Manifestations and treatment of hyperkinesis

General information

Hyperkinesis is usually called involuntary movements of various amplitudes and trajectories that pathologically arise in one muscle or their group under the influence of an “erroneous” command of structures in the brain.
The main causes of such disorders are organic damage to the structures of the extrapyramidal system and the brain as a result of infectious, hypoxic, toxic, vascular, metabolic and other pathogenic agents. Hyperkinesis is characterized by polymorphism and significant differences in prevalence, severity and symmetry, tempo and rhythm, as well as localization of lesions.

Etiology

The main reason for the development of this anomaly is dysfunction of the cerebral motor system. In addition, the following provoking factors for the development of hyperkinesis can be identified:

• damage to cerebral vessels;
• vascular compression of nerves;
• diseases of the endocrine system;
• cerebral palsy;
• congenital pathologies;
• severe brain injuries;
• toxic effects on the brain.

It is also worth noting that hyperkinesia can develop due to severe emotional shock, prolonged exposure to stressful situations and nervous tension. The development of an abnormal process as a result of other ailments - myocardial infarction, chronic cholecystitis - is no exception. In this case, the abnormal process is diagnosed in the area of ​​the gallbladder or left ventricle of the heart.

Pathogenesis

The term “hyperkinesis” comes from two Greek words: hyper - super strong and kineo - movement, but in order to understand the mechanism of sporadic movement of muscles, it is necessary to look more closely at the particularities of their innervation and contraction. Some researchers believed that various types of involuntary tonic, clonic contractions may be associated:

• with pressure on the nerves of ectatic vessels, tumors , vascular malformations, aneurysms in the brain;
• with the loss of the inhibitory effect of the striatum on nearby neurons;
• with the effect of neurovascular conflict;
• with chronic autoimmune attacks;
• with a relative excess of dopamine and catecholamines against the background of a lack of acetylcholine , serotonin and glycine as a result of disruption of neurotransmitter metabolism and the functioning of the extrapyramidal system.

Rings of the extrapyramidal system, providing regulation of motor activity, adequacy of tempo, amplitude and coordination of movements

Complications

Hyperkinesis in neurology often causes the development of joint contracture, and sometimes complete immobility can develop. In addition, hyperkinesis can appear against the background of other diseases and is their first manifestation.

If the disease develops in the area of ​​the gallbladder, this may indicate the onset of the development of chronic cholecystitis. Moreover, the disease is most often chronic.

Damage to hyperkinesis of the left ventricle of the heart is not considered as a separate disease. It is the initial sign of myocardial infarction. Most often, such pain and discomfort develops in patients over 40 years of age.

Classification

Depending on the nature of occurrence and location of localization, hyperkinesis is:

• extrapyramidal - when the basal ganglia or associated structures of the extrapyramidal system are affected (cerebral cortex, subcortical motor centers, brain stem, etc.);
• peripheral – pathogenesis affects the peripheral nervous system;
• medicinal – resulting from adverse reactions and toxic effects of medications, most often antipsychotic;
• hysterical or otherwise functional, are a manifestation of dissociative disorders.

German psychiatrist K. Leonhard separately identified a type called cycloid psychosis , the symptoms of which included hyperkinesis and manic (catatonic) agitation .

According to the form of manifestations and characteristics of the course, hyperkinesis is divided into:

• tremor (physiological, essential, parkinsonian, rubral mesencephalic Holmes tremor , dystonic, neuropathic and psychogenic);
• dystonia (cranial, cervical spastic torticollis , secondary and medicinal);
• mycolonia (physiological, essential, epileptic, symptomatic, multifocal, progressive myoclonic ataxia );
• tardive and paroxysmal dyskinesia (kinesiogenic and non-kinesiogenic paroxysmal);
• as well as tics , akatasia , chorea , athetosis , facial hemispasm , ballism , neuromyotonia , "painful limbs with moving fingers" and "rigid person" .

