Posttraumatic movement disorders

Sith Sathornsumetee MD (Dr. Sathornsumetee of Mahidol University, Thailand, has no relevant financial relationships to disclose.)
Mark A Stacy MD (Dr. Stacy of Duke University Medical Center received research support from Parkinson Study Group and consultation fees from Allergan, Eli Lilly, Merz, and Osmotica.)
Joseph Jankovic MD, editor. (Dr. Jankovic, Director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor College of Medicine, received research funding from Allergan, Allon, Ceregene, Chelsea, EMD Serono, Impax, Ipsen, Lundbeck, Medtronic, Merz, and Teva, and compensation for his services as a consultant or an advisory committee member by Allergan, Auspex, EMD Serono, Lundbeck, Merz, Neurocrine Biosciences, and Teva.)
Originally released November 15, 2004; last updated December 2, 2016; expires December 2, 2019

This article includes discussion of posttraumatic movement disorders and peripherally-induced movement disorders. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

The concept of movement disorders following trauma to the central and peripheral nervous systems has been widely accepted. It has both medical and legal implications to clinicians and their patients. The authors of this clinical article review and provide updates on the pathogenesis, diagnosis, and management of posttraumatic movement disorders.

Key points

 

• Movement disorders can occur following central and peripheral nervous system trauma.

 

Tremors and dystonia are the 2 most common abnormal movements following nervous system injury.

 

• Pathophysiology of posttraumatic movement disorders is complex and may include but not be limited to functional reorganization and alteration of neurotransmitters.

 

• Treatments for posttraumatic movement disorders are similar to those of nontraumatic movement disorders; however, the response is variable.

 

• A multidisciplinary approach is recommended in patients with comorbid psychological conditions and pending litigation.

Historical note and terminology

Although direct causal link between neurologic injury and the development of movement disorders has not been elucidated, tremor, dystonia, and parkinsonism have been reported following trauma to both the central and peripheral nervous system (Gowers 1888). The cause and effect is less apparent in cases of movement disorders following trauma to the peripheral nervous system. Some authors argue against the existence of “peripherally-induced” movement disorders (Weiner 2001; Hawley and Weiner 2011), whereas others have argued that tremor, dystonia, and segmental myoclonus following peripheral trauma are widely accepted (Jankovic 2001; Jankovic 2009; Tyvaert et al 2009). Some authors suggest the term “posttraumatic syndrome” instead of “posttraumatic dystonia” in patients who have developed abnormal posturing of body parts following peripheral injury (Kumar and Jog 2011). Other movement disorders have been reported following trauma including chorea, hemiballism (Kim et al 2008), ballism, paroxysmal dyskinesia, tics (Fahn 1982), progressive supranuclear palsy (Koller et al 1989), painful legs and moving toes (Schott 1981), cortical reflex myoclonus (Hallett et al 1979), palatal myoclonus (Jacobson and Gorman 1949), hemifacial spasm, hemimasticatory spasm, Meige syndrome (Jacome 2010), segmental myoclonus (Jankovic and Pardo 1986; Camerota et al 2006), jumping postamputation stump, and other postamputation dyskinesia (Jankovic 2009). In addition, trauma to both central and peripheral nervous systems may also trigger or accelerate the progression of preexisting movement disorders.

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