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mal dyskinesias according to the duration of each attack and the event or activity that precipitates the abnormal movements (kinesigenic, nonkinesigenic, exertional, or hypnagogic) As with the familial cases, the acquired kinesigenically induced movements improve with anticonvulsants; others respond better to clonazepam Some cases are an expression of a serious neurologic or metabolic disease, or they may follow injuries such as stroke, trauma, encephalitis, perinatal anoxia, multiple sclerosis, hypoparathyroidism, or thyrotoxicosis The most severe instances in our experience have been of the kinesigenic variety due to multiple sclerosis and, in a few recent cases, to HIV, as a result of toxoplasmosis, lymphoma, or a presumed encephalitis due to the retrovirus itself These patients were relatively unresponsive to medications Also, it should be recalled that oculogyric crises and other nonepileptic spasms have occurred episodically in patients with postencephalitic parkinsonism; these phenomena are now seen with acute and chronic phenothiazine intoxication and with Niemann-Pick disease (type C) The Identity of Chorea, Athetosis, and Dystonia It must be evident from the foregoing descriptions that the distinctions between chorea and athetosis are probably not fundamental Even their most prominent differences the discreteness and rapidity of choreic movements and the slowness and con uence of athetotic ones may be more apparent than real As pointed out by Kinnier Wilson, involuntary movements may follow one another in such rapid succession that they become con uent and therefore appear to be slow In practice, one nds that the patient with relatively slow, con uent movements also shows discrete, rapid ones, and vice versa, and that many patients with chorea and athetosis also exhibit the persistent disorder of movement and posture that is generally designated as dystonia In a similar vein, no meaningful distinction except one of degree can be made between choreoathetosis and ballismus Particularly forceful movements of large amplitude (ballismus) are observed in certain patients with Sydenham and Huntington chorea who, according to traditional teaching, exemplify pure forms of chorea and athetosis, respectively The close relationship between these involuntary movements is illustrated by the patient with hemiballismus who, at the onset of the illness, exhibits wild inging movements of the arm and, after a period of partial recovery, shows only choreoathetotic exion-extension movements that are limited to the ngers and hand For this reason, the terms hemiballismus and hemichorea have sometimes been used interchangeably It should be pointed out that all disorders of movement due to lesions of the extrapyramidal system have certain other attributes in common The abnormalities of movement are superimposed on relatively intact praxic and voluntary movements, implying integrity of the cerebral control of the corticospinal systems The persistence of the abnormal movements indicates that they are veritable release phenomena; they are abolished by sleep and enhanced by anxiety and excitement; they are caused by a variety of diseases, some of which evoke one type of movement disorder more than another; and they can be altered by certain pharmacologic agents and by stereotactic lesions in certain parts of the motor systems To the clinician, the most dif cult examples are those in which all types of involuntary movement and tremors are combined a gestalt of dyskinesias Finally, while lesions in these parts of the cerebrum are most certainly manifest as disorders of movement, it would be incorrect to assume that other parts of the brain are not as involved; regions. barcode generator excel add in free Make Barcode in Excel - YouTube
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