involuntary movement
Introduction
Introduction to involuntary movement Involuntary movement (involuntary movement) is when the patient is conscious (sometimes can occur in mild disturbance of consciousness or shallow coma), uncontrollable skeletal muscle abnormal movement, various forms of expression, generally aggravated during emotional excitement, during sleep Stop; most of the lesions occur in the extrapyramidal system, cerebral cortex motor area, brain stem, cerebellum, spinal cord, peripheral nerves and even muscle lesions. basic knowledge Sickness ratio: 0.0002%-0.0004% Susceptible people: no specific people Mode of infection: non-infectious complication:
Cause
Involuntary movement cause
Pathogenesis
In recent years, great progress has been made in the study of neurotransmitters (chemical delivery substances), which are thought to be stored in synaptic vesicles at the axon terminals, including acetylcholine, norepinephrine, dopamine, serotonin, gamma. - Aminobutyric acid and glycine, such as dopamine is mainly inhibited, and acetylcholine is mainly facilitated.
The functional status of extrapyramidal neurons depends on the balance of the transmitter. Dopamine and acetylcholine are more important. For example, the decrease of dopamine in the striatum and the imbalance of acetylcholine are paralyzed. The serotonin and histamine are also related to the occurrence of tremor. Moreover, if the facilitation of dopamine is enhanced, involuntary dance movements will occur. At present, the mechanism of this aspect has not been fully elucidated. The types of postures caused by extrapyramidal lesions, abnormal movements, and involuntary movements mainly include:
1. Patients with Parkinson's disease may have static tremor.
2. In Parkinson's disease, the extensor and flexor muscles are both increased, which can lead to muscle rigidity.
3. Small chorea, Huntington's chorea and application of neuroleptics, often lead to chorea; hemichorea is limited to the side of the body, common in stroke, brain tumors.
4. Huntington's chorea, Wilson's disease, hepatic encephalopathy, Hallervorden-Spatz disease, phenol thiazide and haloperidol chronic poisoning can cause athesis of hand and foot; unilateral hand and foot hyperactivity is more common in stroke .
5. Hemiballismus is caused by acute lesions in the lateral part of the nucleus of the thalamus and its associated globus pallidus.
6. Extrapyramidal lesions (such as hepatolenticular degeneration) may have dystonia (myodystonia).
7. Twitch-Slang Syndrome Most scholars tend to think of a particular type of epilepsy.
Prevention
Involuntary exercise prevention
Pay attention to rest, work and rest, life in an orderly manner, and maintaining an optimistic, positive and upward attitude towards life can be of great help in preventing diseases.
Complication
Involuntary motor complications Complication
Involuntary movements generally do not have complications. Involuntary movement is when the patient is conscious (sometimes it can occur in mild disturbance of consciousness or shallow coma), and there is an uncontrollable skeletal muscle abnormal movement, which is manifested in various forms. Emotional aggravation, stop during sleep; most of the lesions occur in the extrapyramidal, cerebral cortex motor area, brain stem, cerebellum, spinal cord, peripheral nerves and even muscle lesions can also be caused.
Symptom
Involuntary movement symptoms Common symptoms Functional tremor continuous muscle contraction Intermittent muscle contraction muscle fibrillation Hepatolenticular degeneration Tick dementia
What are the performances of involuntary movements and how to diagnose them:
1. Tremor is a rhythmic movement of a certain part of the body in a certain direction, and the involuntary movement of different magnitudes is most common in the hand, followed by the eyelids, the head and the tongue, and the tremor can be divided into physiological and functional. Sexual and pathological three species.
(1) Physiological tremor: The amplitude of tremor is small, it is difficult to see by the naked eye, and it is more obvious during exercise. It is common in the hand and the frequency is 8 to 13 times/s.
(2) Functional tremor: This type of tremor may be an enhancement of physiological tremor, which is a small, rapid and irregular vibration with varying amplitudes. The tremor is often irregular and variable, more common in the fingers, no muscles. The change of tension is often related to mental factors. The tremors caused by hyperthyroidism, anxiety and fatigue are also the same. This is due to the effect of adrenaline on muscle spindles, improving their sensitivity and enhancing sympathetic activity.
