Athetosis manifests itself as uncontrolled movements occurring mainly in the area of the hand and other parts of the upper limb. Athetosis is one of the neurological disorders from the group of involuntary movements. Athetosis can be caused by perinatal complications, such as hypoxia during childbirth, but also by genetic diseases such as Huntington's disease.
Athetosisis a neurological disorder in the form of rhythmic involuntary movements. Various aspects are assessed during a neurological examination, one part of the examination performed by a neurologist is to see if the patient has any involuntary movements. There are different types of them, some of the involuntary movements are more noticeable to the environment, others definitely less - an example of the former is athetosis. Involuntary movements in the form of athetosis were first described in 1871 by W.A. Hammond. According to the original definition, athetotic movements would appear only in the toes and feet, but later this definition changed - it was related to the discovery that athetosis can also be observed in other parts of the body.
Athetosis: clinical course
Athetotic movements may be different in different patients - this is due to the fact that the intensity of this involuntary movement varies in different patients. Athetosis can take the form of both discrete movement disorders, and it can be so strongly expressed that the patient's ability to perform free movements will be significantly limited.
The most characteristic of athetosis are slow, involuntary swaying movements - to illustrate this disorder, one can give an example of athetotic movement in the form of excessive twisting of the fingers. These movements appear due to the patient's uncoordinated contractions antagonistic to the activity of muscle groups. Athetosis is typically observed in the upper limbs, and there is also the possibility of these involuntary movements in the toes, and sometimes even in the tongue, face or even the neck.
Sometimes patients develop more complex involuntary movements. This is the case when one patient has additional motor activities corresponding to both athetosis and chorea - this condition is referred to as choreoathetosis .
A problem that may be related to disorders identical to those in the course of athetosis, but caused by completely different reasons, ispseudoathetosis . In the case of pseudoathetosis, the structures involved in the control of motor activities are not damaged (as is the case in athetosis), but the somatosensory cortex of the brain is damaged, and the associated disturbances of prioproceptive sensation.
Athetosis: causes
Athetosis can be generally caused by various pathological processes, the result of which are damage to the higher structures of the nervous system involved in the control of motor activities. This especially applies to damage to elements of the nervous system such as the basal ganglia, the striatum, the hippocampus and the thalamus.
It is not difficult to guess that defects in the above-mentioned regions of the brain may appear as a result of many different disease processes - examples of individuals that can cause athetosis are:
- Huntington's disease
- cerebral palsy
- neonatal jaundice (this applies to those forms of jaundice that are associated with abnormally high levels of bilirubin, leading to jaundice in the basal ganglia)
- hypoxia in the perinatal period
- Wilson's disease
- stroke
- carbon monoxide poisoning
- Fahr's disease
- infectious diseases of the central nervous system
Athetosis: recognition
Athetosis itself can generally be identified by observing the patient and finding that he has characteristic involuntary movements. However, athetosis is not a disease on its own, but it is a symptom of some disease. For this reason, in patients who are diagnosed with this involuntary movement, various tests are performed as standard, the purpose of which is to find the cause of athetosis. The panel of ordered examinations may be different, it depends on the doctors' suspicions about the basis of this involuntary movement. Laboratory tests and imaging tests (e.g. computed tomography or magnetic resonance imaging of the head) as well as genetic tests (which can be used to confirm the existence of e.g. Huntington's disease in a patient) can play a significant role in the diagnosis of patients with athetosis.
Athetosis: treatment
Patients who develop athetosis should receive treatment primarily directed at the disease that led to this involuntary movement. Management limited to the control of athetosis alone is based on the use of drugs by patients (such as e.g.diazepam, haloperidol or tetrabenazine), the effectiveness of pharmacological treatment of athetosis is, however, limited. In patients struggling with athetotic movements, it is sometimes beneficial to implement physical rehabilitation. In the case of people with the most severe course of athetosis, they may be offered surgical treatment, such surgical procedures include, for example, subtalamotomy, i.e. cutting the thalamus structures.
Sources: 1. Hector A. Gonzales-Usigli, Chorea, Athetosis, and Hemiballismus, Merck Manual; on-line access: http://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/movement-disorders/chorea,-athetosis,-and-hemiballismus2. Materials of The University of British Columbia; on-line access: http://neuroscience.ubc.ca/CourseMat/0_Movement_Disorders_2011_Clinical.pdf
About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.