Ballism: Types, Causes, Signs, Symptoms, Diagnosis, Treatment and Prognosis

In a thousand people who have had a stroke, about 0.45 of them end up with the disorder.

Ballism is a rare disorder characterized by involuntary , constantly varying, large-amplitude movements of the proximal parts of the extremities, traditionally associated with pathology in the subthalamic nucleus of Luys.

In recent years, the subthalamic nucleus of Luys has become a focal point in basal ganglia pathophysiology models.

This activity is almost incessant and the movements are often complex and combined.

People with ballism are subject to serious movement-related symptoms that prevent them from performing their daily activities.

While ballism is an extremely rare disorder, it can also be the result, or it can accompany a host of other injuries or ailments.

Types

The involvement of a single limb has been termed monoballism and both limbs on the same side exclude the head and face, bibalism, the entire half of the body hemiballism, and both sides of the body parabalism.

The term bibalism has largely disappeared from the literature and most of the cases to which it could now be applied are known simply as hemibalism.

Korea and ballism

Chorea is characterized by repetitive , brief, irregular, somewhat rapid, and involuntary movements that typically involve the face, mouth, trunk, and extremities.

The patient with ballism can be identified by presenting frequent throwing movements of his arms and legs.

These random involuntary movements are vigorous, occur continuously, and can span all directions.

Both the proximal and distal muscles of the body participate in this incessant movement, and in most cases, even a patient’s facial muscles exhibit involuntary muscle contractions.

That is why the relationship between Korea and ballism has been hotly debated.

The difference is really quantitative and there are no absolute criteria by which these motion disturbances can be distinguished .

Chorea affects mainly the muscles of the distal extremities, and movements are not as vigorous or wide-ranging as ballism.

Some authors argue that they are two basically separate conditions in which clinical expressions tend to merge, while others consider ballism to be just a severe form of proximal chorea.

There is no doubt that in many cases both types of movements coexist and that, as ballism resolves, it often goes through a phase that is identical to korea.

The confusion also arises because the literature does not distinguish between these conditions or the terminology may be inaccurate.

Therefore, cases can be described in one category that fits equally or better in the other.

However, although there are many similarities, historical, clinical, and etiological ballism has certain characteristics that distinguish it from other forms of chorea.

Causes

One of the most common causes of ballism is an injury to the basal ganglia, an area of ​​the brain responsible for controlling the body’s movement and balance.

It can also be caused by abscesses or tumors in the brain, as well as poorly formed blood vessels, severe head trauma, and even multiple sclerosis.

In people younger than 60, the disorder is likely caused by brain inflammation or infection.

Although this disease is related to people who have suffered structural damage to the brain, it sometimes accompanies some metabolic abnormalities.

When a patient suffering from nonketotic hyperglycemia develops the complication of a lesion of the subthalamic nucleus in the brain, and ballism is one of the results.

Brain injuries like these are the second most common cause of movement disorder and are often attributed to elderly patients of East Asian descent.

This points to a genetic factor that involves the development of symptoms of ballism in patients suffering from hyperglycemia.

Symptoms become apparent whenever a patient’s blood glucose level spikes, and this condition with accompanying ballism symptoms can last up to several hours.

Neoplasms, which are abnormal cell growths in the brain, can also lead to ballism, especially if they form within the basal ganglia area.

Malformed blood vessels, which act to prevent normal blood flow to the brain, can also cause ballism.

This is especially true if this vascular malformation leads to the basal ganglia, where there is a great chance that the patient will have a stroke.

Patients suffering from a tuberculous meningitis infection may have damaged parts of their basal ganglia, and as a result, they may develop ballismus.

Ballism can also be the result of demyelinating plaques that damage the myelin sheaths found in neurons in the brain.

This prevents the conduction of neurons and distorts the signals they send to the basal ganglia. Confused signals result in uncoordinated and involuntary body movements.

As part of the complications derived from HIV infections, ballism can arise in patients due to hypoglycemia derived from their use of pentamidine.

It can also be caused by cerebral toxoplasmosis, a secondary infection that results from an impaired immune system, characteristic of people with HIV.