Tremor

Involuntary movements resembling trembling at a fairly fast speed, but not with a large amplitude. Can be observed in people of any age. Most often, the arms, head, lower jaw “twitch”, and in more rare cases, the legs. Symptoms arise when a person has accumulated muscle fatigue - this is the so-called physiological tremor , or the cause is emotional stress and excitement, so to speak, a neurotic type of genesis. Based on the type of pathological movements, it is customary to distinguish:

• statistical resting tremor - the amplitude is small, the tremor disappears during rest and occurs during periods of physical activity, even as minor as holding a cup, and can subsequently progress, involving the hands, characteristic of parkinsonism ;
• postural - the position of the body changes, the arms are extended forward;
• isometric – voluntary muscle contractions occur, for example, hands clenched into fists;
• intentional - can appear and sharply intensify when you need to perform a finger-nose test or hold a limb in a certain position statically;
• task-specific - manifests itself when you need to perform high-precision movements, for example, writing, playing a musical instrument, fastening jewelry, etc.

The causes of tremor can also be multiple sclerosis , olivopontocerebellar atrophy , various polyneuropathies , and old age.

Dystonia

With this type of hyperkinesis, there is an alternation of muscle hypotonia and rigidity of the extrapyramidal system, which is expressed in the form of slow, uniform rotational (dystonic) movements in various parts of the body. The main characteristic is that the patient assumes a dystonic posture, provided that the duration of muscle contraction is more than 60 seconds.

Taking into account the peculiarities of the distribution of pathological movements, dystonia is isolated:

• focal - covering one part of the body, for example, only the hand - in the form of writer's cramp or foot - with foot dystonia;
• multifocal – affecting many parts of the musculoskeletal system;
• segmental – affecting 2 or more parts of the body, passing one into another, from the neck to the shoulders and arm;
• generalized - dystonic movements are observed in all parts of the body or in several, but not transitioning from one to another, for example, the left arm and right leg, the spine;
• Hemidystonia – pathology affects only one side of the body.

The causes of dystonia are usually hepatocerebral degeneration , postencephalitic parkinsonism , degenerative diseases, posthypoxic and dysmetabolic (hepatic) encephalopathy , as well as hereditary Thien-Openheim disease .

Mycolonia

This term refers to a sudden, short-term, erratic, irregular contraction of individual muscles or groups of muscles, which does not move the corresponding joint. There are positive myoclonus , which is caused by active muscle contractions, and negative - provoked by a decrease in muscle tone.

Rhythmic – myorhythmias are characterized by the presence of a certain rhythm. The most famous cases of pathologies affecting the soft palate and larynx ( Foy-Hilleman syndrome ), pharynx, tongue, vocal folds, diaphragm. Similar symptoms can develop against the background of Economo encephalitis , multiple sclerosis, and brainstem stroke .

Depending on the distribution, myoclonus can be generalized, multifocal, segmental and focal, depending on the mechanism of occurrence - spontaneous, kinetic and reflex (the reason usually lies in sharp sounds, flashes of light, touches). However, the most common causes are intense physical activity, fear, lipidosis , Tay-Sachs syndrome , viral or other encephalopathy , degenerative disorders , stereotactic interventions .

Athetosis

Athetosis is called slow tonic convulsions of the limbs, trunk or face, which combine the features of dystonia and chorea . The pathology provokes cramps of varying degrees, alternately predominant in different muscle groups. The observed violent involuntary pathological movements are slow, worm-like and seem to crawl through the muscles. Athetosis is characterized by variability in muscle tone with the formation of transient contractures. With athetotic dysarthria, as a result of damage to the muscles of the tongue, phonation and articulation are impaired.

Athetosis is a symptom of damage to the basal ganglia and subcortical nuclei, including the striatum and putamen.

Patient with athetosis

Athetosis manifests itself at an early age in children as a result of birth trauma, kernicterus , stroke , and also as a manifestation of hereditary Hammond's disease . Unfortunately, no effective treatment has yet been developed.

Tic hyperkinesis

The tic type of hyperkenesis is manifested by short-term muscle contractions and, as a result, sudden jerky, repetitive movements, periodically migrating and changing intensity, reminiscent of some arbitrary caricature movements of an irresistible nature. Tics may decrease from the upper area of ​​the face to the lower extremities.

The manifestation of tics—simple (stereotypical) and complex (multivariate)—is typical in childhood or adolescence. Tics can occur:

• acutely - when they were provoked by traumatic situations;
• persistent - persisting for many years;
• chronically - pursuing throughout life.

The most typical tics are considered to be blinking and twitching of the face, neck, shoulders, parts of the torso and limbs. Tics are most often a consequence of postencephalic parkinsonism , posthypoxic encephalopathy , carbon monoxide poisoning, minor chorea , overdose of certain drugs (DOPA drugs, psychostimulants, antipsychotics). Separately, it is customary to distinguish Tourette syndrome , which includes a generalized tic with complex hyperkinesis and local tics.

