Peripherally-induced Movement Disorders: An Update

Abstract

Background: Peripherally-induced movement disorders (PIMD) should be considered when involuntary or abnormal movements emerge shortly after an injury to a body part. A close topographic and temporal association between peripheral injury and onset of the movement disorders is crucial to diagnosing PIMD. PIMD is under-recognized and often misdiagnosed as functional movement disorder, although both may co-exist. Given the considerable diagnostic, therapeutic, and psychosocial-legal challenges associated with PIMD, it is crucial to update the clinical and scientific information about this important movement disorder.Methods: A comprehensive PubMed search through a broad range of keywords and combinations was performed in February 2023 to identify relevant articles for this narrative review. Results:The spectrum of the phenomenology of PIMD is broad and it encompasses both hyperkinetic and hypokinetic movements. Hemifacial spasm is probably the most common PIMD. Others include dystonia, tremor, parkinsonism, myoclonus, painful leg moving toe syndrome, tics, polyminimyoclonus, and amputation stump dyskinesia. We also highlight conditions such as neuropathic tremor, pseudoathetosis, and MYBPC1associated myogenic tremor as examples of PIMD.Discussion: There is considerable heterogeneity among PIMD in terms of severity and nature of injury, natural course, association with pain, and response to treatment. As some patients may have co-existing functional movement disorder, neurologists should be able to differentiate the two disorders. While the exact pathophysiology remains elusive, aberrant central sensitization after peripheral stimuli and maladaptive plasticity in the sensorimotor cortex, on a background of genetic (two-hit hypothesis) or other predisposition, seem to play a role in the pathogenesis of PIMD.

Hemimasticatory spasm: a series of 17 cases and a comprehensive review of the literature

“…These results suggest that early cases are often severe with marked hemifacial atrophy, and although mild cases of HMS have been reported, it takes time to make a definitive diagnosis. Injury to the peripheral nervous system has been reported to cause various movement disorders, such as dystonia, hemifacial spasm, tremor, myoclonus, tics, and parkinsonism (70)(71)(72)(73)(74). Although there is no confirmatory test to ascertain whether a movement disorder is genuinely induced by peripheral injury (74), several cases of HMS have been reported after severe dental inflammation (2,4,6).…”

“…Injury to the peripheral nervous system has been reported to cause various movement disorders, such as dystonia, hemifacial spasm, tremor, myoclonus, tics, and parkinsonism (70)(71)(72)(73)(74). Although there is no confirmatory test to ascertain whether a movement disorder is genuinely induced by peripheral injury (74), several cases of HMS have been reported after severe dental inflammation (2,4,6). Recently, dental or oral surgical treatments have been reported to precede HMS (64).…”

Function and dysfunction of the dystonia network: an exploration of neural circuits that underlie the acquired and isolated dystonias

“…These dystonias have the interesting feature of being associated with environmental factors or “overuse,” namely, professional use of voice in laryngeal dystonia or extensive practiced fine motor control in writer’s cramp or musician’s dystonia [ 70 – 74 ]. In addition, frequent case reports arise in the literature of various dystonias associated with other repetitive focused tasks including, briefly, laryngeal dystonia in a telemarketer and focal appendicular dystonias in a typist, a billiards player, a blacksmith, during braking while driving, and in a runner [ 75 – 81 ]. Despite the association of this class of dystonias with environmental factors, there is evidence of underlying genetic associations including both predisposing family history and the identification of genetic mutations [ 82 , 83 ].…”