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Ballismus is most commonly observed in the setting of structural lesions of the contralateral basal ganglia and

subthalamic nucleus (2,3). Cerebral infarct is the most common cause, but tumors of the same region have also

resulted in ballismus (26). Systemic derangements including fever(27) and hyperglycemia (28) have been reported to

cause or exacerbate hemiballismus in patients with underlying lesions or a history of less severe movement

disorders. Medications including levodopa, phenytoin, and oral contraceptives have also been implicated. Bilateral

ballismus has been reported, but is rare (29).

Following cerebral infarct, hemiballismus is often self-limited. For both transient or persistent hemiballismus, therapy

with dopamine antagonists such as haloperidol (12) or risperidone (22) can be useful. Other medications that may

ameliorate ballismus include benodizepines, tetrabenazine, and reserpine. Therapy with valproic acid has also been

reported to be effective (30,31).

Ballismus ini paling sering diamati dalam pengaturan lesi struktural ganglia basal kontralateral dan inti

subthalamic (2,3). Infark serebral adalah penyebab paling umum, tetapi tumor dari daerah yang sama

juga menyebabkan ballismus (26). Kekacauan sistemik termasuk demam (27) dan hiperglikemia (28)

telah dilaporkan menyebabkan atau memperburuk hemiballismus pada pasien dengan lesi yang

mendasari atau riwayat gangguan gerak kurang parah. Obat-obatan termasuk levodopa, fenitoin, dan

kontrasepsi oral juga telah terlibat. Ballismus bilateral telah dilaporkan, namun jarang (29).

Setelah infark serebral, hemiballismus sering diri terbatas. Untuk hemiballismus baik sementara atau

terus-menerus, terapi dengan antagonis dopamin seperti haloperidol (12) atau risperidone (22) dapat

berguna. Obat lain yang dapat memperbaiki ballismus termasuk benodizepines, tetrabenazine, dan

reserpin. Terapi dengan asam valproik juga telah dilaporkan efektif (30,31).

Chorea, Athetosis, and Ballismus

Imitators of Epilepsy. 2nd edition.

Ann Helms, MD and Lisa Shulman, MD.

http://www.ncbi.nlm.nih.gov/books/NBK7479/

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Hemiballismus: Introduction

Hemiballismus: It is usually characterized by involuntary flinging motions of the extremities. The movements are

often violent and have wide amplitudes of motion. More detailed information about thesymptoms,causes,

andtreatmentsof Hemiballismus is available below.

Symptoms of Hemiballismus

The list of signs and symptoms mentioned in various sources forHemiballismusincludes the 4 symptoms listed

below:

Involuntary movements on one side of the body

Involuntary muscle spasms on one side of the body

Violent movements involving one side of the body

Usually arms are more affected than the legs

Common Causes of Hemiballismus

Following is a list of common causes ofHemiballismus:

Stroke

Traumatic brain injury

Amyotrophic lateral sclerosis

Nonketotic hyperglycemia

Neoplasms

Vascular malformation

Other Causes of Hemiballismus

Following is a list of other causes ofHemiballismus:

Tuberculoma

Demyelinating plaques

complications from HIV infection

Home Diagnostic Testing

These home medical diagnostic tests may be relevant toHemiballismus:

Nerve Neuropathy: Related Home Testing:

o Home Diabetes Test Kits

o Home Blood Glucose Testing Kits

http://www.rightdiagnosis.com/h/hemiballismus/intro.htm

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Hemiballismus is a type of movement disorder considered over a hundred times rarer compared tothe more commonParkinsons disease. People who are afflicted with Hemiballismus are subject tosevere movement-related symptoms that render them unable to go about their day-to-day activities.This disease is linked to people who have suffered structural lesions in the brain, but it sometimesaccompanies some metabolic abnormalities.

The frequent flinging movements of their arms andlegscan identify people suffering fromHemiballismus. These random involuntary movements are vigorous, occur continuously, and canencompass all directions. Both the proximal and distal muscles of the body participate in thisincessant movement, and in most cases, even a patients facial muscles exhibit involuntary muscletwitches.

HEMIBALLISMUS SIGNS AND SYMPTOMSIn mild forms of Hemiballismus, only a personsarmorlegmay be affected, rendering normalmovements, such as walking, difficult. When the disease is more advanced, the bodys movementsinvolve irregular and violent writhing, as well as muscle spasms on one or another side of the body.When even the muscles of the torso are affected, the whole body is subject to forceful andinvoluntary movements that last for up to several seconds at a time.

A patient who is awake and active will manifest an increasing number of these involuntarymovements, and oftentimes, the arms and legs move together. However, with relaxation or sleep,these movements decrease considerably.

