the clinical approach to differentiate the dyskinesia

THE CLINICAL APPROACH TO DYSKINESIA

DR MOHAMMAD A.S. KAMELCONSULTANT NEUROLOGIST

AKINESIA/BRADYKINESIA.

RHYTHMIC TREMOR.

DYSTONIA.

MYOCLONUS.

CHOREA

STEREOTYPIES.

TICS.

PAROXYSMAL DYSKINESIA.

ATAXIA.

MORE PROLONGED OBSERVATION.

FEATURES REQUIRING LONGER OBSERVATION

IMMEDIATE IMPRESSION.

IMMEDIATE IMPRESSION

RHYTHMIC VERSUS ARRHYTHMIC

SUSTAINED VERSUS NON SUSTAINED.

PAROXYSMAL VERSUS CONTINUAL VERSUS

CONTINOUSSLEEP VERSUS AWAKE

DIFFRENTIAL DX OF RHYTHMIC AND ARRHYTHMIC HYPERKINESIA

RHYTHMIC•TREMOR(RESTING,POSTURAL,ACTION,INTENTION).•DYSTONIC TREMOR.•DYSTONIC MYORHYTHMIA.•MYOCLONUS,SEGMENTAL.•EPILEPSIA PARTIALIS CONTINUA.•MYOCLONUS,OSCILLATORY.•MOVING TOES,FINGERS.•MYORHYTHMIA.•PERIODIC MOVMENTS IN SLEEP.•TARDIVE DYSKINESIA(TARDIVE STEREOTYPY).

ARHYTHMIC•AKATHETIC MOVEMENTS.•ATHETOSIS•BALLISM.•CHOREA.•DYSTONIA.•HEMIFACIAL SPASIM.•HYPEREKPELXIA.•ARRHYTHMIC MYOCLONUS.•STEREOTYPY.•TICS.

DIFFRENTIAL DX OF SUSTAINED HYPERKINESIA

SUSTAINED CONTRACTIONS OR POSTURES• RIGIDITY.• DYSTONIA.• OCULOGYRIC CRISIS.• PAROXYSMAL DYSTONIA.• DYSTONIC TICS.• SANDIFER SYNDROM.• STIFF PERSON SYNDROM.• NEUROMYOTONIA.• CONGENITAL TORTICOLLIS

NON SUSTAINED CONTRACTIONS• ALL OTHERS.

DIFFRENTIAL DX OF PAROXYSMAL AND NONPAROXYSMAL HYPERKINESIA

PAROXYSMAL CONTINUAL CONTINOUS

TICS BALLISM ABDOMINAL DYSKINESIA

PKD CHOREA ATHETOSIS

PNKD DYSTONIC MOVEMENTS TREMORS

PED MYOCLONUS,ARRHYTHMIC DYSTONIC POSTURES

PRAOXYSMAL ATAXIA SOME STEREOTYPIES MYOCOLNUS,RHYTHMIC

PRAOXYSMAL TREMOR AKATHETIC MOANING TARDIVE STEREOTYPY

HYPNOGENIC DUSTONIA MYOKYMIA

STEREOTYPY TIC STATUS

AKATHETIC MOVEMENTS

JUMPY STUMPS

MOVING TOES

MYOARRHYTHMIA

DIFFRENTIAL DX OF HYPERKINESIA THAT ARE PRESENT ASLEEP OR AWAKE

•HYPNOGENIC DYSKINESIA.•PERIODIC MOVEMENTS IN SLEEP.

APPEARS DURING SLEEP AND DISAPPEARS WHEN AWAKENED

•SECONDARY PALATAL MYOCLONUS.•OCULAR MYOCLONUS.•OCULOFACIOMASTICTORY MYOARHYTHMIA.•MOVING TOES.•MYOKEMIA.•NEUROMYOTONIA(ISAACS SYNDROME)

PERSISTS DURING SLEEP

MORE PROLONGED OBSERVATION

AT REST VERSUS WITH ACTION PATTERNED VERSUS NON PATTERNED. COMBINATIONS OF VARIETIES OF MOVEMENTS.

