Thread by @theneurolander

Belly Dancer's Dyskinesia!!!

“first described by Antonie van Leeuwenhoek in 1723 when he himself experienced the symptoms”

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

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Definition

“rhythmic, involuntary contractions of the diaphragm resulting in undulating, rhythmic movements of the abdomen resembling a belly dance”

-bilateral, most freq
-limited to axial musculature
-sometimes painful
-no suppress on breath holding
-150 contraction/min

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History

1723, Leeuwenhoek
- 1st report
- diaphragmatic flutter

1976, Nichols
- 1st report
- abdominal wall dyskinesia
- phrenic palsy in a newborn

1990, Iliceto
≠ diaphragmatic flutter

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Pathophysiology

- dysfunction of inhibitory interneurons (spinal interneurons)
- structural reorganization of local neuronal circuit

4/

Causes

Phrenic nerve injury
Phrenic nerve irritation: pleurisy, peritonitis, cardiomegaly, post-CABG, abdominal surgery
Spinal cord lesions
Central causes: encephalitis, Extrapontine myelinolysis
Drugs: galantamine, clebopride
Functional
Others: Vit B12 def

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Clinical tips!

Phrenic nerve irritation
- heart most common cause
- flutter synchronous w/ systole

Bilateral diaphragmatic flutter
- central origin

Sleep
- continuous contractions in central
- peripheral, subside

Functional
- breath hold test
- only awake

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Workup

- fluoroscopy
- diaphragmatic EMG
- abdominal imaging
- brain and spinal neuroimaging

7/

Management

“some resolve spontaneously while others persist”

- benzodiazepines
- antipsychotics
- phrenic nerve block

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Belly dancer's dyskinesia

💡patient occasionally voluntarily shrugged her shoulders in response to her abdominal discomfort

doi.org/10.1007/978-1-… via: Movement Disorders: A Video Atlas

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Belly dancer's dyskinesia

via: Seri Jelita

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Belly dancer's dyskinesia

💡chlordiazepoxide-responsive

doi.org/10.2147/IMCRJ.… via: Dove Press

11/

Belly dancer's dyskinesia

💡pregnancy
💡recurrent

doi.org/10.2147/IMCRJ.… via: Dove Press

12/

Belly dancer's dyskinesia

via: ank vaish

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Belly dancer's dyskinesia

💡domperidone-cause
💡clonazepam & promethazine responsive

doi.org/10.7759/cureus… via: Cureus

14/

Belly dancer's dyskinesia

💡levodopa-induced

doi.org/10.1016/j.prdo… via: Clinical Parkinsonism & Related Disorders

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Belly dancer's dyskinesia

💡levodopa-induced

doi.org/10.1016/j.prdo… via: Clinical Parkinsonism & Related Disorders

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Belly dancer's dyskinesia

💡dystonia
💡GPi Pallidotomy-responsive

doi.org/10.1016/j.wneu… via: World Neurosurgery

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Belly dancer's dyskinesia

💡functional
💡EMG helpful to ≠

doi.org/10.1002%2Fmdc3… via: Mov Disord Clin Pract

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Belly dancer's dyskinesia

💡prochlorperazine-induced

doi.org/10.1159/000504… via: Karger

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Belly dancer's dyskinesia

💡 haloperidol & clobazam-responsive

doi.org/10.1055/s-0042… via: J Neurosci Rural Pract

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Belly dancer's dyskinesia

💡vit B12 def
💡clonazepam-responsive

doi.org/10.1159/000521… via: Karger

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Belly dancer's dyskinesia

💡vit B12 def
💡clonazepam-responsive

doi.org/10.1159/000521… via: Karger

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Belly dancer's dyskinesia

💡vit B12 def
💡clonazepam-responsive

doi.org/10.1159/000521… via: Karger

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Belly dancer's dyskinesia

💡US-guided BOTOX-responsive

doi.org/10.1186/s12883… via: BMC Neurol

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Differ

Abdominal segmental myoclonus resembling belly dancer's dyskinesia

💡EMG
💡CASPR2 antibody

doi.org/10.1002/mdc3.1… via: Mov Disord Clin Pract

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