Hemiballismus is an ailment that can leave the patient both physically and mentally exhausted. Dueto the violent motions involved, other injuries involving thejointsand skin can occur. Hemiballismus

is usually seen in people who are over 60 years old.

HEMIBALLISMUS CAUSESOne of the most common causes of Hemiballismus is an injury to the basal ganglia, an area of thebrain responsible for controlling the bodys movement andbalance. It can also be caused by the

presence of abscesses or tumors in the brain, as well as malformedblood vessels, a severe traumato the head, and evenmultiple sclerosis. In people younger than 60 years old, the disorder is likelycaused by a brain inflammation or infection.

While Hemiballismus is an extremely rare disorder, it can also be the result of, or accompany a hostof other injuries or ailments. It does not follow, however, that a patient suffering from any of theseailments and injuries will automatically develop Hemiballismus.

In a thousand people who have suffered a stroke, about 0.45 of them end up with Hemiballismus.Strokes are one of the most common causes of this movement disorder. Hemiballismus occurswhen brain tissues die off from strokes that cause insufficient oxygen and lack ofblood supply to thebrain. This is particularly true if tissues in the basal ganglia are involved. The damaged basalganglia, in turn, sends damaged electrical impulses to the bodys skeletal muscles, and the resultsconform to the symptoms of Hemiballismus.

When a person experiences a severe and traumatic brain injury, whether through an accident or anact of violence, portions of the brain that are attributed to motion can be affected. This can also leadto Hemiballismus movements in a patient. Hemiballismus can also be caused by amyotrophic lateralsclerosis. This disorder is responsible for gliosis and neuronal loss in the brains basal ganglia,

thereby resulting in Hemiballismus.

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HEMIBALLISMUS TREATMENTWhen a patient suffering from nonketotic hyperglycemia develops the complication of a subthalamicnucleus lesion in the brain, Hemiballismus is one of the results. Brain lesions such as these are thesecond most common cause of the movement disorder, and they are often attributed to elderlypatients of East Asian descent. This points toward a genetic factor involving the development ofHemiballismus symptoms in patients suffering from hyperglycemia. The symptoms become apparent

whenever thebloodglucose level of a patient soars, and this condition with its accompanyingHemiballismus symptoms can last for up to several hours.

Neoplasms, which are abnormal cell growths in the brain, can also lead to Hemiballismus,particularly if they form within the area of the basal ganglia. Malformed blood vessels, which act toimpede normal blood flow to the brain, can also cause Hemiballismus. This is especially true if thisvascular malformation leads up to the basal ganglia, in which there is a strong possibility of thepatient having a stroke.

Patients suffering a tuberculousmeningitisinfection may have damaged parts of their basal ganglia,and can develop Hemiballismus as a result. Hemiballismus can also result from demyelinatingplaques that injure the myelin sheaths found in the brainsneurons. This impedesneuronconduction,

and garbles the signals they send to the basal ganglia. The garbled signals result in uncoordinatedand involuntary body movements.

As part of the complications arising fromHIVinfections, Hemiballismus may arise in patients duetohypoglycemiastemming from their use of pentamidine. It can also be the cause ofcerebraltoxoplasmosis, a secondary infection resulting from an impaired immune system,characteristic of persons suffering from HIV. In most cases, Hemiballismus may be one of the visiblemanifestations from which a doctor can determine that a patient hasAIDS.

HEMIBALLISMUS DIAGNOSISTo make an accurate diagnosis, the doctor will take down a patients complete medical history toascertain the existence of a past brain or nervous system injury. The doctor will also perform a

thorough physical examination, taking into account the patients age, drug history, and symptoms inorder to rule out other movement disorders that may be similar to Hemiballismus.

The patient will be put through a series of basic movements, and the doctor will observe the number

of Hemiballistic movements that occur within a given time period. This will enable the doctor to rate

the severity ofthe patients symptoms in order to prescribe appropriate medication and therapy.

In treating Hemiballismus, it is important to first treat the underlying ailment or injury that has caused

or accompanied it, whether the ailment is a stroke, hyperglycemia, brain lesions, or infections. In

some cases, Hemiballismus symptoms may be mild, and treatment can be limited to the underlying

causes of the disorder. There are many types of medications used to treat Hemiballismus. One of

these is dopamine blockers, which have been found to be 90% effective in treating symptoms of the

disorder. An anticonvulsant known astopiramatehas also been successful in treating Hemiballismus

cases.

