Logan Steele
Athetosis is a movement dysfunction characterised by uncontrolled, slow, and involuntary writhing movements of the limbs, face, neck, tongue, and other muscle groups. The condition is often the result of complications at birth, such as a lack of oxygen to the brain, and can make day-to-day activities like walking, standing, and sitting difficult. Treatment options include occupational therapy and anti-dopamine medication to suppress dopamine's effects on the brain.
| Characteristics | Values |
|---|---|
| Definition | Athetosis is a movement dysfunction that includes involuntary writhing movements. |
| Movement Type | Continuous, slow, rolling, and worm-like. |
| Affected Body Parts | Hands, arms, feet, fingers, toes, legs, neck, face, tongue, and trunk. |
| Symptoms | Difficulty maintaining a symmetrical and stable posture, muscle overflow, and abnormal increase in tone. |
| Causes | Lesions in the brain, particularly in the basal ganglia, hippocampus, motor thalamus, corpus striatum, caudate nucleus and putamen. Other causes include Huntington's disease, Wilson’s disease, birth asphyxia, and jaundice. |
| Treatment | Occupational therapy, anti-dopamine medication, and services to increase independence and assist with home modifications, employment, and transportation. |
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What You'll Learn
Athetosis and its causes
Athetosis is characterised by uncontrolled, slow, convoluted, writhing movements of the fingers, hands, toes, feet, arms, legs, neck, and tongue. These movements are often continuous and rolling and can make it difficult to maintain a symmetrical and stable posture. Athetosis is a movement dysfunction and is rarely a disorder in itself. It is usually symptomatic of another disorder.
The most common causes of athetosis are complications from birth, which can include intranatal asphyxia (lack of oxygen), neonatal jaundice (high levels of bilirubin), and Huntington's disease. In newborns, high levels of bilirubin can damage the basal ganglia, which is responsible for smoothing out muscle movements and coordinating changes in posture. Asphyxia can also damage the basal ganglia by causing hypoxia (lack of sufficient oxygen levels), which increases extracellular dopamine levels and leads to over-activity of synapses within the basal ganglia.
In adults, athetosis can be caused by stroke or trauma, which can also damage the basal ganglia and interfere with neuron movement. Drugs that increase dopamine levels in the brain may also contribute to the development of athetosis. Pseudoathetosis, a similar movement disorder, is caused by the inability of the fingers or toes to remain still due to the loss of proprioception or lesions in the central nervous system.
Athetosis is commonly associated with cerebral palsy, with up to 25% of people with the disease exhibiting athetosis symptoms. It can also occur with chorea, a movement disorder characterised by unpatterned, dance-like movements. When they occur together, they are referred to as choreoathetosis. Dystonia, another movement disorder involving involuntary and sustained twisting and repetitive movements, can accompany athetosis as well.
Treatments for athetosis include drugs, surgical intervention, and retraining movements. While there is no single standard drug, antipsychotic medications that block dopamine's action can help control abnormal movements. Surgical intervention can have an immediate impact on relieving symptoms. Retraining movements can be helpful in select situations, though it may not work in all cases.
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Athetosis and treatment
Athetosis is a movement dysfunction characterised by uncontrolled, slow, convoluted, and continuous writhing movements. These movements can affect the fingers, hands, toes, feet, arms, legs, neck, and tongue. Athetosis is often the result of complications from birth, such as asphyxia, which can cause a lack of oxygen to the brain and increase dopamine levels. It can also be caused by high levels of bilirubin after birth, which can damage the basal ganglia. Athetoid movements are also associated with cerebral palsy, which is caused by abnormal development or damage to the brain, affecting a child's ability to control muscle movement. Athetosis is also common in dyskinetic cerebral palsy.
Athetosis can make day-to-day activities such as walking, standing, sitting, and feeding extremely difficult. It can also cause functional difficulties, such as the inability to maintain a symmetrical and stable posture, and muscle "overflow", where attempting to control one muscle or muscle group results in uncontrolled movement in another.
There are several treatment approaches for athetosis, but it is a difficult condition to treat effectively. Treatment focuses on the underlying cause, and in most cases, aims to manage the uncontrollable movements rather than cure the cause. Treatments include anti-dopamine medicines, Botox injections, occupational therapy, and surgical intervention. Drugs that block dopamine's action may help control abnormal movements, such as antipsychotic medications like fluphenazine, haloperidol, and risperidone. In some cases, retraining movements can also be helpful. Neurostimulation has also been demonstrated to be an effective treatment in lessening symptoms in cerebral palsy patients affected by dystonia-choreoathetosis.
