Movement disorders are diseases that affect control of bodily movements. They result from abnormalities in the extrapyramidal system or basal ganglia. This document categorizes and describes different types of involuntary movements including chorea, athetosis, dystonia, tremor, myoclonus, tics, ataxia, and stereotypies. It also discusses convulsions, epilepsy, febrile seizures, status epilepticus, and the approach to evaluating and managing a child presenting with abnormal movements or seizures.

1. Abnormal body
movement
Maryam abdulwahid
Hawar jarjees
Hedy hameed supervised by:
Tanya muhammad Dr. Dler

2. Content
• Introduction
• Types
• Pathophysiology
• Approach
• Convulsion
• Types
• Cause
• Management

3. Introduction
• Movement disorders are a group of diseases and
syndromes affecting the ability to produce and
control bodily movements.
• They are generally the result of abnormalities of the
extra pyramidal system or the basal ganglia.
• Can be the primary or secondary manifestation of
numerous neurologic disorders

4. Classification
involuntary
movements
• rhythmic
• Non –rhythmic
Convulsive
disorders
• Epileptic
• Non- epileptic

5. Slide Title MOVEMENT DISORDERS
PYRAMIDAL
SYMPTOMS
BASAL GANGLIA
DISORDERS
CERBELLAR
DISORDERS
SPASTICITY
ATAXIA
HYPOKINESIAS HYPERKINESIAS MOTOR-SENSORY
BEHAVIOUR
AKINESIA RIGIDITY
TREMOR DYSTONI
A MYOCLONUS CHOREA/
ATHETOSIS
COMPULSION
TICS/
STERIOTYPIES
MANNERISM

6. Chorea
• Irregular, rapid, purposeless,
uncontrolled, involuntary movements,
Worsen on rest, but remain or improve
with involuntary movement.
• muscle tone is decreased.
• May be Congenital, familial, metabolic,
vascular, toxic, infectious or neoplastic.
•

7. Athetosis
• Slow, coarse, writhing, irregular
movement.
• More found over distal parts of limbs and
face.
• non propositional and predominate over
postural.
• Muscle tone may be increased.
• Main cause is encephalopathy.
• Its frequently seen with chorea
(choreoathetosis)
• It present in many cases of mixed form of
cerebral palsy.

8. Dystonia
• Syndrome of sustained muscle contractions,
frequently causing twisting and repetitive
movements or abnormal postures
• It has many causes and neurological sign
• Causes:
Perinatal asphyxia
Kernicterus
Drugs

9. Tremor
• Rhythmic oscillations of a part of the
body around the central point
• In children is usually due to psychological,
familial, or cerebral origin.
• Associated with other diseases like
thyrotoxicosis, hypoglycemia, wilson
disease.
• Drugs (bronchodilators, amphetamine&
TCA)

10. Myoclonus
• Very brief, abrupt, involuntary, non-suppressible,
jerky contraction involving a
single muscle or muscle group- "shock like"
• Presence in normal (associated with sleep,
exercise, anxiety) and numerous pathologic
situations.
• May be epileptic or non epileptic,
• Its distinguished from tremor in that it’s a
simple contraction of an agonist muscle,
while tremor is simultaneous contraction of
agonist and antagonist muscle.

11. Tics
• Repetitive semi-purposeful movements as blinking,
winking, grinning or screwing up of the eyes.
Distinguished from other involuntary movements by
the ability of the patient to suppress their
occurrence. Most of them disappear at adolescent.
• Tourettes syndrom is a chronic tic disorder that begin
before 7 year of age , unknown cause but 50% have
FH.
consists of motor and vocal tics and associated with
ADHS or OCD,
• RX: clonidine &haloperidol
• Has good px 2/3 have complete remission.

12. Ataxia
• Inability to make smooth, accurate and
coordinated movements
• Due to disorder of cerebellum, sensory
pathway in posterior column of spinal
cord)
• Generalized
• primarily affect gait or hands and arms

13. Stereotypies
• are intermittent, involuntary, repetitive,
purposeless, patterned movements that
are usually rhythmic.
• Such as arm flapping, rocking, licking,
mouth opening, and hand waving.
• associated with mental retardation,
autism, Rett syndrome, and blindness,
• but they also occur in otherwise normal
children.

14. APPROACH

15. Key questions:
● Is the pattern of movements normal or
abnormal?
● Is the number of movements excessive or
diminished?
● Is the movement paroxysmal (sudden onset
and offset), Continual (repeated again and
again), or continuous?
● Has the movement disorder changed over
time?
● sleep?

16. • Do environmental stimuli or emotional
states modulate the movement disorder?
● Can the movements be suppressed
voluntarily?
● Is there a family history of a similar or related
condition?

17. HX:
• Age at onset-
• full term neonate : jitteriness
• Infant : myoclonus, athetosis, transient
dystonia
• Older child : chorea
• Sex-
• female: Sydenham’s chorea, thryrotoxicosis
• male : tics, tremors

18. • Type of movement-
• rapid jerky: chorea
• slow movement : athetosis
• sustained: dystonia
• Involvement of body parts:
• distal limb : athetosis
• all body parts : chorea
• hand : focal dystonia
• Presence of movements in sleep :
seizure disorder , nocturnal myoclonus

19. HX:
• Aggravated with stress: tremor, tics, Tourette
synd , Generalised primary dystonia, Nocturnal
myoclonus, Syndenham’s chorea.
• Relieving factors.
• H/o intake of drugs
• Antipychotic, antiepileptic, amphetamine,
cocain& lithium
• Perinatal history/ Dystonia- Asphyxia, Jaundice
Athetosis- Asphyxia, jaundice and prematurity

20. EXAMINATIONS
• General exam.
• Vital signs
• Motor, tone, gait
• Systemic examinations
• Presence of primitive reflexes- cerebral
palsy
• Signs of meningeal irritation?
• any cerebellar signs?