DIFFRENTIAL DX OF HYPERKINESIA THAT ARE PRESENT AT REST OR WIYH ACTIONAT REST ONLY(DISAPPEAR DURING ACTION) WITH ACTION ONLY AT REST AND CONTINOUS WITH ACTION

AKATHETIC MOVEMENTS ATAXIA ABDOMINAL DYSKINESIA

PARADOXICAL DYSTONIA ACTION DYSTONIA ATHETOSIS

RESTING TREMOR ACTION MYOCLONUS BALLISM

RESTLESS LEGS ORTHOSTATIC TREMOR CHOREA

ORTHOSTATIC TREMOR(ONLY ON STANDING) TREMOR:POSTURAL,ACTION,INTENTION. DYSTONIA

TASK SPECIFIC TREMOR JUMPY STUMPS

TASK SPECIFIC DYSTONIA MINIPOLYMYOCLONUS

MOVING TOES /FINGERS

MYOCLONUS

MYOKEMIA

PSEUDODYSTONIA

TICS

PATTERENED AND NON PATTERNED MOVEMENTS

PATTERENED(SAME MUSCLE GROUP)

ABDOMINAL DYSKINESIA

DYSTONIA

HEMIFACIAL SPASM

MOVING TOES/FINGERS

SEGMENTAL MYOCLONUS

MYORHYTMIA

MYOKEMIA

TARDIVE STEREOTYPY

TREMOR

COMBINATIONS OF VARAIETIES

OF MOVEMENTS

PSYCHOGENIC MOVEMENTS DISORDERS

TARDIVE SYNDROMES

NEUROACANTHOCYTOSIS

WILSON DISEASE

HUNTIGTON DISEASE

DRPLA

DYSTONIA

FEATURES REQUIRING LONGER OBSERVATIONSPEED: SLOW VERSUS FAST

AMPLITUDE: BALLISTIC VERSUS NON BALLISTIC

FORCE: POWERFUL,PAINFUL VERSUS EASY TO OVERCOME

SUPPRESSIBILTY

VOCALIZATION

SELF MUTILATION

COMPLEXITY OF MOVEMENTS

SENSORY COMPONENT

SPEEDFASTEST INTERMEDIAT SLOWEST

MINIPOLYMYOCLONUS CHOREA ATHETOSIS

MYOCLONUS BALLISM MOVING TOES/FINGERS

HYPEREKPLEXIA JUMPY STUMPS MYOARHYTHMIA

HEMIFACIAL SPASM TREMORS AKATHETIC MOVEMENTS

TICS TARDIVE STEREOTYPY

AMPLITUDE

BALLISTIC: BALLISIM,JUMPY

STUMPS.

NOT BALLISTIC: CHOREA AND ALL OTHERS.

VERY SMALL:

MINIPOLYMYOCLONUS

FORCEPOWERFUL •STIFF PERSON,JUMPY STUMPS.

INTERMEDIATE •DYSTONIA.

EASY TO OVER COME •ALL OTHER.

SUPPRESSIBILITY

• STEREOTYPY > TICS, AKATHETIC MOVEMENTS > CHOREA > BALLISIM > DYSTONIA > TREMOR > MOVING TOES.

• NOT SUPPRESSIBLE:• HEMIFACIAL SPASM, MYOCLONUS, HYPEREKPLEXIA,

MYORHYTHMIA, MOVING TOES.

VOCALIZATION

SELF MUTILATION

LESCH –NYHAN SYNDROME.

NEUROACANTHOCYTOSIS.

TOURETTE SYNDROME.

PSYCHOGENIC MOVEMENTS

DISOREDRS.

SENSORY COMPONENET

S

AKATHESIA.

MOVING TOES,PAINFUL

LEGS.

RESTLESS LEGS.

TICS.

OCULAR MOVEMENTS

TICS.

OCULOGYRIC CRISES.

OPSOCLONUS.

OCULAR MYOCLON

US.

OCULAR MYORHYTH

MIA.

OCULAR DYSMETRIA.

NYSTAGMUS.

THANK YOU