Definition and classification of hyperkinetic movements in childhood

Abstract

Hyperkinetic movements are unwanted or excess movements that are frequently seen in children with neurologic disorders. They are an important clinical finding with significant implications for diagnosis and treatment. However, the lack of agreement on standard terminology and definitions interferes with clinical treatment and research. We describe definitions of dystonia, chorea, athetosis, myoclonus, tremor, tics, and stereotypies that arose from a consensus meeting in June 2008 of specialists from different clinical and basic science fields. Dystonia is a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. Chorea is an ongoing random-appearing sequence of one or more discrete involuntary movements or movement fragments. Athetosis is a slow, continuous, involuntary writhing movement that prevents maintenance of a stable posture. Myoclonus is a sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction or relaxation of one or more muscles. Tremor is a rhythmic back-and-forth or oscillating involuntary movement about a joint axis. Tics are repeated, individually recognizable, intermittent movements or movement fragments that are almost always briefly suppressible and are usually associated with awareness of an urge to perform the movement. Stereotypies are repetitive, simple movements that can be voluntarily suppressed. We provide recommended techniques for clinical examination and suggestions for differentiating between the different types of hyperkinetic movements, noting that there may be overlap between conditions. These definitions and the diagnostic recommendations are intended to be reliable and useful for clinical practice, communication between clinicians and researchers, and for the design of quantitative tests that will guide and assess the outcome of future clinical trials.

Deep brain stimulation in children and young adults with secondary dystonia: the Children's Hospital Los Angeles experience

“…1,3,13,23,24,26,42 Cerebral palsy is the most common cause of secondary dystonia. 33 The incidence of cerebral palsy is approximately 2 per 1000 births. 41 There is no cure for dystonia, and DBS could therefore potentially improve the lives of a considerable number of patients who suffer from this condition.…”

“…3,38 Even though the most common type of secondary dystonia is categorized as cerebral palsy, 33 patients with secondary dystonia represent a varied population with many different underlying pathophysiologies and potential responses to treatment. 3 At this time, there is no cure for dystonia.…”

Deep brain stimulation: a mechanistic and clinical update

“…Hyperkinetic movements such as these can be observed in a plethora of neurological disorders and can make diagnosis challenging. 167 Dystonia is currently the leading indication for DBS in the pediatric population.…”

Hemichorea Associated With Non-Ketotic Hyperglicemia: Report of Two Cases and Brief Review of the Literature

“…Hemichorea is defined as an involuntary, erratic, abrupt and non-stereotyped hyperkinetic movement disorder in one side of the body varying on intensity and topography (1)(2)(3)(4). It can be caused by a wide variety of etiologies, including ischemia, infection, neoplasm and Huntington's disease.…”