myokymia
P. Myorhythmia
Q. Paroxysmal dyskinesias
R. Restless legs
S. Stereotypies
T. Tics
U. Tremor
MYORHYTHMIAMYORHYTHMIA• An ambiguous term
• Myorhythmia was initially used to refer to the somewhat rhythmic movements that are sometimes seen in patients with torsion dystonia (coined by Ernst Herz in 1944).
• Its more common usage today refers to prolonged, slow frequency (<3 Hz), relatively rhythmic repetitive movements, as seen in Whipple disease, and semirhythmic myoclonus.
• An ambiguous term
• Myorhythmia was initially used to refer to the somewhat rhythmic movements that are sometimes seen in patients with torsion dystonia (coined by Ernst Herz in 1944).
• Its more common usage today refers to prolonged, slow frequency (<3 Hz), relatively rhythmic repetitive movements, as seen in Whipple disease, and semirhythmic myoclonus.
Whipple diseaseWhipple disease
The next two scenes of myorhythmia show two patients with Whipple disease.
The first has ocular myorhythmia that manifests as pendular vergence
oscillations. The second has synchronous facial-
masticatory-pharyngeal-nuchal-brachial myorhythmia as a feature of rhythmical
segmental myoclonus.
The next two scenes of myorhythmia show two patients with Whipple disease.
The first has ocular myorhythmia that manifests as pendular vergence
oscillations. The second has synchronous facial-
masticatory-pharyngeal-nuchal-brachial myorhythmia as a feature of rhythmical
segmental myoclonus.
Meige and Feindel [1907] distinguished between
stereotypies and motor tics
Meige and Feindel [1907] distinguished between
stereotypies and motor tics
• Stereotypies, while illogical, are without an irresistible urge.
• Tics are acts that are impelling but not impossible to resist.
Meige H, Feindel E. Tics and Their Treatment. Translated from the French by Wilson SAK. London, Appleton;1907:57-58.
• Stereotypies, while illogical, are without an irresistible urge.
• Tics are acts that are impelling but not impossible to resist.
Meige H, Feindel E. Tics and Their Treatment. Translated from the French by Wilson SAK. London, Appleton;1907:57-58.
Mov Disord. 2012 Feb;27(2):179-85.
A stereotypy is a non–goal-directed movement or vocalization pattern that is repeated continually for a period of time in the same form and on multiple occasions, and which is typically distractible.
Mov Disord. 2012 Feb;27(2):179-85.
A stereotypy is a non–goal-directed movement or vocalization pattern that is repeated continually for a period of time in the same form and on multiple occasions, and which is typically distractible.
Mov Disord. 2012 Feb;27(2):179-85.
A stereotypy is a non–goal-directed movement or vocalization pattern that is repeated continually for a period of time in the same form and on multiple occasions, and which is typically distractible. “and without an urge.”
from Edwards MJ, Lang AE, Bhatia KP. Stereotypies: a critical appraisal and suggestion of a clinically useful definition. Mov Disord. 2012 Feb;27(2):179-85.
LIST OF MOVEMENT DISORDERSLIST OF MOVEMENT DISORDERSII. HYPERKINESIAS
A. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
II. HYPERKINESIASA. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
L. Jumpy stumps
M. Moving toes/fingers
N. Myoclonus
O. Myokymia
P. Myorhythmia
Q. Paroxysmal dyskinesias
R. Restless legs
S. Stereotypies
T. Tics
U. Tremor
LIST OF MOVEMENT DISORDERSLIST OF MOVEMENT DISORDERSII. HYPERKINESIAS
A. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
II. HYPERKINESIASA. Abdominal dyskinesias
B. Akathitic movements
C. Asynergia/ataxia
D. Athetosis
E. Ballism
F. Chorea
G. Dysmetria
H. Dystonia
I. Hemifacial spasm
J. Hyperekplexia
K. Hypnogenic dyskinesias
L. Jumpy stumps
M. Moving toes/fingers
N. Myoclonus
O. Myokymia
P. Myorhythmia
Q. Paroxysmal dyskinesias
R. Restless legs
S. Stereotypies
T. Tics
U. Tremor
FXTASFXTAS
Fragile-X-associated tremor/ataxia syndrome
• Think of this in patients with tremor that resembles Essential Tremor, and has parkinsonian and/or ataxic features.
Fragile-X-associated tremor/ataxia syndrome
• Think of this in patients with tremor that resembles Essential Tremor, and has parkinsonian and/or ataxic features.
Rest, Postural and Action Tremor with impaired tandem gait in FXTAS
Rest, Postural and Action Tremor with impaired tandem gait in FXTAS
• 65 yo RH retired mechanic with 10 year history of hand tremor and 5 year history of imbalance and slurred speech.
• Worsening of tremor in the past 5 years; developed poor balance and slurred speech.
• Now needs help with dressing, shower, cutting his food and other activities of daily living due to profound tremor. To undergo DBS.
• Daughter just had triplets and a screen for fragile X she is a carrier, both boys in the triplets have Fragile X premutation.
• One brother presented with tremor and is now at the age of 55. Another brother has Mental Retardation.
• Patient has a premutation of the Fragile X (FMR1) gene and has FXTAS.
• 65 yo RH retired mechanic with 10 year history of hand tremor and 5 year history of imbalance and slurred speech.
• Worsening of tremor in the past 5 years; developed poor balance and slurred speech.
• Now needs help with dressing, shower, cutting his food and other activities of daily living due to profound tremor. To undergo DBS.
• Daughter just had triplets and a screen for fragile X she is a carrier, both boys in the triplets have Fragile X premutation.
• One brother presented with tremor and is now at the age of 55. Another brother has Mental Retardation.
• Patient has a premutation of the Fragile X (FMR1) gene and has FXTAS.