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Semin Neurol 2010; 30(1): 015-022
DOI: 10.1055/s-0029-1245005
© Thieme Medical Publishers

Pearls: Hyperkinetic Movement Disorders

Stephen G. Reich1
  • 1Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
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Publication History

Publication Date:
01 February 2010 (online)

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ABSTRACT

Hyperkinetic movement disorders are characterized by an excessive degree of involuntary motor activity and are classified by their clinical phenomenology. The five major categories include tremor, dystonia, chorea and ballismus, tics, and myoclonus. This article presents a series of “pearls” for each category of movements, emphasizing the recognition of common disorders as well as rare, but treatable hyperkinesias. In addition to the major categories, clinical pearls also cover drug-induced movement disorders and psychogenic movement disorders.

KEYWORDS

Tremor - dystonia - chorea - myoclonus - tics - tardive dyskinesia - psychogenic movement disorder

REFERENCES

  • 1 Deuschl G, Bain P, Brin M. Ad Hoc Scientific Committee . Consensus statement of the Movement Disorder Society on Tremor.  Mov Disord. 1998;  13(Suppl 3) 2-23
    CrossrefPubMedGoogle Scholar
  • 2 Reich S G. Tremor. In: Slavney PR, Hurko O Common Neurologic and Psychiatric Disorders Seen and Treated by Primary Care Physicians. Baltimore, MD; Johns Hopkins University Press 2001: 214-230
    PubMedGoogle Scholar
  • 3 Hallett M. Classification and treatment of tremor.  JAMA. 1991;  266(8) 1115-1117
    CrossrefPubMedGoogle Scholar
  • 4 Benito-León J, Louis E D. Clinical update: diagnosis and treatment of essential tremor.  Lancet. 2007;  369(9568) 1152-1154
    CrossrefPubMedGoogle Scholar
  • 5 Morgan J C, Sethi K D. Drug-induced tremors.  Lancet Neurol. 2005;  4(12) 866-876
    CrossrefPubMedGoogle Scholar
  • 6 Koller W C, Rubino F A. Combined resting-postural tremors.  Arch Neurol. 1985;  42(7) 683-684
    PubMedGoogle Scholar
  • 7 Jankovic J, Schwartz K S, Ondo W. Re-emergent tremor of Parkinson’s disease.  J Neurol Neurosurg Psychiatry. 1999;  67(5) 646-650
    CrossrefPubMedGoogle Scholar
  • 8 Rajput A H, Rozdilsky B, Ang L, Rajput A. Significance of parkinsonian manifestations in essential tremor.  Can J Neurol Sci. 1993;  20(2) 114-117
    PubMedGoogle Scholar
  • 9 Cohen O, Pullman S, Jurewicz E, Watner D, Louis E D. Rest tremor in patients with essential tremor: prevalence, clinical correlates, and electrophysiologic characteristics.  Arch Neurol. 2003;  60(3) 405-410
    CrossrefPubMedGoogle Scholar
  • 10 Shahed J, Jankovic J. Exploring the relationship between essential tremor and Parkinson’s disease.  Parkinsonism Relat Disord. 2007;  13(2) 67-76
    CrossrefPubMedGoogle Scholar
  • 11 Klawans H L, Glantz R, Tanner C M, Goetz C G. Primary writing tremor: a selective action tremor.  Neurology. 1982;  32(2) 203-206
    PubMedGoogle Scholar
  • 12 Marsden C D, Sheehy M P. Writer’s cramp.  Trends Neurosci. 1990;  13(4) 148-153
    CrossrefPubMedGoogle Scholar
  • 13 Heilman K M. Orthostatic tremor.  Arch Neurol. 1984;  41(8) 880-881
    CrossrefPubMedGoogle Scholar
  • 14 Zesiewicz T A, Reich S G. A woman who can walk but not stand. In: Reich SG Movement Disorders: 100 Instructive Cases. London, United Kingdom; Informa 2008: 27-29
    PubMedGoogle Scholar
  • 15 Piboolnurak P, Yu Q P, Pullman S L. Clinical and neurophysiologic spectrum of orthostatic tremor: case series of 26 subjects.  Mov Disord. 2005;  20(11) 1455-1461
