Can peripheral trauma induce dystonia and other movement disorders? Yes!

Jankovic, Joseph

doi:10.1002/1531-8257(200101)16:1<7::aid-mds1005>3.0.co;2-0

Cited by 166 publications

(85 citation statements)

References 66 publications

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“…However, considering that pathologic changes such as aberrant reinnervation, ephatic transmission, remyelination or late inflammatory changes may cause the disturbance, more extensive latency periods should theoretically be accepted 4 . In a recent review, Jankovic 8 has described the clinical characteristics of peripherally induced dystonia, tremor, parkinsonism and other movement disorders providing a critical analysis of the scientific evidences supporting a relationship between peripheral trauma and movement disorders. Nonetheless this concept has been recently disputed and some controversy still remains 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite those first descriptions, only recently attention has been drawn to peripheral trauma as a possible predisposing factor for movement disorders and growing scientific support for this concept has developed. Although temporal and topographic relationships have been closely established, including the concomitant occurrence of reflex sympathetic dystrophy in some cases, the pathophysiologic mechanisms underlying these phenomena are not well understood [2][3][4][5][6][7][8] .…”

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confidence: 99%

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Movement disorders induced by peripheral trauma

Nóbrega

Campos

Limongi

et al. 2002

Arq. Neuro-Psiquiatr.

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-Movement disorders induced by central nervous system trauma are well recognized. However, over the last few years, attention has been drawn to the role of peripherally induced movement disorders. We describe three patients presenting respectively dystonia, tremor and choreoathetosis associated with tremor and dystonia of the body parts previously exposed to traumatic injuries. Pathophysiological mechanisms underlying these phenomena are not entirely known, but functional changes in afferent neuronal input to the spinal cord and secondary affection of higher brain stem and subcortical centers are probably involved.KEY WORDS: movement disorders, peripheral trauma, chorea.Distúrbios do movimento induzidos por traumatismo periférico Distúrbios do movimento induzidos por traumatismo periférico Distúrbios do movimento induzidos por traumatismo periférico Distúrbios do movimento induzidos por traumatismo periférico Distúrbios do movimento induzidos por traumatismo periférico RESUMO -Distúrbios do movimento induzidos por traumatismo de sistema nervoso central já são conhecidos. Entretanto, nos últimos anos tem se dado maior atenção ao traumatismo periférico como indutor desses distúrbios. Relatamos três pacientes que apresentaram respectivamente distonia, tremor e coreoatetose com tremor e distonia em partes do corpo previamente traumatizadas. Os mecanismos fisiopatológicos que explicam esse fenômeno não são totalmente conhecidos, mas alterações nos impulsos neuronais aferentes para a medula interferindo secundariamente no funcionamento de estruturas corticais e subcorticais estão provavelmente envolvidas. PALAVRAS-CHAVE: distúrbios do movimento, trauma periférico, coréia. Movement disorders after traumatic events are usually related to central nervous system injuries, but sometimes may result from peripheral lesions. The association between peripheral trauma and movement disorders was first described by Gowers in 1888 who observed a patient with cervical dystonia after a local neck injury and noted that a patient with writer's cramp had previously sprained his thumb 1 . Despite those first descriptions, only recently attention has been drawn to peripheral trauma as a possible predisposing factor for movement disorders and growing scientific support for this concept has developed. Although temporal and topographic relationships have been closely established, including the concomitant occurrence of reflex sympathetic dystrophy in some cases, the pathophysiologic mechanisms underlying these phenomena are not well understood 2-8 .We report three patients presenting a variety of movement disorders which developed few weeks after peripheral injuries nearby to the sites of the abnormal movements. CASESPatient 1. A 23-year-old man had been diagnosed with paranoid schizophrenia since 13. He had been treated with haloperidol, periciazine and biperidene for approximately 12 years. Three years before the present evaluation he suffered a blunt trauma on his left shoulder and two weeks later he noticed involuntary contract...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Movement disorders induced by peripheral trauma

Nóbrega

Campos

Limongi

et al. 2002

Arq. Neuro-Psiquiatr.

