PedsDyskinesias - Dyskinesiasin Dyskinesiasin...

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Dyskinesias in  Dyskinesias in  Children/Adolescents Children/Adolescents CPT Timothy L. Switaj, MC, FS, USA CPT Timothy L. Switaj, MC, FS, USA Neurology (Child) Intern Neurology (Child) Intern
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    Objectives To demonstrate the basic abnormal movements in  children/adolescents To begin to think about a differential for each  type of movement Brief discussion of the most likely etiologies of the  abnormal movements
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    Basic Movement Types * Chorea/Athetosis Ballismus Dystonia Hemifacial Spasm Mirror Movements * Myoclonus Stereotypies * Tics * Tremor Fasciculations Myokymia Seizures
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    Things to ask yourself when  seeing patient What does the movement look like? Is it rhythmical, jerky or “dancelike”? Can it be suppressed? What medications is the patient taking? Any Family History of similar movements?
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    General Characteristics (1) Chorea/Athetosis – usually seen together Chorea – rapid movement affecting body part that is incorporated into  voluntary movement to hide it, NO FIXED FORM Constant movement (restlessness) Movements flow from side to side and limb to limb Athetosis – slow, writhing movement of the limbs Can occur alone but usually associated with chorea – athetosis without chorea  is due to perinatal brain injury (most likely perinatal asphyxia) Ballismus – high-amplitude, violent flinging of a limb (an extreme form of  chorea) Tardive Dyskinesia – uncommon in children
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    General Characteristics (2) Dystonia – sustained muscle contractions Can be focal, segmental, hemi or generalized Hemifacial spasm – involuntary, irregular contraction of muscles  innervated by one facial nerve Very rare in children Mirror movements – involuntary movements of one side of body  that are mirror reversals of intended movements on the other side Normal during infancy and disappear before age 10 –  persistence can be familial trait Obligatory movements are abnormal at any age
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    General Characteristics (3) Myoclonus – involuntary movements  characterized by rapid muscle jerks Can be rhythmic, nonrhythmic; focal, multifocal or  generalized; spontaneous, action or reflex Stereotypies – repeated, purposeless movements Can be simple or complex
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    General Characteristics (4) Tics – “habit spasms”; complex, stereotyped  movements or utterances that are sudden, brief  and purposeless As opposed to chorea, are stereotyped
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