(3) Pathological tremor can be divided into the following types:
1 Resting tremor: When tremor is seen at rest, the tremor is reduced or disappeared after starting. The common one is tremor paralysis. This is due to the alternating contraction of the two groups of muscles that are antagonistic, the frequency is 4-6 times/s, and the tremor is first. Starting from the hand, it is a "pill-like action", which can be extended to the lower jaw, lips, tongue and head. It is common in tremor palsy and tremor paralysis syndrome. In addition to tremor, it is often accompanied by strong muscle tension and exercise. Symptoms and autonomic dysfunction, the main lesions of tremor paralysis in the substantia nigra, globus pallidus, midbrain are covered near the intersection of the arms, the cause of tremor paralysis syndrome can be many, can be caused by cerebral arteriosclerosis, craniocerebral injury, carbon monoxide , lithium, lead, cyanide, reserpine, phenothiazine drugs and antidepressants and other poisoning caused by, but also have unknown causes.
Disturbed tremors of tremors must be distinguished from senile tremors. Aged tremors are also static tremors. The head, jaw, and lips are more common. They are nodding or head-left, and the right side is tremor. Increased tension, but often combined with dementia.
2 Intentional tremor: Actually, it is action tremor. When the limb moves close to the target, the frequency of tremor increases. Compared with resting tremor, it has arrhythmia and amplitude. The patient's finger test is nasal and heel. The test is easy to detect, tremor disappears at rest, common in the cerebellar dentate nucleus or lesions related to the dentate nucleus, due to multiple sclerosis, diffuse periarthritis, measles or varicella after disseminated encephalomyelitis Wait.
3 orthostatic tremor: The tremor that occurs when the limb maintains a certain position is called orthostatic tremor. The most common is when the upper limb is stretched. The tremor is often suppressed during active exercise. When the emotion is tense, it strengthens. When it is completely rested and disappears, it disappears. Sexual tremor can be physiological and functional, and cerebellar diffuse lesions can also occur. Gross tremor can occur in the head, trunk and limbs, causing the patient not to sit, but the tremor disappears when the bed is at rest, hereditary tremor Mostly this is the case.
4 flapping tremor: manifested as upper and lower limbs, such as bird flapping, when the limb activity tends to a certain position, the tremor is strengthened, so there are also components of orthostatic tremor, mainly found in hepatolenticular degeneration and systemic metabolic diseases. Such as hepatic encephalopathy, pulmonary encephalopathy, uremia, as well as some poisoning, acute infections, etc.
2. The dance movement is an involuntary movement with no purpose, no rhythm, asymmetry, uncoordinated and fast, and varying amplitudes. It is expressed as a pouting, blinking an eyebrow, a tongue, etc., and the limbs are unoriented. The large-scale movement, rapid flexion and extension of the upper limbs, rapid flexion of the lower extremities, abduction, adduction, and flexion of the toes from time to time, etc., when shaking hands with the patient, you can feel the time is tight, the dance action is often due to Striatal lesions, especially when involved in the caudate nucleus, are commonly seen in chorea in dance.
(1) Small chorea: This disease is closely related to rheumatism, so it is also called rheumatoid chorea or Sydenham chorea. The disease is mostly children aged 5 to 15 years old. It must be distinguished from habitual sputum. The latter The involuntary movements are stereotyped, repetitive, confined to the contraction of the same muscle group, and the symptoms of rheumatoid disease are not seen in laboratory tests.
(2) Chronic progressive chorea: In addition to dance movements, patients often have dementia, and the onset is mostly in middle age. It is an autosomal dominant hereditary disease with lesions in the caudate nucleus and putamen, small nerves. Cell reduction, glial cell hyperplasia, cerebral cortical atrophy, this disease is thought to be due to the lack of enzymes that synthesize GABA in the striatum, or the lack of neurons containing this enzyme and the lack of choline.
(3) senile chorea: This disease occurs in elderly people over 50 years old. It has rapid onset, sometimes accompanied by local paralysis, dementia and mental disorders. The brain has extensive scattered softening lesions. There is no family history of this disease. Identification with chronic progressive chorea.
(4) Half-sided chorea: This disease is characterized by a dance-like movement that is confined to one side and involuntary of the lower extremities. It is often the result of vascular damage of the basal ganglia, and the patient is more common in middle-aged or old-age.
(5) Pregnancy chorea: This patient is often a young primipara, mostly in the first half of pregnancy.
(6) Congenital chorea: This disease is seen in infants born 6 months after birth, often accompanied by decreased muscle tone and developmental retardation.
