2What is a Movement disorder?“ A disorder which impairs the regulation of voluntary motor activity without directly affecting strength, sensation or cerebellar function ”Sometimes also known as “ extrapyramidal disorders”

3It is a disorder of basal ganglia which are group of the neuclei located subcortically which take part in motor movements of body.Abnormal increment or decrement in its parts causes various movements disorders.

9TremorRhythmicInvoluntary movements of fingers, hand, arms, legs, tongue, or headDue to alternate contraction and relaxation of agonist and antagonist muscle groupsSometimes they can be so fine that they cant be easily recognizedPut a paper on dorsum of an out streched handMay be coarse

12Ballismus, Chorea, Athotosis and DystoniaThese should NOT be thought of as separate entities amenable to specific definition but rather as a SPECTRUM of movements that blend into one-anotherWHY?

13Because…….. They often co-existThey often ( with some notable exceptions ) have the same significance in terms of aetiology.

14The spectrum Ballismus Chorea Athetosis DystoniaMovements become - Less violent / explosive / jerky- Smoother and more flowing- More sustainedThey differ from tics in that they cannot be suppressed by voluntary control

15Ballismus Violent “flinging” movement of entire limbAlmost always unilateral and therefore use term “ HEMIBALLISMUS”Involves proximal musculature and is sometimes thought of as a “ proximal unilateral chorea ”Usually due to a stroke in contralateral subthalamic nucleus

16Chorea ( “dance” in Greek)Rapid irregular muscle jerksMay affect limbs, head, face and tongueIn the limbs chorea refers more to distal movements ( as proximal movements usually called ballismus)Patients often attempt to conceal involuntary movements by superimposing voluntary movements onto them e.g. an involuntary movement of arm towards face may be adapted to look-like an attempt to look at watch

17Athetosis “ changeable” in GreekSlow, flowing, often twisting movementsOccurs mainly distally ( hands, fingers)Can also affect face and tongueOften use term “ choreoathetosis ” due to overlap between syndromes ( chorea referring to less smooth , more jerky movements)

18Dystonia“ condition in which the patient assumes a sustained, abnormal posture or limb position”Due to co-contraction of agonist and antagonist muscles in part of bodyThe part of the movement when the limb was held, unmoving, in an abnormal position would be considered a dystonia ( may occur alone).

19Classification:focal (single body part); affect one part of the body such as eyes, neck, arm or vocal cords.Usually idiopathicMost common typeBlepharospasmTorticollisWriter’s crampMusician’s cramp

20Hemidystonia affects an arm and a leg on one side of the body.Generalized dystonia affects most of the body, frequently involving the legs and back.