Other solutions include ITB therapy involving an implanted ITB pump to decrease Hemiballismus

episodes, botulinum injections, administration of tetrabenazine, and the antipsychotic

drughaloperidol. In severe cases of Hemiballismus that do not respond to traditional treatment,

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neurosurgical procedures for lesioning the brains globus pallidus or to undertake deep brain

stimulation are other viable options.

Hemiballismus adalah jenis gangguan gerakan dianggap lebih dari seratus kali lebih jarang dibandingkan

dengan penyakit yang lebih umum Parkinson. Orang yang menderita Hemiballismus tunduk pada gejala

gerakan terkait parah yang membuat mereka tidak dapat pergi tentang kegiatan sehari-hari mereka.Penyakit ini terkait dengan orang-orang yang telah menderita lesi struktural dalam otak, tetapi kadang-

kadang menyertai beberapa kelainan metabolik.

Gerakan melemparkan sering lengan dan kaki mereka dapat mengidentifikasi orang yang menderita

Hemiballismus. Gerakan-gerakan disengaja acak kuat, terjadi terus menerus, dan dapat mencakup

segala arah. Kedua otot proksimal dan distal tubuh berpartisipasi dalam gerakan ini terus-menerus, dan

dalam kebanyakan kasus, bahkan otot-otot wajah pasien menunjukkan berkedut otot tak sadar.

TANDA DAN GEJALA HEMIBALLISMUS

Dalam bentuk ringan Hemiballismus, hanya lengan atau kaki seseorang mungkin akan terpengaruh,

rendering gerakan normal, seperti berjalan, sulit. Bila penyakit ini lebih maju, gerakan tubuh melibatkan

teratur dan kekerasan menggeliat, serta kejang otot pada satu atau sisi lain dari tubuh. Ketika bahkan

otot-otot batang tubuh yang terkena, seluruh tubuh tunduk pada gerakan kuat dan sukarela yang

berlangsung hingga beberapa detik pada suatu waktu.

Seorang pasien yang terjaga dan aktif akan terwujud peningkatan jumlah ini gerakan tak terkendali, dan

seringkali, lengan dan kaki bergerak bersama. Namun, dengan relaksasi atau tidur, gerakan ini menurun

jauh.

Hemiballismus adalah penyakit yang dapat meninggalkan pasien baik secara fisik dan mental kelelahan.

Karena gerakan kekerasan yang terlibat, luka lain yang melibatkan sendi dan kulit dapat terjadi.

Hemiballismus biasanya terlihat pada orang yang berusia lebih dari 60 tahun.

PENYEBAB HEMIBALLISMUS

Salah satu penyebab paling umum dari Hemiballismus adalah cedera pada ganglia basalis, daerah otak

yang bertanggung jawab untuk mengendalikan gerakan tubuh dan keseimbangan. Hal ini juga dapat

disebabkan oleh adanya abses atau tumor di otak, serta pembuluh darah cacat, trauma parah pada

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kepala, dan bahkan multiple sclerosis. Pada orang yang lebih muda dari 60 tahun, gangguan ini

kemungkinan disebabkan oleh peradangan otak atau infeksi.

Sementara Hemiballismus adalah gangguan yang sangat langka, juga dapat merupakan hasil dari, atau

menemani sejumlah luka lain atau penyakit. Tidak mengikuti, bagaimanapun, bahwa pasien yang

menderita salah satu penyakit dan cedera otomatis akan mengembangkan Hemiballismus.

Dalam seribu orang yang telah menderita stroke, sekitar 0,45 dari mereka berakhir dengan

Hemiballismus. Stroke adalah salah satu penyebab paling umum dari gangguan ini gerakan.

Hemiballismus terjadi ketika jaringan otak mati dari stroke yang menyebabkan oksigen tidak cukup dan

kurangnya pasokan darah ke otak. Hal ini terutama berlaku jika jaringan di ganglia basal terlibat. Yang

rusak ganglia basal, pada gilirannya, mengirimkan impuls listrik yang rusak ke otot rangka tubuh, dan

hasilnya sesuai dengan gejala Hemiballismus.

Ketika seseorang mengalami cedera otak parah dan traumatis, baik melalui kecelakaan atau tindak

kekerasan, bagian otak yang dikaitkan dengan gerak dapat terpengaruh. Hal ini juga dapat menyebabkan

gerakan Hemiballismus pada pasien. Hemiballismus juga dapat disebabkan oleh amyotrophic lateral

sclerosis. Gangguan ini bertanggung jawab untuk gliosis dan hilangnya neuron di ganglia basal otak,

sehingga menghasilkan Hemiballismus.