Choreic hyperkinesis

Chorea or trochaic hyperkinesis is also commonly called the dance of St. Vitus . Most often it manifests itself against the background of rheumatism or is part of Huntington's disease , Loesch-Nychen syndrome , hepatocerebral dystrophy , paroxysmal choreoathetosis , as well as as a result of viral, bacterial, vascular, traumatic, dysimmune, metabolic or toxic damage to the subcortex.

Typically, patients are exhausted from rapid arrhythmic movements of the tongue, face, body and limbs, expressed in the form of grimaces, unexpected sharp movements, rotations and flexions of the limbs, body and neck. Choreic disturbances increase during excitement, when trying to delay them or perform a purposeful action, including walking, speaking, sitting.

Types of hyperkinesis

Today, the following types of hyperkinesis have been officially established in medicine:

• choreic hyperkinesis (generalized);
• hemifacial;
• athetoid;
• trembling (tremor);
• tic anomaly;
• slow;
• myoclonic hyperkinesis.

Each of these subtypes has its own clinical picture and possible complications.

Choreic hyperkinesis

Choreic hyperkinesis manifests itself in the form of abnormal movements of the limbs and muscles of the face.

Choreic hyperkinesis can appear as a consequence of rheumatism, difficult pregnancy or degenerative diseases. Also, this subtype of pathology can be congenital.

However, choreic hyperkinesis can also develop as a result of severe brain injury or the development of a malignant tumor. If a person makes strong swings of his arms from side to side, then such a symptom may indicate the development of a brain tumor.

Facial hyperkinesis

Hemifacial hyperkinesis is usually diagnosed on only one side of the face. It can manifest itself in a variety of ways - a person often spontaneously closes his eyes, can stick his tongue out, or makes strange movements with his mouth. In some clinical cases, the development of a pathological process over the entire face is possible. In this case, paraspasm is diagnosed.

Athetoid hyperkinesis

Athetoid hyperkinesis has a well-defined clinical picture:

• involuntary flexion of fingers and toes;
• muscle spasms on the face;
• trunk cramps.

The main danger of this subtype of hyperkinesis is that if the anomaly is not treated, joint contracture (severe stiffness or immobility) may develop.

Trembling subtype

This subtype of hyperkinesis (tremor) manifests itself in the form of rhythmic, systematically repeated movements up and down with the head, limbs, and sometimes the entire body. In some cases, such a symptom may be especially severe when trying to perform some action or at rest. It is noteworthy that trembling hyperkinesis is the first sign of Parkinson's disease.

Tic subtype

Tic hyperkinesis is most often diagnosed. It manifests itself in the form of rhythmic vibrations of the head, frequent blinking or squinting. Symptoms are especially strong when a person is in strong emotional arousal. In addition, the tic subtype of anomaly may be some kind of reflex reaction to sudden loud sounds or a flash of bright light. Tic hyperkinesis occurs as a result of damage to the central nervous system.

Slow hyperkinesis

As for slow-type hyperkinesis, it is characterized as a simultaneous spasmodic contraction of some muscles and low tone of others. In view of this, a person can take the most unexpected poses. The more developed this syndrome is, the greater the threat to the entire musculoskeletal system. Such sudden changes in position against a person’s will and prolonged stay in them can lead to joint contracture.

Twitching of facial muscles

Myoclonic subtype

Myoclonic hyperkinesis has the following clinical picture:

• synchronous, shock-point contractions of the muscles of the face and lower extremities;
• After an attack, tremors of the limbs are possible.

As medical practice shows, myoclonic hyperkinesis often implies a congenital form.

Causes

The causes of hyperkinesis are organic and functional lesions of the nervous system. They come in different natures, including:

• a side effect of some antipsychotics, causing neuroleptic syndrome ;
• infectious diseases - against the background of encephalitis , rheumatism , discirculatory encephalopathies , etc.;
• mental disorders, primarily dissociative;
• intoxication;
• hypoxia;
• hereditary diseases;
• vitamin or food starvation;
• emotional overstrain, stress and psychological trauma;
• traumatic brain injuries.