(7) Dance movements can also be seen in other intracranial lesions and systemic lesions, such as encephalitis, brain tumors and brain degenerative diseases.
3. Hand and foot hyperactivity disorder, also known as finger movement, is characterized by dystonia and slow and irregular torsional movements of the hands and feet, mainly due to damage to the putamen and globus pallidus, the following two types are common in clinical practice.
(1) Congenital acromegaly: a few weeks or months after birth, there is often a decrease in intelligence, high and low muscle tension, bilateral hand and foot movements, and half may be associated with spastic paralysis of both lower extremities. When the throat muscle is involved, speech and dysphagia may occur, and the pathological change is striatum marble-like change, which is caused by cerebral hypoxia.
(2) Symptomatic acromegaly: can be seen in encephalitis, hepatolenticular degeneration and bilirubin encephalopathy.
4. Twisting sputum, also known as deformed dystonia, torsional dystonia, lenticular dystonia, manifested as involuntary movement of the limb or trunk in the longitudinal axis of the deformity, clinically with dystonia and limbs, The trunk and even the whole body are characterized by intense and involuntary torsion, the muscle tension is increased when twisted, and normal when the torsion is stopped.
The cause of primary torsion is unknown, and some are hereditary; symptomatic torsion can be seen in encephalitis, carbon monoxide or phenothiazine poisoning, hepatolenticular degeneration, bilirubin encephalopathy, etc.
The spastic torticollis is caused by the involuntary contraction of the cervical muscles, causing the head to twist to one side, causing the neck to be tilted obliquely, which is a symptom of torsion spasm, which may be caused by a high-level center related to the lost function; In addition, localized lesion stimulation can also lead to spastic torticollis.
5. Throwing action (twittering) is a kind of involuntary movement of the limb, which is expressed as a throwing dance movement, with obvious proximal muscles, which can be divided into single limb throwing movements, unilateral throwing movements and bilateral throwing movements. The subthalamic nucleus (Luys body) and its directly related structures are mostly caused by vascular damage, and can also be seen in encephalitis or brain tumors.
6. The involuntary contraction of the muscles or muscles of the fingers refers to the excitement of any part of the movement pathway from the cerebral cortex motor area to the muscle fibers. The types of sputum are:
(1) clonic sputum: for intermittent muscle contraction, repeated episodes of rapid onset and rhythmic tendons, such as facial muscle twitching, eyelids, diaphragmatic spasm, and limb spasms during seizures.
(2) tonic sputum: for sustained muscle contraction, often leading to long-lasting position changes or movement restrictions, seen in tetanus, hand and foot sputum, sinensis poisoning, rabies and occupational (or functional) tendon.
(3) Painful phlegm: It is an ankylosing tendon with pain. The pain is relieved with the relief of sputum. The pathogenesis may be that the overactive muscles need energy to increase, which causes relative ischemia and accumulation of metabolic products. It can be seen in fatigue and electrolyte disturbances, and the tendon of trigeminal neuralgia is also of this type.
7. Myoclonus muscles are fast and short, and the lightning-like irregularities do not contract at random. They are related to the damage of the olive nucleus, the dentate nucleus, the binding arm, the striatum and the central cover, from which there is no rhythm and can be divided. for:
(1) Rhythmic myoclonus: rhythmic contraction of soft palate, eye, throat or diaphragm, sometimes still occurs during sleep, seen in head trauma, vertebral-basal artery vascular disease.
(2) Non-rhythmic myoclonus: non-rhythmic myoclonic movements of limbs and trunk muscles can be seen in multiple myoclonus, myoclonic epilepsy, and central nervous system hypoxic lesions.
8. Muscle beam fibrillation and muscle fiber fibrillation
(1) Muscle beam fibrillation: Involuntary contraction of the muscle fiber bundle caused by increased excitability of motor neurons, and thus small, rapid or peristaltic fibrillation, which is insufficient to cause joint movement of the limb, but the patient has a sense of jumping at that place. After fatigue, sniper or cold stimulation, the symptoms are more obvious, often occurring in the hand muscles, the tongue muscles, and are characteristic signs of progressive lesions of the anterior horn cells and cranial nerve nucleus.
(2) Muscle fibrillation: refers to the electrical activity of muscle fibers damaged by a single denervation. It is only found during electromyography. It is worth noting that fasciculation without muscle atrophy is not necessarily a manifestation of disease. Normal people can also Appears after fatigue or tension, but occurs for a short period of time, called benign fasciculation.