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“…Its pathophysiology is not fully understood; however, several evidences suggest that an asymptomatic underlying dysfunction of the central nervous system plays a significant role in this abnormal movement 2,4 . In spite of considering this an organic movement, it is important to remember that complete recovery is rare 2 after surgical intervention in organic dystonia and so it could reinforce a probable psychogenic origin.…”

Section: Patientmentioning

confidence: 99%

“…In 2001, Jankovic 2 proposed the following criteria for the diagnosis of peripherally induced movement disorders: [1] the trauma is severe enough to cause local symptoms for at least two weeks; [2] the initial manifestation of the movement disorders is anatomically related to the site of injury; [3] the onset of the movement disorders is within days or months (up to one year) after the injury. On the other hand, clues to the diagnosis of psychogenic dystonia, according to Fahn Our patient fulfilled all of the Jankovic's criteria for the diagnosis of organic dystonia induced by peripheral trauma, that is: severe injury; anatomical relationship to the site of injury; and onset one week after the trauma.…”

Section: Patientmentioning

confidence: 99%

“…On the other hand, clues to the diagnosis of psychogenic dystonia, according to Fahn Our patient fulfilled all of the Jankovic's criteria for the diagnosis of organic dystonia induced by peripheral trauma, that is: severe injury; anatomical relationship to the site of injury; and onset one week after the trauma. Its pathophysiology is not fully understood; however, several evidences suggest that an asymptomatic underlying dysfunction of the central nervous system plays a significant role in this abnormal movement 2,4 . In spite of considering this an organic movement, it is important to remember that complete recovery is rare 2 after surgical intervention in organic dystonia and so it could reinforce a probable psychogenic origin.…”

Section: Patientmentioning

confidence: 99%

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Dystonia induced by peripheral trauma: organic or psychogenic?

Nicaretta

Rosso²,

Mattos³

et al. 2011

Arq. Neuro-Psiquiatr.

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Dystonia is defined as a syndrome of sustained muscle contractions, frequently causing twisting and repetitive movements or abnormal postures. A causeand-effect relationship between brain injury and subsequent movement disorder is well established, but a link with peripheral trauma is more controversial 1 . Our objective is to discuss the challenge of the differential diagnosis between organic or psychogenic dystonic posture in a patient with post-traumatic hand dystonia. PatientA 16-year-old right-handed girl developed an abnormal posture of the right hand one week after a fall. The symptoms got steadily worse and a fixed posture (flexion and subluxation of the third and fourth right fingers, flexion and aduction of the right thumb and flexion of the right wrist) soon developed with complete loss of function of the hand. Oral drug treatment was ineffective. After four subsequent applications of botulinum toxin type A she was able to move her thumb and partially her second and third fingers. She required a three-step surgical approach due to subluxations over 17 months. MRI of the brain and right brachial plexus were normal. The patient has a stable moderate improvement of the symptoms. Many subsequent psychiatry evaluations failed to disclosure any psychiatric disturbances. Three years later she had another trauma on the right shoulder but did not developed any movement disorder.In 2001, Jankovic 2 proposed the following criteria for the diagnosis of peripherally induced movement dis- Our patient fulfilled all of the Jankovic's criteria for the diagnosis of organic dystonia induced by peripheral trauma, that is: severe injury; anatomical relationship to the site of injury; and onset one week after the trauma. Its pathophysiology is not fully understood; however, several evidences suggest that an asymptomatic underlying dysfunction of the central nervous system plays a significant role in this abnormal movement 2,4 . In spite of considering this an organic movement, it is important to remember that complete recovery is rare 2 after surgical intervention in organic dystonia and so it could reinforce a probable psychogenic origin. If we take into account the sudden onset, the fixed posture and the incongruous movement, all are in favor of a psychogenic dystonia. In contrast this patient never had a history of an affective disorder. A clear diagnostic is often difficult to establish but we believe that our patient has an organic origin although she had unusual features.

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