Psychogenic tics, nervous tics

Psychogenic tics occur against the background of an acute or chronic traumatic situation. They are divided into obsessive and neurotic. Obsessive tics are more common during school age. Motor disorders in these patients are quite complex and unusual, often combined with other manifestations of obsession. Their mental trauma is long-term and chronic. Sarclinic specialists have noticed that children with nervous tics often have poor academic performance in secondary schools due to overload (especially in gymnasiums and specialized schools). A conflict arises between the sense of duty and the child’s capabilities. And parents demand good and excellent grades.

Symptoms

Hyperkinesis is expressed mainly in the form of attacks of muscle spasms and spontaneously occurring movements, which can be:

• rare differently directed muscle contractions, which gradually progress, increase and spread radially, and when affecting sensory structures, for example, visual ones, can deprive a person of the ability to see for some time, for example, with hemispasm ;
• slow stereotypical and pretentious movements of the limbs with a small scope, as in athetosis , which can cover the face, forming various grimaces;
• reminiscent of dance (trochaic hyperkinesis) as a result of chaotic, jerky, irregular gestures and movements that vary in amplitude and sharpness can be overly pretentious and grotesque;
• rhythmic trembling - tremor of various parts of the body in the form of fast, stereotypical oscillations of insignificant amplitude;
• short-term muscle contractions cause sudden jerky, repetitive movements, which in tic hyperkinases resemble caricatures;
• slow, uniform rotational dystonic movements in a certain part or throughout the body.

In addition, frequent attacks of hyperkinesis provoke fatigue, stress and anxiety.

Diagnostics

Diagnosis of hyperkinesis is almost entirely based on the clinical picture. A doctor with extensive practice can immediately determine the type of disorder. And since in some diseases the form and symptoms of hyperkinesis are the only “key” to diagnosis, treatment and prognosis, every neurologist must know them.

In some cases, on the contrary, there are symptomatic forms that proceed similarly to various injuries, infections, and strokes. It is almost always necessary to perform MRI and CT to exclude space-occupying formations; in some cases, an EEG and genetic counseling are required, and in Wilson-Konovalov disease, for example, the determination of copper in the body is decisive.

About the treatment of hyperkinesis

Treatment of hyperkinesis is a complex and multidisciplinary task. In some cases, for example, with a successful fight against the underlying disease (brucellosis, streptococcal infection), the violent movement goes away on its own. With successful treatment of kernicterus and hemolytic disease, hyperkinesis in newborns also disappears.

Essential tremor has a different fate: tremors often have to be treated throughout life, using symptomatic remedies, for example, beta blockers. In some cases, treatment involves the use of drugs that act on dopaminergic and cholinergic receptors, and in severe cases, surgery or botulinum toxin injections are required to resolve muscle spasms.

In special cases, hyperkinesis is a symptom of a progressive and incurable disease, which can lead to death and dementia. This is, for example, Huntington's chorea. But the search for drugs and new methods continues, and we hope that a successful cure for this and many other diseases is not far off.

Tests and diagnostics

The main way to determine the causes of hyperkinesis since the 70s has been magnetic resonance imaging, which can sometimes give a false-negative result without revealing a neurovascular conflict, but allows one to detect tumors , aneurysms , vascular malformations , foci of demyelination and areas affected by lacunar infarction. In addition, building a model of neurovascular relationships using three-dimensional reconstruction can be useful at the preoperative planning stage.

Hyperkinesis in children

The most common problem of involuntary pathological movements is hyperkenesis in children - up to 6% of cases, a third of which are tics. They usually develop against the background of attention deficit disorder , stereotypy , anxiety, learning difficulties, mood swings and sleep disorders.

Parents should understand that the pathology can be paroxysmal and not manifest itself all the time, but only during mental or muscle strain. And despite the fact that the movements may seem completely natural, they are not involuntary, they can progress and spread.

If you do not seek treatment in time, then in addition to discomfort and the risk of progression of the pathology, the child will have problems with school, communication with other people and, in general, psychological trauma, which, even after excluding organic disorders, will need to be corrected by a good psychoanalyst.

Symptoms

The clinical picture of the disease is characterized by polymorphism, varying degrees of severity and prevalence of symptoms.

The first signs of pathology appear in early childhood and are diagnosed somewhat later. In children, hyperkinetic syndrome is manifested by the following initial signs:

• Excessive activity
• Strong excitability
• Inattention,
• Impaired cognitive functions,
• Impatience
• Imbalance,
• Restlessness,
• Anxiety
• Constant movements of arms and legs.

