Jerks/ twitches resident survival guide

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Jerks/ twitches Resident Survival Guide Microchapters

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


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. The most common hyperkinetic disorder is essential tremor, while the most common hypokinetic disorder is Parkinson's disease.


Life Threatening Causes

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

Common Causes


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
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
Parkinson's disease
• Juvenile parkinsonism
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
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
• Tardive dystonia
• Cervical dystonia
• Oromandibular dystonia
• Writer's Cramp (hand dystonia)
• Paroxismal dystonia


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.




  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.