Chorea

Chorea; Athetosis; Ballism

1. Chorea (Athetosis – Ballism) Ade Wijaya, MD – November 2019

2. Definition S yndrome characterized by the continuous flow of random muscle contractions When choreic movements are more severe, assuming a flinging , sometimes violent, character, they are called ballism Athetosis describes sinuous , slow movements affecting distal limbs, particularly in the arms. There is a clear decline of the use of this term in the contemporary literature. The reason behind this tendency is the realization that athetosis is better defined as dystonia occasionally associated with some degree of chorea Cardoso F. Chorea, Ballism, and Athetosis. InMovement Disorders Curricula 2017 (pp. 275-282). Springer, Vienna.

3. Hamani C, Saint-Cyr JA, Fraser J, et al. The subthalamic nucleus in the context of movement disorders . Brain . 2004;127:4–20.

4. Bridenbaugh S.A., Kressig R.W. (2018) Movement Disorders. In: Roller-Wirnsberger R., Singler K., Polidori M. (eds) Learning Geriatric Medicine. Practical Issues in Geriatrics. Springer, Cham

5. Luciano MS, Saunders-Pullman R. Substance abuse and movement disorders. Current drug abuse reviews. 2009 Sep 1;2(3):273-8.

6. Etiology Vascular chorea Autoimmune chorea Drug-induced chorea Metabolic chorea Infectious chorea Cardoso F. Chorea, Ballism, and Athetosis. InMovement Disorders Curricula 2017 (pp. 275-282). Springer, Vienna.

7. Vascular Chorea Unusual; less than 1 % of acute stroke patients Hemiballism Basal ganglia Related to type 2 diabetes Outside the subthalamus Resolve spontaneously In acute phase: patients may require such as neuroleptics or dopamine depletors Persistent: stereotactic surgery Cardoso F, Jankovic J, Grossman RG , Hamilton WJ . Outcome after stereotactic thalamotomy for dystonia and hemiballismus. Neurosurgery. 1995;36:501–7. Choi SJ, Lee SW, Kim MC, et al. Posteroventral pallidotomy in medically intractable postapoplectic monochorea: case report. Surg Neurol. 2003;59:486–90. Ghika-Schmid F, Ghika J, Regli F , Bogousslavsky J . Hyperkinetic movement disorders during and after acute stroke: the Lausanne Stroke Registry. J Neurol Sci . 1997;146:109–16.

8. Autoimmune Chorea Sydenham’s chorea Other autoimmune choreas - Systemic lupus erythematosus - Primary antiphospolipid syndrome - Vasculitis - Paraneoplastic syndromes Cardoso F. Chorea, Ballism, and Athetosis. InMovement Disorders Curricula 2017 (pp. 275-282). Springer, Vienna.

9. Drug-induced Chorea Alcohol Anticholinergics Antiepileptic agents (hydantoin, lamotrigine , valproic acid ) Antihypertensive agents (captopril, alpha-methyldopa) Calcium channel blockers (cinnarizine, flunarizine) Cocaine Dopamine agonists Hormones (Chorea gravidarum) Levodopa Lithium Methadone Neuroleptics Stimulants (amphetamine, methylphenidate, pemoline) Superselective serotonin reuptake inhibitors (fluoxetine, paroxetine) Tricyclic antidepressants (imipramine) Cardoso F. Chorea, Ballism, and Athetosis. InMovement Disorders Curricula 2017 (pp. 275-282). Springer, Vienna.

10. Metabolic Chorea Liver disease Nonketotic hyperglycemia in type II diabetes mellitus Hyperthyroidism Cardoso F. Chorea, Ballism, and Athetosis. InMovement Disorders Curricula 2017 (pp. 275-282). Springer, Vienna.

11. Infectious Chorea HIV infection Opportunistic infections (toxoplasmosis , syphilis, and others ) Tuberculosis Creutzfeldt-Jakob disease Cardoso F. Chorea, Ballism, and Athetosis. InMovement Disorders Curricula 2017 (pp. 275-282). Springer, Vienna.

12. Athethosis In Cerebral Palsy A few patients may improve with levodopa , clonazepam, baclofen , anticholinergics, or tetrabenazine . Most of them, however, are refractory to clinical treatment , and even surgical treatment has not been successful. Pseudoathetosis due to peripheral neuropathy Krauss JK, Loher TJ, Weigel R, et al. Chronic stimulation of the globus pallidus internus for treatment of non-DYT1 generalized dystonia and choreoathetosis : 2-year follow up. J Neurosurg. 2003;98:785–92. Morris JG, Grattan-Smith P, Jankelowitz SK, et al . Athetosis II: the syndrome of mild athetoid cerebral palsy . Mov Disord. 2002;17:1281–7. Sharp FR, Rando TA, Greenberg SA, et al . Pseudochoreoathetosis . Movements associated with loss of proprioception. Arch Neurol. 1994;51:1103–9.

13. THANK YOU