Involuntary movement

Introduction Involuntary movement or abnormal movement is an involuntary contraction of a part of a muscle, a muscle or a certain muscle group. It refers to the skeletal muscle movement in which the patient has a clear consciousness and cannot control it by himself. Clinically common are fasciculation, muscle fiber twitching, convulsions, convulsions, myoclonus, tremors, dance-like movements, hand and foot movements, and twisting sputum.

Cause

1, tremor: seen in Parkinson's tremor, encephalitis, toxic diseases such as carbon monoxide, manganese, mercury, lead poisoning, infectious diseases such as typhoid, neurosyphilis, drugs such as reserpine, chlorpromazine, haloperidol, metabolism Toxic diseases such as hepatic coma, uremia, multiple lacunar infarction, multiple system atrophy, hepatolenticular degeneration, multiple sclerosis, heart failure and so on.

2, dance-like movement: seen in intracranial diseases such as inflammation, vascular disease, tumors, etc.; systemic diseases such as rheumatic fever, syphilis, poisoning, pernicious anemia, liver disease, hyperthyroidism, hypothyroidism, systemic lupus erythematosus, etc.; Poisoning reactions such as antipsychotics; chorea chorea and unexplained chorea.

3, hand and foot hyperactivity: the most common in neonatal asphyxia, nuclear jaundice, accompanied by stunting, walking time, speaking time are delayed. Adults occasionally see vascular lesions in the basal ganglia, chronic hepatic encephalopathy, can also be caused by excessive antipsychotic drugs.

4, machine tension changes: muscle strength is seen in Parkinson's syndrome and so on. Reduced muscle tone, common in chorea. Increased or decreased migratory muscle tone is common in new striatum lesions, hand and foot movements, and twisting.

5, torsion : see basal ganglia disease, hepatolenticular degeneration, encephalitis sequelae, drug-induced ADHD and so on.

6, myoclonus: rhythmic myoclonus is more common in head injury, cerebrovascular disease, tumor, degenerative diseases. Non-rhythmic hernias are found in primary genetic diseases such as multiple myoclonic diseases. Symptomatic myoclonus is seen in cerebral hypoxia, metabolic or toxic encephalitis, and degenerative lesions.

7, fasciculation: common in motor neuron disease, spinal cord or medullary cavity, multiple sclerosis, also seen in peripheral neuropathy, thyroid toxic myopathy, severe anemia, electrolyte imbalance, drug poisoning.

8, tendon: clonic tendon seen in localized seizures, trigeminal neuralgia and facial spasm. Myotonic tendon is seen in tetanus, hand and foot sputum, strychnine poisoning, rabies and physical pain such as tonic pain in the triceps of the calf, and localized severe pain.

9, basal ganglia calcification: a family history called familial basal calcification, sporadic called idiopathic basal ganglia calcification. Some cases may be associated with hypoparathyroidism or pseudohypothyroidism.

10. Others: spastic torticollis, idiopathic tremor, tics of snoring syndrome, progressive supranuclear palsy, and echinocytosis.

mechanism

The main function of the extrapyramidal system is to regulate muscle tone, coordinate muscle activity, maintain and adjust body posture, and perform habitual and rhythmic movements to assist in the completion of random movements. In addition, the extrapyramidal system also performs some large random movements. It is a complex functional system involving many structures in the brain, including the cerebral cortex (mainly frontal), thalamus, globus pallidus, striatum, substantia nigra, red nucleus, subthalamic nucleus, midbrain cap, Some reticular nucleus covered by the nucleus, pons nucleus, vestibular nucleus, lower olive nucleus, cerebellum, brainstem, and their associated fibers. The extrapyramidal system includes the striate system and the structures of the vestibular cerebellar system and their associated fibers.

(a) striatum system

Including the striatum, red nucleus, substantia nigra, and subthalamic nucleus, collectively referred to as the basal ganglia. The main cortical part associated with it is the premotor area. The striatum is divided into two parts: the new striatum (the shell nucleus and the caudate nucleus) and the old striatum globus pallidus and the substantia nigra (the nucleus and the globus globus are called the lenticular nucleus). Normally, the striatum is subject to the cortical motor area. Its function is to maintain and regulate the posture of the body, and to bear the semi-automatic rigid and reflective movements: joint movements such as two-arm swing when walking, expression movement, defense Reaction diet action, etc. The main symptoms of striatum damage are changes in muscle tone and abnormalities in motor status. Pale globules and substantia nigra lesions often have increased muscle tone and decreased exercise, and can have resting tremors such as tremor paralysis. Caudate nucleus and nucleus lesions produce hypotonia and excessive exercise, such as chorea, acromegaly. Hemiplegia can occur in lesions of the subthalamic nucleus. The increase in muscle tone is due to the release of the anterior horn cells of the spinal cord after its inhibition. The decrease in muscle tone and excessive exercise are caused by the inhibition of the striatum, which relieves the inhibition of the globus pallidus, resulting in an increase in the inhibitory function of the globus pallidus on the anterior horn of the spinal cord.

