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The clinical approach to differentiate the dyskinesia

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dyskinesia is very difficult issue

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The clinical approach to differentiate the dyskinesia

  1. 1. AKINESIA/BRADYKINESIA. RHYTHMIC TREMOR. DYSTONIA. MYOCLONUS. CHOREA STEREOTYPIES. TICS. PAROXYSMAL DYSKINESIA. ATAXIA.
  2. 2. MORE PROLONGED OBSERVATION. FEATURES REQUIRING LONGER OBSERVATION IMMEDIATE IMPRESSION.
  3. 3. IMMEDIATE IMPRESSION RHYTHMIC VERSUS ARRHYTHMIC SUSTAINED VERSUS NON SUSTAINED. PAROXYSMAL VERSUS CONTINUAL VERSUS CONTINOUS SLEEP VERSUS AWAKE
  4. 4. DIFFRENTIAL DX OF RHYTHMIC AND ARRHYTHMIC HYPERKINESIA RHYTHMIC • TREMOR(RESTING,POSTURAL,ACTION,INTENTION). • DYSTONIC TREMOR. • DYSTONIC MYORHYTHMIA. • MYOCLONUS,SEGMENTAL. • EPILEPSIA PARTIALIS CONTINUA. • MYOCLONUS,OSCILLATORY. • MOVING TOES,FINGERS. • MYORHYTHMIA. • PERIODIC MOVMENTS IN SLEEP. • TARDIVE DYSKINESIA(TARDIVE STEREOTYPY). ARHYTHMIC • AKATHETIC MOVEMENTS. • ATHETOSIS • BALLISM. • CHOREA. • DYSTONIA. • HEMIFACIAL SPASIM. • HYPEREKPELXIA. • ARRHYTHMIC MYOCLONUS. • STEREOTYPY. • TICS.
  5. 5. DIFFRENTIAL DX OF SUSTAINED HYPERKINESIA
  6. 6. DIFFRENTIAL DX OF PAROXYSMAL AND NONPAROXYSMAL HYPERKINESIA PAROXYSMAL CONTINUAL CONTINOUS TICS BALLISM ABDOMINAL DYSKINESIA PKD CHOREA ATHETOSIS PNKD DYSTONIC MOVEMENTS TREMORS PED MYOCLONUS,ARRHYTHMIC DYSTONIC POSTURES PRAOXYSMAL ATAXIA SOME STEREOTYPIES MYOCOLNUS,RHYTHMIC PRAOXYSMAL TREMOR AKATHETIC MOANING TARDIVE STEREOTYPY HYPNOGENIC DUSTONIA MYOKYMIA STEREOTYPY TIC STATUS AKATHETIC MOVEMENTS JUMPY STUMPS MOVING TOES MYOARRHYTHMIA
  7. 7. DIFFRENTIAL DX OF HYPERKINESIA THAT ARE PRESENT ASLEEP OR AWAKE • HYPNOGENIC DYSKINESIA. • PERIODIC MOVEMENTS IN SLEEP. APPEARS DURING SLEEP AND DISAPPEARS WHEN AWAKENED • SECONDARY PALATAL MYOCLONUS. • OCULAR MYOCLONUS. • OCULOFACIOMASTICTORY MYOARHYTHMIA. • MOVING TOES. • MYOKEMIA. • NEUROMYOTONIA(ISAACS SYNDROME) PERSISTS DURING SLEEP
  8. 8. MORE PROLONGED OBSERVATION AT REST VERSUS WITH ACTION PATTERNED VERSUS NON PATTERNED. COMBINATIONS OF VARIETIES OF MOVEMENTS.