Infants are highly sensitive to external stimuli - noise, light, hypo- and hyperthermia, changes in their usual environment. They are overly active not only during the day, but also in the evenings. Before bedtime, babies resist swaddling, eat poorly, and cannot calm down for a long time. Their sleep is disturbed: it becomes short and intermittent. Patients often wake up due to active movements of their arms and legs. One-year-old babies usually do not sit, do not crawl, and rarely roll over onto their stomachs. They sharply throw their head back or turn it around. They make quick and sweeping, worm-like movements with their hands, often shuddering and closing their eyes.

Sick children 4-5 years old are bothered by twitching of different parts of the body - squeezing the gluteal muscles, twisting the arms and legs in different directions, opening the mouth, as well as vocalisms - coughing, sniffing, grunting. These symptoms occur suddenly, periodically becoming more frequent or weakening. They may disappear at night, but they always worsen before bed. Patients are characterized by delayed speech and psycho-emotional development with preservation of intelligence. Such children do not study in kindergarten themselves and interfere with others. When trying to force them to do something, they show aggression, beat and bite other children and the teacher. Sick children cannot play or spend leisure time in peace. They do not concentrate and prefer physical activity.

Boys and girls are able to restrain themselves. By pacifying their motor restlessness at least for a short time, they begin to feel internal discomfort, tension and anxiety.

Adolescents have the following characteristics:

1. Impulsiveness,
2. Nervousness,
3. Emotionality,
4. Intolerance,
5. Impressionability,
6. Impetuousness,
7. Excitability,
8. Expansiveness.

Patients constantly interrupt the conversation, interrupt the interlocutor, and cannot listen to him to the end. Questions are answered harshly and often inadequately, which is due to an inability to listen. They behave unmotivated, do unexpected things - run, jump, interrupt a game or conversation. Children with pathology experience difficulties in learning: they have poor memory, handwriting, sound perception and speech are impaired. At the same time, intelligence does not suffer. They are characterized by sudden changes in mood - from aggression and protest to anxiety and sadness. Often depression is caused by intra-family and interpersonal conflicts.

Hyperkinetic syndrome is characterized by rash and unexpected actions of patients. They are aggressive, tactless, rude, and prone to nervous disorders. Patients sleep poorly, have no appetite, and their mood often changes. It is difficult to communicate with them, because their sympathies are short-term, they cannot wait, they need to get everything at once.

Clinical signs of the syndrome in adults are:

• Tiki,
• Tremor,
• Twitching of facial muscles
• Chaotic movements of various parts of the body,
• Impaired gesticulation
• Mimic disorders,
• Speech dysfunction.

Motor acts that develop against the patient’s will are violent. The intensity of clinical signs increases with walking, writing, speech activity, and in states of psycho-emotional stress. Patients can suppress them for a short time.

When making a diagnosis, it is necessary to take into account the age characteristics of patients. Symptoms of a pathology of the cardiac type are: pulsation in the head and neck, tachycardia, hypertension. Hyperkinetic syndrome with a predominance of hypotension is manifested by cephalgia, tinnitus, dizziness, lethargy, blurred vision, and hyperhidrosis.

Clinical manifestations stop by the age of 20, first gradually weakening and then completely disappearing. First, excess mobility goes away, and then attention disorder. If left untreated, the syndrome can lead to antisocial behavior and personal and emotional disorders. Complications of the pathology are severe mental disorders that make a person disabled.

Video: example of a patient with hyperkinesia

Diet for hyperkinesis

Individuals suffering from tremor , myoclonus , tics or any other type of hyperkinesis are advised to follow a diet that is primarily rich in vitamins . It is important to establish a diet so that the body does not experience depletion of certain microelements and plastic materials, so the patient should eat 3-5 times a day at a certain time of day and receive in sufficient quantities:

• protein – dietary meat, according to its weight and type of activity;
• plant foods - vegetables and grains should always be present on the plate;
• fats – exclusively healthy vegetable fats from unrefined oils, seeds, nuts and seafood;
• carbohydrates - simple “empty” carbohydrates in the form of white bread, sugar, pasta and, to a greater extent, healthy sweets such as halva, marshmallows, dried fruits and, in particular, a variety of fruits rich in vitamins, which can be consumed fresh, should be on the table in a minimum amount form, in the form of salads, juices, smoothies, and also baked.