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