Differentiating Hemiballismus from Chorea: Key Points to Understand
News Article: Understanding the Spectrum of Hyperkinetic Movement Disorders
Hyperkinetic movement disorders, a group of neurological conditions that cause involuntary movements, can sometimes appear on a spectrum of severity. The three main types in this spectrum are athetosis, chorea, and hemiballismus.
Ahetosis, the least severe form, causes slow, writhing, or twisting movements. Chorea, a step up in severity, presents with abrupt, irregular, and sudden movements. Hemiballismus, the most severe form, involves violent flinging of the limbs.
These conditions are often caused by damage to the areas of the brain that control movement, and may be due to overactivity of the chemical dopamine in the brain. Common causes for these conditions include infections, endocrine and metabolic problems, drug use, exposure to toxins, neurological conditions, primary brain tumors or metastatic lesions on the brain, vascular conditions, vitamin deficiencies, and more.
Chorea can result from diverse etiologies, including Sydenham's chorea, metabolic/endocrine disorders, drugs, vascular events, trauma, tumors, and hereditary conditions like Huntington’s disease. Hemiballismus most commonly arises from a lesion in the subthalamic nucleus of the basal ganglia on one side, often due to a stroke. Athetosis is often seen in basal ganglia injury due to cerebral palsy, metabolic disorders, or inherited conditions like Wilson’s disease.
The foundational approach to treatment is addressing the underlying cause when possible. Symptomatic treatment aims to reduce excessive dopaminergic activity. Antipsychotics (dopamine receptor blockers) and GABA agonists are used to suppress involuntary movements in chorea and ballismus. In refractory or severe cases, surgical procedures like pallidotomy or thalamotomy may be considered. For athetosis, management focuses on treating underlying causes and symptomatic control, possibly with medications affecting neurotransmission and physical therapy.
In summary, chorea, hemiballismus, and athetosis are hyperkinetic movement disorders associated with basal ganglia dysfunction and abnormal neurotransmitter activity. Each disorder has unique characteristics, distribution, common causes, and treatments.
| Movement Disorder | Characteristics | Distribution | Common Causes | Treatments | |-------------------|--------------------------------|-----------------------|------------------------------------|-----------------------------------| | Chorea | Rapid, irregular, nonrhythmic | Usually generalized | Infection, metabolic, hereditary | Antipsychotics, GABA agonists, surgery | | Hemiballismus | Violent, flinging, large amplitude | One side (hemibody) | Stroke (subthalamic nucleus lesion) | Antipsychotics, GABA agonists, surgery | | Athetosis | Slow, writhing, continuous | Distal limbs | Cerebral palsy, metabolic, hereditary | Underlying cause treatment, meds, therapy |
It is important to note that it is possible for a person to experience all three conditions simultaneously or shortly after each other. Seeking prompt medical attention is crucial for proper diagnosis and treatment.
- The neurological disorder known as chorea, characterized by rapid, irregular, and nonrhythmic movements, can stem from a variety of causes such as infections, metabolic disorders, and hereditary conditions.
- Treatment for chorea often involves the use of antipsychotics (dopamine receptor blockers) and GABA agonists to suppress the involuntary movements, with surgery being considered for refractory or severe cases.
- Athetosis, the least severe form of hyperkinetic movement disorders, is typically associated with basal ganglia injury and presents as slow, writhing, and continuous movements. It can be caused by conditions like cerebral palsy, metabolic disorders, or inherited conditions.
- Under proper medical attention, a person showing signs of all three hyperkinetic movement disorders (chorea, hemiballismus, and athetosis) must be promptly diagnosed and treated, considering the unique characteristics, underlying causes, and treatments for each condition.