In most cases, ballism can be one of the visible manifestations from which a doctor can determine that a patient has AIDS.

Ballism is a type of movement disorder considered rarer compared to Parkinson’s disease.

Strokes are one of the most common causes of this movement disorder.

Ballism occurs when brain tissues die from strokes that cause insufficient oxygen and lack of blood supply to the brain.

This is particularly true if tissues in the basal ganglia are involved.

The damaged basal ganglia, in turn, send damaged electrical impulses to the skeletal muscles of the body, and the results are adjusted to the symptoms of ballism.

When a person experiences a severe and traumatic brain injury, whether from an accident or an act of violence, parts of the brain that are attributed to movement can be affected. This can also lead to ballism movements in a patient.

Ballism can also be caused by amyotrophic lateral sclerosis. This disorder is responsible for gliosis and neuronal loss in the basal ganglia of the brain, resulting in ballism.

Ballism signs and symptoms

The signs and symptoms of ballism consist of involuntary, irregular and often violent movements while the patient is awake.

In mild forms of ballism, only a person’s arm or leg can be affected, making normal movements, such as walking, difficult.

When the disease is more advanced, body movements involve violent and irregular twisting, as well as muscle spasms on one side or the other of the body.

When even the muscles of the torso are affected, the whole body is subjected to forced and involuntary movements that last up to several seconds at a time.

A patient who is awake and active will manifest an increasing number of these involuntary movements, and often the arms and legs move together. However, with relaxation or sleep, these movements slow down considerably.

Ballism is an ailment that can leave the patient exhausted both physically and mentally. Due to the violent movements involved, other joint and skin related injuries can occur.

Ballism is generally seen in people over the age of 60.

Diagnosis

To make an accurate diagnosis, the doctor will examine a patient’s complete medical history to determine the existence of an anterior nervous system or brain injury.

The doctor will also perform a complete physical examination, taking into account the patient’s age, medication history, and symptoms to rule out other movement disorders that may be similar to ballism.

The patient will be subjected to a series of basic movements and the doctor will observe the number of ballistic movements that occur within a given period of time.

This will allow the doctor to assess the severity of the patient’s symptoms to prescribe the appropriate medications and therapy.

In medical evaluation, the diagnosis of ballism is based on symptoms. However, tests can be done to identify the cause.

These tests may include brain imaging, such as MRI or CT scan, to detect tumors or evidence of a stroke.

Ballism treatment

Ballism usually goes away on its own after several days, but sometimes it lasts for 6 to 8 weeks.

In treating ballism, it is important to first treat the underlying medical condition or injury that caused or accompanied it, be it a stroke, hyperglycemia, brain injury, or infection.

In some cases, the symptoms of ballism may be mild, and treatment may be limited to the underlying causes of the disorder.

The early treatment of choice for ballism is medication to help regulate dopamine and other brain chemicals and processes that control movement and emotions.

There are many types of medications used to treat ballism.

One of these is dopamine blockers, which have been shown to be 90% effective in treating the symptoms of the disorder.

An anticonvulsant known as topiramate has also been successful in treating cases of ballism.

Other solutions include intrathecal baclofen therapy involving an implanted pump to decrease episodes of ballism, injections of Clostridium botulinum, administration of tetrabenazine, and the antipsychotic drug haloperidol.

Since this disorder is usually temporary, if the symptoms persist for several months, or if the movements are so violent that the patient is exhausted, they are serious cases of ballism.

In these cases, the patient does not respond to traditional treatment, neurosurgical procedures to injure the globe pallus of the brain or to perform deep brain stimulation are other viable options.

Stereotactic surgery allows doctors to locate locations in the thalamus, the part of the brain that transmits sensory impulses, and perform interventions that alleviate abnormal movements.

These surgical options have been explored with some success. Interventions have been based on advances in the ability to place precise lesions on a variety of targets, including the globus pallidus, thalamus, and subthalamic sites.

Forecast

There is a high probability of response, especially to neuroleptic or catecholamine depletion treatments, and other data where ballism can often be self-limited.