(2) vestibular cerebellar system

The cerebellum and its afferent and efferent nerve fibers are reflex organs of balance, mutual movement and muscle tone. The cerebellum regulates the impulses of the cerebral cortex through impulses from tendons, joint positions and motor sensations, as well as balance sensations from the vestibular organs, in order to coordinate random movements to make them precise and accurate, while also reflecting the body's posture and balance. Sexual adjustment. The afferent fibers are bundles of iliac bridges and occipital bridges, mainly ending in the posterior lobe of the cerebellar cortex. They also receive deep sensory impulses from the anterior and posterior cerebral cerebral ventricles, fibers from the vestibular or vestibular nucleus, and the lower olive nucleus. Fiber. The efferent fiber is mainly a nucleus nucleus red nucleus, which also emits fibers from the dentate nucleus to the contralateral thalamus as well as the frontal and parietal cortex. Because the fibers from the dentate nucleus cross the binding arm to the contralateral red nucleus, and the red nucleus spinal cord also crosses down to the anterior horn cells of the spinal cord, the two crosses are so that the cerebellum is ipsilateral. The cerebellar vermis is associated with the spinal cord and vestibular organs, and its symptoms are mainly manifested in the trunk.

(iii) Fiber contact of the extrapyramidal system

The extrapyramidal system is composed of multipolar neurons, and their relationship to each other is very complex. Among them, the striatum has no fibers directly to the spinal cord, and it affects the motor function of the anterior horn cells of the spinal cord through the reticular spinal cord bundle and the red nucleus spinal cord. The subthalamic nucleus and the substantia nigra also have fibers to the red nucleus, which acts on the spinal cord. In addition, the extrapyramidal system still has a nerve fiber loop: 1 cerebral cortex caudal nucleus or putamen thalamus cortical loop; 3 cerebral cortex caudate nucleus or putamen globus pallidus thalamus cortical loop; 3 cerebral cortex substantia nigra globus pallidus thalamus cortical loop formed a progressive cycle inhibition pathway to regulate the movement of the pyramidal system.

an examination

Related inspection

Brain nerve examination, brain CT examination, brain ultrasound, EEG examination, involuntary motion examination

Physical examination

Physical examination of involuntary movements is extremely important, relying on medical history and physical examination to diagnose involuntary movements and the type of involuntary movement. Pay attention when checking the body.

1. Tremor: Is it a part or all of the body, whether it is a certain direction, involuntary, rhythmic or arrhythmic, whether it is static tremor or action tremor.

2, dance-like movement: pay attention to check the head and face and limbs and trunk, upper limb weight or lower limb weight, pay attention to shrug, turn neck, stretch arms, swing hands, stretch fingers. Pay attention to muscle tension, whether it is pregnant or not.

3, hand and foot hyperactivity disorder: pay attention to hand and foot torsion movement, muscle tension, muscle tension when the tendon, muscle tension when muscle relaxation, muscle tension during free movement and quiet state.

4, muscle tension changes: pay attention to muscle rigidity is gear-like or lead-like tonic or folding knife-like, is the transformation of muscle tension, or migratory muscle tension increased or decreased seizures, with emotional excitement, quiet rest or sleep Happening.

5, myoclonus: is a rhythmic myoclonus or non-rhythmic clonic.

6, muscle bundle tremor: attention to the parts such as hands, arms, strands, tongue. The nature, extent, amplitude, frequency and time of the tremor of the trunk and calf muscles or limbs, face and other parts.

7, M: clonic tendon or tonic tendon.

Auxiliary inspection

Due to the cerebral cortex motor area and its descending fibers, lesions in the basal ganglia, brainstem, cerebellum, spinal cord, peripheral nerves, and various parts can cause involuntary movement. The variety of manifestations of involuntary movements is mainly related to the dysfunction of the extrapyramidal system. Clinically, the auxiliary examination should be examined around the above anatomical location. Therefore, in addition to blood, urine, stool routine, rheumatism, rheumatoid, erythrocyte sedimentation rate, etc., CT or MRI, EMG, and/or muscle and nerve biopsy should be selected according to the situation.

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Paroxysmal ataxia type III (EA3), also known as paroxysmal ataxia with paroxysmal dance, hand and foot hyperkinesia, usually 2 to 15 years old, mainly manifested as paroxysmal involuntary movement. Mainly manifested as paroxysmal involuntary movement, posture dystonia, balance disorder, dysarthria. Emotional stress and drinking can aggravate seizures. The physical examination during the interictal period was normal.

2. Dance-like involuntary movement: a clinical manifestation of involuntary movement. Involuntary movement or abnormal movement is an involuntary contraction of a part of a muscle, a muscle or a certain muscle group. It refers to the skeletal muscle movement in which the patient has a clear consciousness and cannot control it by himself. Clinically common are fasciculation, muscle fiber twitching, convulsions, convulsions, myoclonus, tremors, dance-like movements, hand and foot movements, and twisting sputum.

3. Rhythmic stereotyped repetitive involuntary movements: Delayed dyskinesia (TD), also known as delayed onset ADHD, persistent dyskinesia, induced by antipsychotic drugs, is a persistent stereotyped repetitive involuntary movement.

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