Thread by @theneurolander

Paroxysmal Movement Disorders!

Dyskinesias!!!

- 4 groups, overlap
- Prevalence: 1/150 000
- Myoclonus, dystonia, chorea, athetosis, tics

#MedTwitter #neurotwitter #EndNeurophobia #movementdisorder

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First report of paroxysmal dyskinesia

1892 by Shuzo Kure, Japanese psychiatrist (1865-1932).

Referred to as atypical Thomsen’s disease (Myotonia congenital)


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Kinesigenic

-Precipitated by sudden voluntary movement
-Most common paroxysmal movement disorders
-Multiple attacks, frequency up to 100/day
-Attacks are brief, seconds
-Antiepileptic drug responsiveness

ja.ma/3CJAhFv via @JAMANeuro

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Kinesigenic

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NON-Kinesigenic

- Precipitated by alcohol, fatigue, caffeine, strong emotion
- Onset childhood
- Multiple attacks, frequency 2-3/day
- Duration: minutes to hours
- Avoid triggers, benzo responsive
- NO antiepileptics responsiveness

ja.ma/3CJEol2 via @JAMANeuro

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Exercise-induced

- Precipitated by a prolonged or sustained exercise
- Onset childhood
- Attacks: 2-5 min (up to 2 hours), stop within 10 min after stopping exercise
- Most common presentation dystonia
- Relationship: Young-onset PD, GLUT1 def, DYT 9& 18
- Restrict exercise

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Exercise-induced

classic.neurology.org/cgi/content/lo… via @GreenJournal

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Exercise-induced

ja.ma/3Vj6riK via @JAMANeuro

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Hypnogenic

- Is this a real paroxysmal movement disorder?
- Attacks occur during Non-REM sleep
- Many attacks < 1 min, can be indistinguishable from frontal lobe epilepsy
- Dystonic posturing, ballistic or choreic movements, without ictal EEG abnormalities
- ADCY-5 mutation!

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Summary

Kinesigenic: ⬆️⬆️⬆️ attacks/day; seconds; response AED

NON-Kinesigenic: ⬆️ attacks/day; minutes; non-response AED

Exercise-induced: exercise

Hypnogenic: ???

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NeuroTeach 8 - Paroxysmal Movement Disorders (Dyskinesias)

neuronland.blogspot.com/2022/11/neurot…