Hyperkinesia: Definition, Classification and Diagnosis

It refers to an increase in muscle activity that can cause excessive abnormal movements, excessive normal movements or a combination of both.

Hyperkinesia is a state of excessive restlessness that occurs in a wide variety of disorders that affect the ability to control motor movement, such as Huntington’s disease.

It is the opposite of hypokinesia , which refers to the decrease in body movement, as commonly manifested in Parkinson’s disease.

Many hyperkinetic movements are the result of inadequate regulation of the circuits of the thalamocortical basal ganglia.

The hyperactivity of a direct pathway combined with decreased activity of an indirect pathway results in the activation of thalamic neurons and the excitation of cortical neurons, which results in an increase in motor power.

Often, hyperkinesia is combined with hypotonia , a decrease in muscle tone.

Many hyperkinetic disorders are psychological in nature and are typically prominent in childhood.

Depending on the specific type of hyperkinetic movement, there are different treatment options available to minimize symptoms, including different medical and surgical therapies.

Classification

The basic hyperkinetic movements can be defined as any unwanted excessive movement. These abnormal movements can be distinguished from each other depending on whether or not they are, or to what degree they are, rhythmic, discrete, repeated and random.

When evaluating the individual with a suspected form of hyperkinesia, the physician will record a comprehensive medical history that includes a clear description of the movements in question, medications prescribed in the past and present, family history of similar diseases, medical history, including past infections.

Also any previous exposure to toxic chemicals.

Hyperkinesia is a defining characteristic of many childhood movement disorders, although it differs clearly from both hypertonia and negative signs, which are also often involved in these disorders.

Several prominent forms of hyperkinetic movements include:

Ataxia:

The term ataxia refers to a group of progressive neurological diseases that alter coordination and balance.

Atethosis:

Athetosis is defined as a slow, continuous and involuntary twisting movement that prevents the individual from maintaining a stable posture.

Korea:

Chorea is a continuous sequence of random appearance of one or more discrete involuntary movements or fragments of movement.

Distonía:

Dystonia is a movement disorder in which involuntarily sustained or intermittent muscle contractions cause twisted or repetitive movements, abnormal postures, or both.

Hemibalism:

Typically caused by damage to the nucleus or subthalamic nuclei, the movements of hemiballism are non-rhythmic, rapid, non-suppressible and violent. They usually occur in an isolated part of the body, such as the proximal arm.

Hemifacial spasm:

Hemifacial spasm (HFS) is characterized by involuntary contraction of the facial muscles, which usually occurs only on one side of the face.

myoclonus:

Myoclonus is defined as a sequence of repetitive jerks, often non-rhythmic, brief, beating-like due to sudden involuntary contraction or relaxation of one or more muscles.

Stereotypes:

Stereotypes are repetitive, rhythmic and simple movements that can be voluntarily suppressed. Like tremors, they are usually back and forth movements, and most commonly they occur bilaterally.

Late dyskinesia / late dystonia:

Tardive dyskinesia or late dystonia, both referred to as TD, refer to a wide variety of involuntary stereotypic movements caused by prolonged use of dopamine receptor blocking agents.

Tics:

A tic can be defined as a repeated movement, individually recognizable, intermittent or fragments of movement that are almost always briefly suppressible and are generally associated with the awareness of the urgency to perform the movement.

Temblor:

A tremor can be defined as an involuntary rhythmic movement, forward and backward or oscillating around an axis of articulation.

Volatile Hiperquinesia:

Volitional hyperkinesia refers to any type of involuntary movement described above that interrupts voluntary intentional muscle movement.

These movements tend to be jerks that occur suddenly during a coordinated action without skeletal muscle problems.

Diagnosis

Diseases that present one or more hyperkinetic movements as prominent symptoms include:

Huntington’s disease:

Hyperkinesia, more specifically chorea, is the characteristic symptom of Huntington’s disease, formerly known as Huntington’s chorea.

Hyperkinesis exhibited in the disease can vary from just the little finger to the whole body, resembling intentional movements that occur involuntarily.

In children, stiffness and seizures are also symptoms.

Other hyperkinetic symptoms include:

  • Turn the head to change the position of the eye.
  • Facial movements, including grimaces.
  • Slow and uncontrollable movements.
  • Rapid, sudden and sometimes wild spasmodic movements of the arms, legs, face and other parts of the body.
  • Unstable march.
  • Abnormal reflexes

Wilson’s disease:

Wilson’s disease (WD) is a rare inherited disorder in which patients have a problem metabolizing copper. In patients with WD, copper accumulates in the liver and other parts of the body, especially the brain, eyes and kidneys.

After accumulation in the brain, patients may experience speech problems, incoordination, swallowing problems, and prominent hyperkinetic symptoms, including tremors, dystonia, and walking difficulties.

Also common are psychiatric disorders such as irritability, impulsivity, aggression and mood alterations.

Uneasy leg syndrome:

Restless legs syndrome is a disorder in which patients feel unpleasant sensations in their legs.

These sensations usually occur at night, while the patient is sitting or lying down and relaxed.

Patients feel that they have to move their legs to relieve the sensations, and walking usually causes the symptoms to disappear.

In many patients, this can cause insomnia and excessive daytime sleepiness. This is a very common problem and can occur at any age.

Repercussions after stroke:

A multitude of movement disorders have been observed after an ischemic or hemorrhagic stroke.

Some examples include: athetosis, chorea with or without hemiballism, tremor, dystonia and segmental or focal myoclonus. Although the prevalence of these manifestations after the stroke is quite low.

The amount of time that elapses between the event of the stroke and the presentation of hyperkinesia depends on the type of hyperkinetic movement since their pathologies differ slightly.

Atrophy Dentatorubral-pallidoluysian:

DRPLA is a rare disorder of trinucleotide recurrence (polyglutamine disease) that may be juvenile onset, early onset in the young adult, or late onset in the adult.