Dr Heera E Chand
Movement disorders are common neurologic disturbances in childhood. There are two major types of movement disorders, hyperkinetic and hypokinetic. Hyperkinetic movements are most commonly seen in pediatric age group whereas Hypokinetic movements are very unusual in the paediatric age group. Therefore this article deals with some common hyperkinetic movement disorders in children and its homoeopathic management.
Key words : Movement disorders, hyperkinetic, hypokinetic, homoeopathy.
Movement disorders are abnormal , excessive, involuntary movements that may result in abnormalities in posture , tone, balance or fine motor control. Most of movement disorders in children are characterized by involuntary movements. Movement disorders are classified broadly in to hyperkinetic and hypokinetic disorders.
Hyperkinetic movements are abnormal, repetitive, excessive and involuntary movements ( Chorea, dystonia, athetosis, myoclonus, tics, tremor and ballism). And are most commonly seen in pediatric age group.
Hypokinetic movements are slow voluntary movements and akinesia. These are very unusual in paediatric age group.
Movement disorders can be grouped according to the speed of movements. Fastest being myoclonus, slightly slower will be ballism , then chorea, athetosis and slowest is dystonia.
Types of hyperkinetic movements seen in children.
Dance like , rapid , high amplitude , chaotic movement that seems to flow from one body part to another. They are involuntary, continual, irregular movements or movement fragments with variable rate and direction that occur unpredictably and randomly. These movements cannot be suppressed voluntarily. Proximal part is more affected than distal. Most of them have history of brain injuries but rare genetic causes should be considered. There are numerous causes for chorea , common etiologies are cerebral palsy, stroke, cerebral vasculitis, brain tumors, encephalitis , post encephalitis, Drugs( Antiseizure drugs, Stimulants),Paroxysmal disorders like Migraine.
Dystonia is characterized by involuntary muscle contractions, frequently causing painful or uncomfortable twisting and repetitive movements or abnormal intermittent fixed postures or both. It is due to simultaneous agonist – antagonist muscles contraction. Exacerbated by voluntary actions, stress, fatigue and pain. It will decrease or disappears at sleep. Common etiologies of dystonia in children are Cerebral palsy, kernicterus, Hypoxic – ischemic injury, stroke, Niemann- Pick type C, Wilson disease, Drugs/Toxins ,Paroxysmal disorders
It is characterized by slow continuous, writhing movements that repeatedly involve the same body parts, usually the distal extremities, face, neck or trunk. Like chorea , athetosis may occur at rest and is often worsened by voluntary movement. Athetosis tends to occur with chorea it is called chorea athetosis. chorea athetosis is associated with cerebral palsy, kernicterus and other forms of basal ganglia injury ; there fore , it is often seen in conjunction with rigidity. As with chorea, athetosis/choreoathetosis can also seen with hypoxic – ischemic injury and dopamine blocking drugs.
Myoclonus refers to very brief , abrupt, involuntary, nonsuppressible , jerky contractions ( or interruption of contractions) involving a single muscle or muscle group. Rapidity of these movements is often described as shock – like . Can be elicited by a sensory stimulus. It is present in normal and pathological situations, both epileptic and non epileptic. Common causes of myoclonus seen in children are hiccups, hypnic jerks, nocturnal myoclonus, myoclonus with fever, Juvenile Gauchers disease( type III), GM1 gangliosidosis. Huntington disease, Infectious and post infectious diseases : Meningitis, Encephalitis, EBV, HIV, metabolic causes: Uremia, hepatic failure, hypoglycemia or hyperglycemia and drugs/toxins.
Tics are the most common movement disorder in childhood, these are involuntary, sudden , rapid, abrupt, repetitive, nonrythemic , simple or complex motor movements or vocalizations ( phonic productions). Tics are usually preceded by an urge that is relieved by carrying out the movement. Tics are suppressive and almost always disappear at sleep and can be exacerbating with stress, excitement and anxiety. Tourette syndrome or disease is the most severe and disabling chronic form of tic disorder that usually comorbid with Attention deficit hyperactive disorder (ADHD), Obsessive compulsive disorder (OCD) and interfere with normal daily activities. Etiological factors includes, genetic , neurological, psychological, environmental, Premature birth, nicotine and caffeine use, tumors, poisoning , infection and head trauma.
These are oscillating, involuntary , regular and rhythmic movements of body parts about a fixed point , axis or plane. Can affect head, extremities, trunk and even soft palate separately or combined. Tremors are relatively common in adolescents and fine motor activity of involved person can be limited by severe sustained tremors. Pathophysiologically any dysfunction of cortex , basal ganglia , brainstem and cerebellum can cause tremor. Etiologies include , stroke( mid brain), multiple sclerosis, familial essential tremor, Juvenile Parkinson and Wilson disease. Hyperthyroidism, hypoglycemia , hypocalcemia, and hepatic encephalopathy, Cerebellar disorders and functional tremor.