    CrossrefPubMedGoogle Scholar
  • 16 Schwartz M A, Selhorst J B, Ochs A L et al.. Oculomasticatory myorhythmia: a unique movement disorder occurring in Whipple’s disease.  Ann Neurol. 1986;  20(6) 677-683
    CrossrefPubMedGoogle Scholar
  • 17 Revilla F J, de la Cruz R, Khardori N, Espay A J. Teaching NeuroImage: oculomasticatory myorhythmia: pathognomonic phenomenology of Whipple disease.  Neurology. 2008;  70(6) e25
    CrossrefPubMedGoogle Scholar
  • 18 Geyer H L, Bressman S B. The diagnosis of dystonia.  Lancet Neurol. 2006;  5(9) 780-790
    CrossrefPubMedGoogle Scholar
  • 19 Nygaard T G, Wilhelmsen K C, Risch N J et al.. Linkage mapping of dopa-responsive dystonia (DRD) to chromosome 14q.  Nat Genet. 1993;  5(4) 386-391
    CrossrefPubMedGoogle Scholar
  • 20 Ichinose H, Ohye T, Takahashi E et al.. Hereditary progressive dystonia with marked diurnal fluctuation caused by mutations in the GTP cyclohydrolase I gene.  Nat Genet. 1994;  8(3) 236-242
    CrossrefPubMedGoogle Scholar
  • 21 Segawa M, Hosaka A, Miyagawa F, Nomura Y, Imai H. Hereditary progressive dystonia with marked diurnal fluctuation.  Adv Neurol. 1976;  14 215-233
    PubMedGoogle Scholar
  • 22 Trender-Gerhard I, Sweeney M G, Schwingenschuh P et al.. Autosomal-dominant GTPCH1-deficient DRD: clinical characteristics and long-term outcome of 34 patients.  J Neurol Neurosurg Psychiatry. 2009;  80(8) 839-845
    CrossrefPubMedGoogle Scholar
  • 23 Brewer G J, Fink J K, Hedera P. Diagnosis and treatment of Wilson’s disease.  Semin Neurol. 1999;  19(3) 261-270
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Jankovic J, Orman J. Blepharospasm: demographic and clinical survey of 250 patients.  Ann Ophthalmol. 1984;  16(4) 371-376
    PubMedGoogle Scholar
  • 25 Chan J, Brin M F, Fahn S. Idiopathic cervical dystonia: clinical characteristics.  Mov Disord. 1991;  6(2) 119-126
    CrossrefPubMedGoogle Scholar
  • 26 Reich S G, Meyer T. Teaching video NeuroImage: spasmodic dysphonia: adductor and abductor.  Neurology. 2008;  70(19) e78
    CrossrefPubMedGoogle Scholar
  • 27 Frucht S J. Focal task-specific dystonia in musicians.  Adv Neurol. 2004;  94 225-230
    PubMedGoogle Scholar
  • 28 Lederman R J. Neuromuscular problems in musicians.  Neurologist. 2002;  8(3) 163-174
    CrossrefPubMedGoogle Scholar
  • 29 Schwarz C S, Bressman S B. Genetics and treatment of dystonia.  Neurol Clin. 2009;  27(3) 697-718
    CrossrefPubMedGoogle Scholar
  • 30 Schneider S A, Edwards M J, Grill S E et al.. Adult-onset primary lower limb dystonia.  Mov Disord. 2006;  21(6) 767-771
    CrossrefPubMedGoogle Scholar
  • 31 McKeon A, Matsumoto J Y, Bower J H, Ahlskog J E. The spectrum of disorders presenting as adult-onset focal lower extremity dystonia.  Parkinsonism Relat Disord. 2008;  14(8) 613-619
    CrossrefPubMedGoogle Scholar
  • 32 Reich S G, Grill S E. Corticobasal degeneration.  Curr Treat Options Neurol. 2009;  11(3) 179-185
    CrossrefPubMedGoogle Scholar
  • 33 Mahapatra R K, Edwards M J, Schott J M, Bhatia K P. Corticobasal degeneration.  Lancet Neurol. 2004;  3(12) 736-743
    CrossrefPubMedGoogle Scholar
  • 34 Jankovic J. Peripherally induced movement disorders.  Neurol Clin. 2009;  27(3) 821-832
    CrossrefPubMedGoogle Scholar
  • 35 Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients.  Brain. 2004;  127(Pt 10) 2360-2372
    CrossrefPubMedGoogle Scholar
  • 36 Postuma R B, Lang A E. Hemiballism: revisiting a classic disorder.  Lancet Neurol. 2003;  2(11) 661-668