HEMIBALLISMUS PENGOBATAN

Ketika seorang pasien menderita hiperglikemia nonketotic mengembangkan komplikasi dari inti

subthalamic lesi di otak, Hemiballismus adalah salah satu hasil. Lesi otak seperti ini adalah penyebab

kedua yang paling umum dari gangguan gerakan, dan mereka sering dikaitkan dengan pasien tua

keturunan Asia Timur. Ini mengarah ke faktor genetik yang melibatkan perkembangan gejala

Hemiballismus pada pasien yang menderita hiperglikemia. Gejala-gejala menjadi jelas ketika tingkat

glukosa darah dari pasien melonjak, dan kondisi ini dengan gejala Hemiballismus menyertainya dapat

berlangsung sampai beberapa jam.

Neoplasma, yang adalah pertumbuhan sel yang tidak normal di otak, juga dapat menyebabkan

Hemiballismus, terutama jika mereka membentuk dalam wilayah ganglia basal. Pembuluh darah cacat,

yang bertindak untuk menghambat aliran darah yang normal ke otak, juga dapat menyebabkan

Hemiballismus. Hal ini terutama berlaku jika malformasi pembuluh darah ini mengarah ke ganglia basal,

di mana ada kemungkinan kuat dari pasien mengalami stroke.

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Pasien yang menderita infeksi meningitis TB mungkin telah merusak bagian basal ganglia mereka, dan

dapat mengembangkan Hemiballismus sebagai hasilnya. Hemiballismus juga bisa terjadi akibat

demielinasi plak yang melukai selubung mielin ditemukan di neuron otak. Hal ini menghambat neuron

konduksi, dan garbles sinyal yang mereka kirim ke ganglia basal. Sinyal kacau mengakibatkan gerakantubuh tidak terkoordinasi dan tidak sukarela.

Sebagai bagian dari komplikasi yang timbul dari infeksi HIV, Hemiballismus mungkin timbul pada pasien

akibat hipoglikemia berasal dari penggunaan pentamidin. Hal ini juga dapat menjadi penyebab

toksoplasmosis otak, infeksi sekunder yang dihasilkan dari sistem kekebalan yang terganggu,

karakteristik orang yang menderita HIV. Dalam kebanyakan kasus, Hemiballismus mungkin salah satu

manifestasi yang terlihat dari dokter dapat menentukan bahwa pasien memiliki AIDS.

HEMIBALLISMUS DIAGNOSIS

Untuk membuat diagnosis yang akurat, dokter akan mengambil riwayat medis lengkap pasien untuk

memastikan keberadaan otak masa lalu atau cedera sistem saraf. Dokter juga akan melakukan

pemeriksaan fisik secara menyeluruh, dengan mempertimbangkan usia pasien, riwayat obat, dan gejala

untuk mengesampingkan gangguan gerakan lain yang mungkin mirip dengan Hemiballismus.

Pasien akan dimasukkan melalui serangkaian gerakan dasar, dan dokter akan mengamati sejumlah

gerakan Hemiballistic yang terjadi dalam jangka waktu tertentu. Ini akan memungkinkan dokter untuk

menilai tingkat keparahan gejala pasien untuk meresepkan obat dan terapi yang tepat.

Dalam mengobati Hemiballismus, penting untuk terlebih dahulu mengobati penyakit yang mendasari

atau cedera yang telah menyebabkan atau mengikutinya, apakah penyakitnya adalah stroke,

hiperglikemia, lesi otak, atau infeksi. Dalam beberapa kasus, gejala Hemiballismus mungkin ringan, dan

pengobatan dapat dibatasi penyebab gangguan tersebut. Ada banyak jenis obat yang digunakan untuk

mengobati Hemiballismus. Salah satunya adalah dopamin blocker, yang telah ditemukan menjadi 90%

efektif dalam mengobati gejala gangguan tersebut. Antikonvulsan yang dikenal sebagai topiramate juga

telah berhasil dalam mengobati kasus Hemiballismus.

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Solusi lain termasuk terapi ITB melibatkan pompa ITB ditanamkan untuk mengurangi episode

Hemiballismus, suntikan botulinum, administrasi tetrabenazine, dan haloperidol obat antipsikotik.

Dalam kasus yang parah Hemiballismus yang tidak menanggapi pengobatan tradisional, prosedur bedah

saraf untuk lesioning globus pallidus otak atau untuk melakukan stimulasi otak dalam adalah pilihan

yang layak lainnya.

http://www.medicalook.com/Neurological_disorders/Hemiballismus.html

http://www.medicalook.com/Neurological_disorders/Hemiballismus.htmlhttp://www.medicalook.com/Neurological_disorders/Hemiballismus.htmlhttp://www.medicalook.com/Neurological_disorders/Hemiballismus.html

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