Abnormal, repetitive, purposeless rhythmic , patterned , episodic, involuntary movements that occur in the same fashion with each repetition. These movements are not seen in lower extremities and usually occur in head and distal parts of upper extremities. Can occur in neurologically impaired patients or in otherwise normal children. Common under lying etiologies associated with stereotypes are Autistic spectrum disorders , intellectual disabilities and sensory deficits. Abnormal movements include head banging, body rocking, thumb sucking, facial grimacing, waving and wrist rotation. It won’t interfere with daily activities of involved children and could be ceased by distraction or engaging in a new activity. It can be exacerbating by fatigue , stress and excitement.
These are involuntary , high – amplitude , flinging movements typically occurring proximally. Ballism is essentially a large amplitude chorea.
It causes convulsions, preceded by trembling. Mouth, Jaws fixed. Bites tongue; trembles. Tremor is a marked feature, tremor of tongue, heart. Chorea.
Involuntary movements while awake, cease during sleep, chorea from simple motions and jerks of single muscle to dancing of whole body; trembling of the hands. Uncertainty in walking, stumbling gait. Fingers fly spasmodically while holding things. White coated tongue along with increased thirst and trembling of tongue. Very sensitive to cold air.
Trembling; with shivering, when yawning. Convulsions, with consciousness. Tosses arms from side to side (children).Sudden inward jerking of fingers of right hand. Stretches out feet spasmodically (children).Twitching and jerking in limbs. Left foot in constant spasmodic motion. Choreic movements of the face and hands. Nocturnal convulsions.
Left arm feels as if bound to the side; constant irregular motion of left arm ( Chorea). Hands treble while writing. Alternation of rheumatic and mental symptoms. Trembling of legs can scarcely walk. Uneasy and restless feeling in the limbs. Chorea at puberty with delayed menses. I’ll effects of anxiety, fright, disappointed love, overexertion business failure, child bearing. Children during dentition. Difficult speech, patient bites tongue when talking.
Convulsions may be either tonic or clonic; start in the knees, toes or fingers and radiate over the whole body; with piercing cries, twisting of the head to one side; trismus, followed by headache, spasmodic laughter, shivering, deathly exhaustion, cold perspiration etc.; epilepsy; at night. Convulsions of children, during dentition; children lie on abdomen and jerk the buttock up. Jerking during sleep. Shakes the head from side to side. Chewing motion of lower jaw. Skin bluish, marbled.
Dizziness, drowsiness, dullness, and trembling. Muscular weakness. Lack of muscular co-ordination. Emotional excitement, fear, etc. Lead to bodily ailments. Excessive trembling and weakness of all limbs. Hysteric convulsions. Fever, thirst absent; with trembling.
Trembling of all limbs. Loss of power in extremities. Spasmodic motions of arms and legs. Cannot write; cannot hold a glass of water. Trembling of hands in paralysis. Tongue tremulous.
Emotional chorea; trembling the head, arms and hands. Arms are thrown out at right angles with the body and spasmodic jerking of the flexors; convulsive movements of one or other arm to and fro. Twitching continue during sleep.
Constant motion of whole body. Tremulous. Twitching of facial muscles and limbs, head jerked to one side. Restless hands. Convulsive uncontrollable movements of arms and leg. Limbs drag while walking5,8.Fever with excessive thirst and trembling of limbs.
Extremities, weakness and trembling from every exertion can scarcely hold anything with hands. Associated with numbness of hands.
Stinging and tearing in limbs, also twitching and tingling, numbness, pain or tremor. With the chronic affection of the head there is contraction of the muscles of the back and neck; drawing and twitching indicating meningeal troubles; spasmodic jerking. Paralysis; hysterical; infantile; of single parts, (wrist drop), flaccid; with hyperaesthesia; agg. Touch. Tremors, followed by paralysis.
Increases the mobility of the muscles of expression and of locomotion; the motions may be graceful, rhythmic or disorderly, of head and arms. Dread of Darkness, and has a horror of glistening objects. Wringing of hands. Staggering gait. Suppressed secretions and excretions. Absence of pain and muscular mobility especially of muscles of expression and of locomotion.
Nervous, irritable, obstinate and headstrong nature. Very offensive foot sweat. Chilly and cannot tolerate a slight draught of air. Defective nutrition and imperfect assimilation. Trembling of hands when attempting to do something.
Choreic movements affect the right arm and right leg, and when the movements continue even at night, and are brought on by fright, grief, etc., The patient is restless , fidgety ; hurried in constant motion, though walking aggravates. Can run better than walk.Quivering; jerking; trembling; twitching. The spine is sensitive, and there is trembling. It is the remedy when diversion of the mind, especially music, relieves.
Child cries out during sleep, whole body jerks during sleep, wakes frightened, starts, and rolls the head from side to side. Incessant and violent fidgety feeling in feet or lower extremities, must move them constantly. Twitching and jerking of single muscle. Automatic motion of hands and head or one hand and head. History of suppression of skin eruptions. Convulsion with pale face and no heat
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Dr Heera E Chand
PG Scholar Fr Muller Homoeopathic medical college, Mangaluru