9. Muscle fiber twitch, also known as multiple fibrosis, refers to the non-segmental involuntary contraction of a small number of muscle bundles in a muscle. When it is quiet, it can be seen slowly under the skin, irregular repetitive corrugated muscle contraction. Can cause joint movement, its movement and range is thicker, slower, longer lasting and extensive than fasciculation, without muscle atrophy, seen in anterior horn cells, peripheral nerves and muscle lesions.
10. Twitching is a repetition of a group of muscles or a muscle. The plate is contracted. Its amplitude is large. It can spread from one place to another. The frequency is not equal, and it has no rhythm. It is characterized by blinking, shrug, neck and other stereotypes. It is considered to be habitual paralysis, and most of them are spiritual. Children have more problems and can be temporarily controlled by their will.
This type of convulsion is different from the fact that multiple convulsions can occur in the same patient, not limited to one or a group of muscles.
Examine
Involuntary movement check
The necessary optional auxiliary inspection items include:
1. Cerebrospinal fluid examination, blood routine, blood electrolytes, blood sugar, urea nitrogen.
2. Patients suspected of hepatolenticular degeneration should be measured for liver function, 24h urinary copper, serum copper, serum ceruloplasmin, serum copper oxidase activity, etc. to assist in diagnosis.
3. Suspected intracranial lesions can be used for CT and MRI examinations; early CT examination of hepatolenticular degeneration can reveal low density shadows in the basal ganglia, and extensive brain atrophy, lateral ventricle enlargement, and sulcular widening in the later stage; Sexual chorea patients also have brain atrophy.
4. Bottom of the skull, chest, ECG, ultrasound.
5. Electromyography can be performed on patients with tremor and myoclonus.
Diagnosis
Involuntary motion diagnosis
The diagnosis and identification of involuntary movements and their causes are mainly based on medical history and neurological examination, combined with laboratory examinations and instrument examinations.
1. The age of onset of illness, the onset of urgency, the evolution of symptoms and whether the disease process is static or progressive, etc., the onset of infancy may be congenital, should pay attention to its production history, growth and development history, premature delivery Childhood and birth injury, history of asphyxia, postnatal mental and/or motor system developmental delay, suggesting brain hypoplasia; postpartum severe neonatal jaundice may be caused by bilirubin encephalopathy, acute onset may be infection ( Such as various encephalitis) or infectious diseases (such as rheumatic fever), the drug can cause acute onset (such as perphenazine, acute dystonia caused by chlorpromazine), but also slowly onset (such as pheno Delayed dyskinesia caused by neuropsychiatric inhibitors such as thiazides and butanamide derivatives. Excessive unilateral exercise in early childhood. Even if the onset is slow and the course of disease is progressively increased, cerebrovascular disease should be considered. The possibility of progressive attack and progressive development, at any age to suggest degenerative diseases, family history is very important, should carefully ask the brothers and sisters and their families for similar or related diseases, if necessary, should be checked.
2. Physical examination The neurological examination should first carefully observe the posture and position and the performance of involuntary movement, pay attention to its location, time (continuous or intermittent, speed), amplitude (size of motion, several joints or even the whole body), Regularity and form (action rules, stereotypes or changes), when asking for medical history and physical examination, should pay attention to the effects of sleep, rest, mental and emotional stress on involuntary movement, tremor caused by extrapyramidal lesions, dance-like movements, Hand and foot movements, twisting sputum, etc., are aggravated in mental and emotional stress, disappearing during sleep, involuntary movement can be obvious at the distal end of the limb, such as the movement of the hand and foot; also at the proximal end, such as deformable dystonia, can It is slow, and the abnormal posture can last for several minutes, such as the movement of the hand and foot and the twisting of the sputum; it can also be very fast, such as dance-like movements, the tremor of the hand must observe the upper limbs in the static movement, the extension and the finger-nose test, etc. Changes, pay attention to changes in muscle tone, the muscle tension of various tremor paralysis syndrome is increased in tonicity, combined with tremor can be "gear-like rigidity", dance-like exercise There may be a decrease in muscle tone, and the varying muscle tone is a feature of hand and foot hyperkinesia, torsion spasm, dystonia, etc. Examination of the cornea with or without the Kayser-Fleischer pigment ring is a simple and reliable method for determining hepatolenticular degeneration.