  9. 9. DIFFRENTIAL DX OF HYPERKINESIA THAT ARE PRESENT AT REST OR WIYH ACTION AT REST ONLY(DISAPPEAR DURING ACTION) WITH ACTION ONLY AT REST AND CONTINOUS WITH ACTION AKATHETIC MOVEMENTS ATAXIA ABDOMINAL DYSKINESIA PARADOXICAL DYSTONIA ACTION DYSTONIA ATHETOSIS RESTING TREMOR ACTION MYOCLONUS BALLISM RESTLESS LEGS ORTHOSTATIC TREMOR CHOREA ORTHOSTATIC TREMOR(ONLY ON STANDING) TREMOR:POSTURAL,ACTION,INTENTION. DYSTONIA TASK SPECIFIC TREMOR JUMPY STUMPS TASK SPECIFIC DYSTONIA MINIPOLYMYOCLONUS MOVING TOES /FINGERS MYOCLONUS MYOKEMIA PSEUDODYSTONIA TICS
  10. 10. PATTERENED AND NON PATTERNED MOVEMENTS PATTERENED(SAME MUSCLE GROUP) ABDOMINAL DYSKINESIA DYSTONIA HEMIFACIAL SPASM MOVING TOES/FINGERS SEGMENTAL MYOCLONUS MYORHYTMIA MYOKEMIA TARDIVE STEREOTYPY TREMOR NON PATTERENED ALL OTHERS
  11. 11. COMBINATIONS OF VARAIETIES OF MOVEMENTS PSYCHOGENIC MOVEMENTS DISORDERS TARDIVE SYNDROMES NEUROACANTH OCYTOSIS WILSON DISEASE HUNTIGTON DISEASE DRPLA DYSTONIA
  12. 12. FEATURES REQUIRING LONGER OBSERVATION SPEED: SLOW VERSUS FAST AMPLITUDE: BALLISTIC VERSUS NON BALLISTIC FORCE: POWERFUL,PAINFUL VERSUS EASY TO OVERCOME SUPPRESSIBILTY VOCALIZATION SELF MUTILATION COMPLEXITY OF MOVEMENTS SENSORY COMPONENT
  13. 13. SPEED FASTEST INTERMEDIAT SLOWEST MINIPOLYMYOCLONUS CHOREA ATHETOSIS MYOCLONUS BALLISM MOVING TOES/FINGERS HYPEREKPLEXIA JUMPY STUMPS MYOARHYTHMIA HEMIFACIAL SPASM TREMORS AKATHETIC MOVEMENTS TICS TARDIVE STEREOTYPY
  14. 14. AMPLITUDE BALLISTIC: BALLISIM,JUMPY STUMPS. NOT BALLISTIC: CHOREA AND ALL OTHERS. VERY SMALL: MINIPOLYMY OCLONUS
  15. 15. FORCE POWERFUL •STIFF PERSON,JUMPY STUMPS. INTERMEDIATE •DYSTONIA. EASY TO OVER COME •ALL OTHER.
  16. 16. SUPPRESSIBILITY • STEREOTYPY > TICS, AKATHETIC MOVEMENTS > CHOREA > BALLISIM > DYSTONIA > TREMOR > MOVING TOES. • NOT SUPPRESSIBLE: • HEMIFACIAL SPASM, MYOCLONUS, HYPEREKPLEXIA, MYORHYTHMIA, MOVING TOES.
  17. 17. VOCALIZATION VOCAL TICS:SIMPLE OR COMPLEX. AKATHESIA: MOANING. HUNTIGTON DISEASE. NEUROACANT HOCYTOSIS. CRANIAL DYSTONIA.
  18. 18. SELF MUTILATION LESCH – NYHAN SYNDROME. NEUROACANT HOCYTOSIS. TOURETTE SYNDROME. PSYCHOGENIC MOVEMENTS DISOREDRS.
  19. 19. SENSORY COMPONENETS AKATHESIA. MOVING TOES,PAINFUL LEGS. RESTLESS LEGS. TICS.
  20. 20. OCULAR MOVEMENTS TICS. OCULOGYRIC CRISES. OPSOCLONU S. OCULAR MYOCLONUS . OCULAR MYORHYTH MIA. OCULAR DYSMETRIA. NYSTAGMUS.

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