Definition

Abnormal movements are unusual voluntary or involuntary motions that an individual makes. Movement disorders are broken up into those that have insufficient movement and those that have excessive movement. Excessive movement is further divided into jerky and non-jerky movement disorders.

History

Site
Where are the abnormal movement?

Quality

Are the movements there at rest?
Are the movements there when you move?
Are the movements jerky?

Severity

How bad are the movements?
What do the movements stop you from doing?

Time Course

Onset-Offset

Do the movements come on suddenly?

Duration

How long have the abnormal movements been happening for?
How long do the abnormal movements last for?

Temporal Profile

Are they there all the time?
Do they come and go?

Context

Can you think of anything that may have caused the abnormal movements?

Aggravating Factors

Is there anything that makes it better?

Relieving Factors

Is there anything that makes it worse?

Associated Features

Have you noticed anything else with the abnormal movements?
Have you had any of the following:

Past History

Have you ever had depression in the past? (If it is a hypokinetic disorder)

Medications

Do you take any dopamine antagonist medications for nausea, depression or psychosis

Family History

Has anybody in you family ever had a movement disorder?

Social History

  • Can you tell me about you where you live?
  • Where do you work?
  • What are your hobbies?
  • Do you smoke?
  • Do you drink alcohol?

Examinations and Investigations

Bloods

Imaging

  • MRI Brain

Differential Diagnosis

  • Insufficient movement
  • Too much movement
    • Jerky movements
      • Myoclonus - Temporary involuntary twitch of a muscle or group of muscles. One form of this occurs during epilepsy
      • Chorea - Non repetitive jerky movements
      • Tic disorders - sudden, rapid, non-repetitive movements. Tourette's also has a vocal component
    • Non-jerky movements
      • Dystonia - sustained muscle contraction - twisting movements, repetitive movements, abnormal postures
      • Athetosis - slow, continuously changing, writhing, or contorting movements.
      • Tremor (Tremor has its own presentation page)

Red Flags

Management

Depends on the underlying condition. Refer to neurologist.

See also

Tremor
The Clinical Approach to Movement Disorders
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