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Movement disorder tutorial

Surat Tanprawate, MD, FRCPT! Division of Neurology, Chaing Mai University

Step approach
3 question should be asked!

1.Is it hypokinetic or hyperkinetic


movement disorder?!

2.What is the pattern of movement


disorder?!

3.What is the classication of such


movement disorder?

Movement disorder
Hypokinetic
Hyperkinetic rigid syndrome Hypokinetic rigid syndrome

Hyperkinetic
Pattern of movement disorder
Classify by anatomy, distribution, cause, age

Hyperkinetic movement disorder


Rhythmic, sustained, intermittent,
speed, suppressibility, complex movement! myoclonus, ballism, tic

Tremor, Chorea, athetosis, dystonia,

Chorea = dance
irregular, nonrhythmic, unsustained involuntary movement that ows from one part of the body to another motor impersistence

Dancing lady

Dystonia
syndrome of sustained muscle contractions, frequently causing twisting, repetitive movements, or abnormal postures
sustained contractions, consistent directional or patterned character (predictable), and exacerbation during voluntary movements! sensory trick

Myoclonus
sudden, brief, jerky, and shock-like involuntary movements involving face, trunk, and extremities

positive myoclonus! negative myoclonus

Tremor
a rhythmic oscillation of a body part produced by alternating or synchronous contraction of opposing muscles

other movement clinical symptoms can be act like tremor: dystonic tremor, myoclonic tremor

Tics
repetitive, stereotyped, involuntary, sudden, inopportune, non-propositional, and irresistible movement
unpleasant feeling! not absolutely clear as patients can exert some control on the movement! can be simple or complex

Ballism=dacing
involuntary, inging motions of the extremities, the movement are often violent and have wide amplitude of motion, continuous and random, can involve proximal or distal

Athetosis = without xed position


involuntary, convoluted, writhing, slow movements of the arms, ngers and legs