Jerks/ twitches resident survival guide

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Jerks/ twitches Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts

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.

Common Causes


Diagnosis

Shown below is an algorithm summarizing the diagnosis of Abnormal movements according thee American Academy of Neurology guidelines:[1][2][3]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 encephalopathy
Hyperthyroidism
Electrolyte imbalances
Metabolic imbalances
 
Huntington's disease
• Familial benign chorea
• Familial inverse choreoathetosis
CNS infections
Electrolyte imbalances
• Metabolic imbalances
 
• Transient tic disorder
Tourette'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.

Do's

Don'ts

References

  1. 1.0 1.1 Flemming, Kelly D; Jones, Lyell K (2015). doi:10.1093/med/9780190244927.001.0001. Missing or empty |title= (help)
  2. 2.0 2.1 2.2 2.3 2.4 Abdo, Wilson F.; van de Warrenburg, Bart P. C.; Burn, David J.; Quinn, Niall P.; Bloem, Bastiaan R. (2010). "The clinical approach to movement disorders". Nature Reviews Neurology. 6 (1): 29–37. doi:10.1038/nrneurol.2009.196. ISSN 1759-4758.
  3. Kojovic, Maja; Cordivari, Carla; Bhatia, Kailash (2011). "Myoclonic disorders: a practical approach for diagnosis and treatment". Therapeutic Advances in Neurological Disorders. 4 (1): 47–62. doi:10.1177/1756285610395653. ISSN 1756-2856.
  4. Hao SS, Feng YH, Zhang GB, Wang AP, Wang F, Wang P (July 2015). "Neuropathophysiology of paroxysmal, systemic, and other related movement disorders". Eur Rev Med Pharmacol Sci. 19 (13): 2452–60. PMID 26214782.
  5. Bhatia KP (2001). "Familial (idiopathic) paroxysmal dyskinesias: an update". Semin Neurol. 21 (1): 69–74. doi:10.1055/s-2001-13121. PMID 11346027.
  6. Chouksey, Anjali; Pandey, Sanjay (2020). "Clinical Spectrum of Drug-Induced Movement Disorders: A Study of 97 Patients". Tremor and Other Hyperkinetic Movements. 10 (1). doi:10.5334/tohm.554. ISSN 2160-8288.
  7. Piccini P, Whone A (May 2004). "Functional brain imaging in the differential diagnosis of Parkinson's disease". Lancet Neurol. 3 (5): 284–90. doi:10.1016/S1474-4422(04)00736-7. PMID 15099543.
  8. Seppi K, Schocke MF (August 2005). "An update on conventional and advanced magnetic resonance imaging techniques in the differential diagnosis of neurodegenerative parkinsonism". Curr Opin Neurol. 18 (4): 370–5. doi:10.1097/01.wco.0000173141.74137.63. PMID 16003111.
  9. Paschen, Steffen; Deuschl, Günther (2018). "Patient Evaluation and Selection for Movement Disorders Surgery: The Changing Spectrum of Indications". 33: 80–93. doi:10.1159/000480910. ISSN 0079-6492.
  10. Deuschl, Günther; Schade-Brittinger, Carmen; Krack, Paul; Volkmann, Jens; Schäfer, Helmut; Bötzel, Kai; Daniels, Christine; Deutschländer, Angela; Dillmann, Ulrich; Eisner, Wilhelm; Gruber, Doreen; Hamel, Wolfgang; Herzog, Jan; Hilker, Rüdiger; Klebe, Stephan; Kloß, Manja; Koy, Jan; Krause, Martin; Kupsch, Andreas; Lorenz, Delia; Lorenzl, Stefan; Mehdorn, H. Maximilian; Moringlane, Jean Richard; Oertel, Wolfgang; Pinsker, Marcus O.; Reichmann, Heinz; Reuß, Alexander; Schneider, Gerd Helge; Schnitzler, Alfons; Steude, Ulrich; Sturm, Volker; Timmermann, Lars; Tronnier, Volker; Trottenberg, Thomas; Wojtecki, Lars; Wolf, Elisabeth; Poewe, Werner; Voges, Jürgen (2006). "A Randomized Trial of Deep-Brain Stimulation for Parkinson's Disease". New England Journal of Medicine. 355 (9): 896–908. doi:10.1056/NEJMoa060281. ISSN 0028-4793.