    CrossrefPubMedGoogle Scholar
  • 37 Shannon K M. Hemiballismus.  Curr Treat Options Neurol. 2005;  7(3) 203-210
    CrossrefPubMedGoogle Scholar
  • 38 Oh S H, Lee K Y, Im J H, Lee M S. Chorea associated with non-ketotic hyperglycemia and hyperintensity basal ganglia lesion on T1-weighted brain MRI study: a meta-analysis of 53 cases including four present cases.  J Neurol Sci. 2002;  200(1-2) 57-62
    CrossrefPubMedGoogle Scholar
  • 39 Cardoso F. Huntington disease and other choreas.  Neurol Clin. 2009;  27(3) 719-736
    CrossrefPubMedGoogle Scholar
  • 40 Lorincz M T. Geriatric chorea.  Clin Geriatr Med. 2006;  22(4) 879-897
    CrossrefPubMedGoogle Scholar
  • 41 Gilstad J, Reich S G. Chorea in an octogenarian.  Neurologist. 2003;  9(3) 165-166
    CrossrefPubMedGoogle Scholar
  • 42 Schneider S A, Walker R H, Bhatia K P. The Huntington’s disease-like syndromes: what to consider in patients with a negative Huntington’s disease gene test.  Nat Clin Pract Neurol. 2007;  3(9) 517-525
    CrossrefPubMedGoogle Scholar
  • 43 García Ruiz P J, Gómez-Tortosa E, del Barrio A et al.. Senile chorea: a multicenter prospective study.  Acta Neurol Scand. 1997;  95(3) 180-183
    CrossrefPubMedGoogle Scholar
  • 44 Caviness J N. Pathophysiology and treatment of myoclonus.  Neurol Clin. 2009;  27(3) 757-777
    CrossrefPubMedGoogle Scholar
  • 45 Krumholz A, Stern B J, Weiss H D. Outcome from coma after cardiopulmonary resuscitation: relation to seizures and myoclonus.  Neurology. 1988;  38(3) 401-405
    CrossrefPubMedGoogle Scholar
  • 46 Wijdicks E F, Hijdra A, Young G B, Bassetti C L, Wiebe S. Quality Standards Subcommittee of the American Academy of Neurology . Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 2006;  67(2) 203-210
    CrossrefPubMedGoogle Scholar
  • 47 Goetting M G, Thirman M J. Neurotoxicity of meperidine.  Ann Emerg Med. 1985;  14(10) 1007-1009
    CrossrefPubMedGoogle Scholar
  • 48 Caviness J N. Myoclonus and neurodegenerative disease—what’s in a name?.  Parkinsonism Relat Disord. 2003;  9(4) 185-192
    CrossrefPubMedGoogle Scholar
  • 49 Jankovic J. Tourette’s syndrome.  N Engl J Med. 2001;  345(16) 1184-1192
    CrossrefPubMedGoogle Scholar
  • 50 Jimenez-Shahed J. Tourette syndrome.  Neurol Clin. 2009;  27(3) 737-755
    CrossrefPubMedGoogle Scholar
  • 51 Chouinard S, Ford B. Adult onset tic disorders.  J Neurol Neurosurg Psychiatry. 2000;  68(6) 738-743
    CrossrefPubMedGoogle Scholar
  • 52 Kenney C, Hunter C, Davidson A, Jankovic J. Metoclopramide, an increasingly recognized cause of tardive dyskinesia.  J Clin Pharmacol. 2008;  48(3) 379-384
    PubMedGoogle Scholar
  • 53 Miller L G, Jankovic J. Metoclopramide-induced movement disorders. Clinical findings with a review of the literature.  Arch Intern Med. 1989;  149(11) 2486-2492
    CrossrefPubMedGoogle Scholar
  • 54 Pasricha P J, Pehlivanov N, Sugumar A, Jankovic J. Drug insight: from disturbed motility to disordered movement—a review of the clinical benefits and medicolegal risks of metoclopramide.  Nat Clin Pract Gastroenterol Hepatol. 2006;  3(3) 138-148
    PubMedGoogle Scholar
  • 55 Esper C D, Factor S A. Failure of recognition of drug-induced parkinsonism in the elderly.  Mov Disord. 2008;  23(3) 401-404
    CrossrefPubMedGoogle Scholar
  • 56 Stewart R B, Cerda J J, Moore M T, Hale W E. Metoclopramide: an analysis of inappropriate long-term use in the elderly.  Ann Pharmacother. 1992;  26(7-8) 977-979
    PubMedGoogle Scholar