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Pseudoathetosis
Athetosis is a movement dysfunction that includes uncontrolled and involuntary writhing movements, which are often slow and continuous. These movements can affect the ability to walk, stand, sit, and feed oneself. The same regions of the body are repeatedly affected, including the hands, arms, feet, neck, face, tongue, and trunk. Athetosis is usually the result of complications from birth.
Reports of multiple sclerosis (MS) with pseudoathetosis are extremely rare. However, in one case, a 29-year-old woman arrived at the emergency department complaining of sensory loss in her left arm. Neurological examination revealed left hemiataxia, pseudoathetosis in the upper left limb, and Lhermitte's sign. The patient responded well to pulse corticosteroid therapy, with remission of pseudoathetosis symptoms after 14 days.
Another case of pseudoathetosis was reported in a 69-year-old woman who noticed abnormal movements in her hands. This case was diagnosed as pseudoathetosis caused by cervical myelitis associated with an aquaporin-4 antibody.
In addition to multiple sclerosis, various other conditions have been reported to cause spinal pseudoathetosis, including myelitis, spinal cord infarct, trauma, tumors, spondylotic myelopathy, leprosy, and vitamin B12 deficiency.
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Chorea and its relationship with athetosis
Chorea and athetosis are two types of hyperkinetic movement disorders characterised by involuntary movements. Chorea is characterised by irregular, excessive, and random movements that can range in severity from gentle limb movements to intense and
Athetosis, on the other hand, is characterised by slower, continuous, and non-rhythmic writhing movements that predominantly affect the distal muscles and can result in abnormal posturing. The term "athetosis" comes from the Greek word "athetos", meaning "without place or position", referring to the person's inability to maintain a stable posture. Athetosis often occurs as a result of injury to the basal ganglia during the neonatal period or infancy and can be caused by severe distal sensory loss in adults, in which case it is known as pseudoathetosis.
Chorea and athetosis are often seen together, and this combination is referred to as choreoathetosis. The primary difference between the two conditions is the speed of the movements, with athetosis being slower and more continuous than chorea. Due to this similarity, some neurologists argue that the term athetosis is unnecessary and confusing, suggesting that a simpler nomenclature based on the speed of movement would be more appropriate.
The treatment for chorea and athetosis depends on the underlying cause. For example, in cases caused by lupus, immune therapy may be required, while brain tumours may require surgery or other treatments to shrink or remove the tumour. Medications such as anticonvulsants, neuroleptics, and deep brain stimulation (DBS) can be used to manage symptoms and control movements, although these treatments may have side effects.
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Dystonia and its differences from athetosis
Athetosis is a movement dysfunction characterised by involuntary writhing movements. These movements are often continuous, slow, and rolling, and can make maintaining a symmetrical and stable posture difficult. Athetosis is rarely a disorder by itself, but rather a symptom of an underlying disorder. It is often the result of complications from birth, or a symptom of certain neurological diseases, and rarely, it is caused by stroke or trauma. In adults, it can occur due to severe distal sensory loss, or brain damage and medication.
Dystonia, on the other hand, is a neurological disorder that causes involuntary movements or muscle spasms. It involves involuntary and sustained muscle contractions that can be twisting and repetitive. Dystonia can be focal, affecting one part of the body, or generalized, affecting the whole body. It can also be acquired, describing symptoms that result from environmental factors. Dystonia usually affects the same group of muscles, and people tend to adopt similar postures during each episode. Symptoms vary in severity from mild to completely debilitating.
Both athetosis and dystonia can make maintaining a normal posture difficult. They can also both be symptoms of dyskinetic cerebral palsy (CP), a movement disorder where the body makes involuntary movements. Dystonia is present in approximately 70% of people with CP. Athetosis is often found with chorea, a movement disorder that causes irregular, involuntary movements. Chorea is frequently associated with Huntington's disease, but can also be caused by medication side effects. Dystonia is also associated with chorea, and while there is no cure, doctors can treat the symptoms.
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Frequently asked questions
Athetosis is a movement dysfunction that includes involuntary writhing movements. These movements may be continuous, slow, and rolling, and can make maintaining a symmetrical posture difficult. The hands, arms, feet, legs, neck, face, tongue, and trunk can be involved.
Athetosis is caused by lesions in several brain areas, such as the hippocampus, motor thalamus, corpus striatum, and basal ganglia. It is often a result of cerebral palsy or complications from birth, such as a lack of oxygen during birth, which causes brain damage.
Treatment for athetosis involves addressing the underlying cause to reduce or eliminate symptoms. This may include occupational therapy to help the muscles regain some control and anti-dopamine medicine to suppress dopamine effects on the brain. Early intervention is key to managing changes in ability and function.
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