Jerks/ twitches resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo, M.D.

Synonyms and Keywords: jerks, twitches, abnormal movements, movement disorders, movement disorders approach

Overview

Movement disorders are common conditions. The clinical presentation of movement disorders is complex and often has variation from person to person. Therefore, finding the correct diagnosis may be challenging. A focused physical examination and history are imperative, and many times the only required resource to establish the diagnosis. Movement disorders may be divided into hyperkinetic and hypokinetic, and this can be evaluated by performing a finger or foot tapping. Among the hyperkinetic disorders, you may classify them as jerky and non-jerky, while hypokinetic may vary in velocity, but in the end, are classified as a whole. The most common hyperkinetic disorder is essential tremor, while the most common hypokinetic one is Parkinson's disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Head trauma
• Toxins
• Metabolic
• Vascular

Common Causes

• Parkinson's disease
• Huntington chorea
• Lewy Body Dementia
• Tardive Dyskinesia

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Abnormal movements according thee American Academy of Neurology guidelines:

Patient with movement disorders

Perform physical examination

Perform finger or foot tapping

Increased alternating movements

Progressive fatiguing and decrement of repetitive alternating movements

Hyperkinetic/non-rigid

Rigid

Jerky

Non-jerky

Akinetic

Hypokinetic

Bradykinetic

Sudden, brief, shock-like involuntary movements

Randomly flowing movements, which are, individually, jerky in nature

‘Stereotyped’ character of the recurrent movements

Involuntary, rhythmic and sinusoidal alternating movements of one or more body parts

Involuntary abnormal co-contraction of antagonistic muscles, which may cause sustained abnormal postures or twisting and repetitive movements

Parkinsonism

Myoclonus

Chorea

Tics

Tremor

Dystonia

• Parkinson's disease • Juvenile parkinsonism • Infectious • Drugs • Toxins • Vascular • Trauma • Metabolic • Corticobasal degeneration (CBD) • Progressive Supranuclear Palsy (PSP) • Multiple System Atrophy (MSA) • Lewy Body Dementia (LBD)

• tardive dyskinesia • Storage diseases • Friedriech's ataxia • Ataxia-telangectasia • Prion diseases • CNS infections • Hashimoto encephalopaty • Hypertiroidism • Electrolyte imbalances • Metabolic imbalances

• Huntington's disease • Familial benign chorea • Familial inverse choreoatetosis • CNS infections • Electrolyte imbalances • Metabolic imbalances

• Transient tic disorder • Torette's disorder • Chronic vocal or motor tic disorder • Tic disorder not otherwise specified

• Essential tremor • Postural tremor • Action tremor • Resting tremor • Pyschogenic tremor • Physiologic tremor

• Blepharospasm • Tardive dystonia • Cervical dystonia • Oromandibular dystonia • Writer's Cramp (hand dystonia) • Paroxismal dystonia

Treatment

Management of movement disorders will vary depending on the underlying cause, among the treatment strategies, there is physical therapy, medical therapy, botulin toxin injection, and deep brain stimulation.

• To view the specific treatment of myoclonus click here.
• To view the specific treatment of tics click here.
• To view the specific treatment of essential tremors click here.
• To view the specific treatment of Parkinson's disease click here.
• To view the specific treatment of progressive supranuclear palsy (PSP) click here.
• To view the specific treatment of multiple system atrophy (MSA) click here.
• To view the specific treatment of Lewy body dementia (LBD) click here.
• To view the specific treatment of Tourette's disorder click here.
• To view the specific treatment of Huntington's disease click here.
• To view the specific treatment of ataxia-telangiectasia click here.
• To view the specific treatment of tardive dyskinesia click here.
• To view the specific treatment of Friedreich's ataxia click here.

Do's

• Perform a physical examination with finger or foot tapping.
• Always ask for exacerbating and relieving factors; for example, involuntary movements that present in frequent, brief attacks that are induced by sudden movements (such as rising from a chair) suggest the diagnosis of paroxysmal kinesigenic dyskinesia.
• Perform a urine toxicology test to look for drug-induced movement disorders such as tardive dystonia, postural tremor, parkinsonism, etc.
• Have in mind the possibility of adverse drug effects medication whenever patients present with a mixed movement disorder; the most common are dopamine D2 receptor-blocking agents such as neuroleptics.

Don'ts

• Do not order imaging or laboratory tests to diagnose clinical disorders, such as Parkinson's disease and essential tremor.
• Do not apply deep brain stimulation therapy for Parkinson's disease if any of the following are present: cognitive disturbances (Mattis score ≥130), major comorbidities, major depression (Beck depression score II <25), or other psychiatric contraindications, or neurosurgical contraindications.