21. Rx
• Hypokinetic - dopamine decreased -
treat with dopamine replacement or anticholinergic
drugs.
• Hyperkinetic - dopamine increased and
acetylcholine decreased -
treat with a dopamine antagonist or cholinergic drug.

22. Convulsion

23. Convulsion
Convulsion is defined as a transient, involuntary
alteration of consciousness, behavior, motor activity,
sensation, or autonomic function caused by an
excessive rate of discharges from a group of cerebral
neurons leading to a sudden biochemical imbalance at
the cell membrane.
Seizures are the most common pediatric neurologic
disorder, the incidence is highest in children younger
than 3 years of age.
Could be either acute symptomatic or remote
symptomatic

24. Causes
1. Infectious: brain abscess, encephalitis, febrile seizure,
meningitis.
2. Neurologic or developmental: Birth injury, congenital
anomalies, hypoxic-ischemic encephalopathy, Ventriculo
peritoneal shunt malfunction.
3. Metabolic: hypocalcemia, hypoglycemia,
hypomagnesemia, hypoxia, inborn errors of metabolism,
pyridoxine deficiency.
4. Traumatic: child abuse, head trauma, intracranial
hemorrhage .
5. Toxicologic: Drugs like(amphetamines,
theophyline),Lead, lithium, organophosphates and
withdrawals ( anticonvulsants).

25. Febrile convulsion
• Are the most common seizure disorder in
childhood, affecting 2 - 5% of children between
the ages of 6 months _5 years, are usually
benign.
• Criteria for diagnosis :
1. major: age<1 year, fever of<24 hours,
fever(38_39)
2. Minor : +family history (febrile seizure and
epilepsy), complex partial seizure , male
gender.

26. • Simple:
1. generalized
2. <15 minutes
3. 1time/day
complex:
1. partial
2. Prolonged >15minutes
3. Frequent attacks in 24 hours

27. Epilepsy
Is the occurrence of recurrent seizure(2
unprovoked seizure >24 apart) not caused
by fever or an acute illness.
could be generalized or partial,
Recurrent seizure in epilepsy despite
treatment could be due to:
1.Wrong diagnosis.
2.Incorrect type or improper dose of drug.
3.Underlying structural lesion.
4.Metabolic disorders.

28. Classification

29. Status epilepticus
• Seizures that persist without interruption for
more than 30 minutes or recurrence of serial
convulsion where the patient is unconscious
in between.
is usually of generalized tonic clonic type
and commonly
occurs in children with epilepsy.
Conditions in which SE is common:
1.Complex febrile seizure(>30 mins) is the
most common
2.Sudden withdrawal of anticonvulsant.
3.Sleep deprivation.
4.Intercurrent infection.

30. Differential diagnosis
• 1.Psuedoseizure: could be differentiated
from true seizure by:
 conscious
 a lack of coordination of movements.
 talking during the episode,
 the absence of incontinence or body injury
 EEG is usually normal.

31. 2.Disorders with altered consciousness( no
postictal phase +rapid recovery)
• Syncope(brief, sudden loss of consciousness usually
preceded by a feeling of light headedness.)
• Breath-holding spells(crying +breath
holding+cyanosis+twitching of extremities)
3. Sleep disorders
• Narcolepsy(sudden fall into sleep )
• Cataplexy(sudden fall into sleeep +loss of muscle
tone)
• Night terrors( preschool-aged child, with a sudden
awakening fromsleep,followedbycrying,screaming.
4.Psychologic disorders

32. Approach

33. Case
• 1yr old female presented with abnormal
body movement of 5 minutes duration ,
generalized tonic clonic, with high grade
fever, frothy mouth and rolled up eyes,
preceded by FBM 2times,
• Temperature 38.8c, PR 102 b/min, RR
24breath/min

34. HX
Preictal phase : any triggering factor like; fever,
sleep disturbance ,any illness, stress, trauma.
Ictal phase : during which the patient could
have :
Repetitive purposeless movement, Falling down
without cause, perioral cyanosis, Stiffening of any
or all extremities, Rhythmic shaking of any or all
extremities, deviation of the eyes ,bladder or
bowel incontinence, diminished level of
consciousness or unresponsive and unconscious.
Postictal phase: sleepy, headache or confusion
and gain of consciousness, hyperthermia..

35. Other questions
• HX of seizures
• FH of seizures, PMH
• developmental history
• Drug hx
• Immunization

36. Examination:
• General observation
• Physical examination:
• Vital signs, growth parameter,
developmental stage of child in gross motor,
fine motor, language and social, delay may
include cerebral palsy, chronic ongoing eg:
tumor, or secondary to another diseases

37. • Neurological examination:
• Cranial nerve examination
• Motor and reflexes
• Coordination and gait
• Signs of meningitis (neck stiffness,
kerning sign, brudzinski sign)

38. Investigation
1- RBS
2-S.electrolyate
3-CSF examinations: indication for
LP:1.infant<12months with 1st time febrile
convulsion to determine meningitis
2.12 to 18 months with a simple febrile
seizure
3.any child with meningial signs
4-EEG: if normal not exclude diagnosis
5-Ctscan:if head trauma present, & MRI: focal
neurological deficit, recurrent seizure

39. Management
• The objectives:
• Maintenance of adequate airway, breathing and
circulation (ABCs).
• Termination of the seizure and prevention of
recurrence.
• Diagnosis and initial therapy of life-threatening
causes of CSE (eg, hypoglycemia, meningitis and
cerebral space-occupying lesions).
• Management of refractory status epilepticus
(RSE).

41. THANK YOU
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