  • 57 Kaplan S, Staffa J A, Dal Pan G J. Duration of therapy with metoclopramide: a prescription claims data study.  Pharmacoepidemiol Drug Saf. 2007;  16(8) 878-881
    CrossrefPubMedGoogle Scholar
  • 58 Chou K L, Friedman J H. Tardive syndromes in the elderly.  Clin Geriatr Med. 2006;  22(4) 915-933
    CrossrefPubMedGoogle Scholar
  • 59 Fernandez H H, Friedman J H. Classification and treatment of tardive syndromes.  Neurologist. 2003;  9(1) 16-27
    CrossrefPubMedGoogle Scholar
  • 60 Skidmore F, Reich S G. Tardive dystonia.  Curr Treat Options Neurol. 2005;  7(3) 231-236
    CrossrefPubMedGoogle Scholar
  • 61 Reich S G. Psychogenic movement disorders.  Semin Neurol. 2006;  26(3) 289-296
    Article in Thieme ConnectPubMedGoogle Scholar
  • 62 Peckham E L, Hallett M. Psychogenic movement disorders.  Neurol Clin. 2009;  27(3) 801-819
    CrossrefPubMedGoogle Scholar
  • 63 Stone J. The bare essentials: functional symptoms in neurology.  Pract Neurol. 2009;  9(3) 179-189
    CrossrefPubMedGoogle Scholar
  • 64 Williams D T, Ford B, Fahn S. Phenomenology and psychopathology related to psychogenic movement disorders.  Adv Neurol. 1995;  65 231-257
    PubMedGoogle Scholar
  • 65 Factor S A, Podskalny G D, Molho E S. Psychogenic movement disorders: frequency, clinical profile, and characteristics.  J Neurol Neurosurg Psychiatry. 1995;  59(4) 406-412
    CrossrefPubMedGoogle Scholar
  • 66 Thomas M, Jankovic J. Psychogenic movement disorders: diagnosis and management.  CNS Drugs. 2004;  18(7) 437-452
    CrossrefPubMedGoogle Scholar
  • 67 Kim Y J, Pakiam A S, Lang A E. Historical and clinical features of psychogenic tremor: a review of 70 cases.  Can J Neurol Sci. 1999;  26(3) 190-195
    PubMedGoogle Scholar
  • 68 Deuschl G, Köster B, Lücking C H, Scheidt C. Diagnostic and pathophysiological aspects of psychogenic tremors.  Mov Disord. 1998;  13(2) 294-302
    CrossrefPubMedGoogle Scholar
  • 69 Monday K, Jankovic J. Psychogenic myoclonus.  Neurology. 1993;  43(2) 349-352
    PubMedGoogle Scholar
  • 70 Lang A E. Psychogenic dystonia: a review of 18 cases.  Can J Neurol Sci. 1995;  22(2) 136-143
    PubMedGoogle Scholar
  • 71 Ranawaya R, Riley D, Lang A. Psychogenic dyskinesias in patients with organic movement disorders.  Mov Disord. 1990;  5(2) 127-133
    CrossrefPubMedGoogle Scholar
  • 72 Jankovic J. Can peripheral trauma induce dystonia and other movement disorders? Yes!.  Mov Disord. 2001;  16(1) 7-12
    CrossrefPubMedGoogle Scholar
  • 73 Weiner W J. Can peripheral trauma induce dystonia? No!.  Mov Disord. 2001;  16(1) 13-22
    CrossrefPubMedGoogle Scholar
  • 74 Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients.  Brain. 2004;  127(Pt 10) 2360-2372
    CrossrefPubMedGoogle Scholar
  • 75 Anderson K E, Gruber-Baldini A L, Vaughan C G et al.. Impact of psychogenic movement disorders versus Parkinson’s on disability, quality of life, and psychopathology.  Mov Disord. 2007;  22(15) 2204-2209
    CrossrefPubMedGoogle Scholar
  • 76 Stone J, Sharpe M. Functional symptoms in neurology: case studies.  Neurol Clin. 2006;  24(2) 385-403
    CrossrefPubMedGoogle Scholar
  • 77 Crimlisk H L, Bhatia K, Cope H, David A, Marsden C D, Ron M A. Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms.  BMJ. 1998;  316(7131) 582-586
    PubMedGoogle Scholar

Stephen G ReichM.D. 

University of Maryland School of Medicine, Department of Neurology

110 S. Paca Street, 3rd Floor, RM: 03-S-125, Baltimore, MD 21201

Email: sreich@som.umaryland.edu

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