Voluntary Inhibitory Control of Chorea: A Case Series

Bonomo, Roberta; Latorre, Anna; Balint, Bettina; Śmiłowska, Katarzyna; Rocchi, Lorenzo; Rothwell, John C.; Zappia, Mario; Bhatia, Kailash P.

doi:10.1002/mdc3.12907

Cited by 7 publications

(4 citation statements)

References 9 publications

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“…16 Voluntary suppression of chorea on demand in some people with chorea. 17,18 Flexible use of proactive and reactive inhibition.…”

Section: Dystoniamentioning

confidence: 99%

Rethinking Movement Disorders

Münchau,

Klein,

Beste

2024

Movement Disorders

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At present, clinical practice and research in movement disorders (MDs) focus on the “normalization” of altered movements. In this review, rather than concentrating on problems and burdens people with MDs undoubtedly have, we highlight their hidden potentials. Starting with current definitions of Parkinson's disease (PD), dystonia, chorea, and tics, we outline that solely conceiving these phenomena as signs of dysfunction falls short of their complex nature comprising both problems and potentials. Such potentials can be traced and understood in light of well‐established cognitive neuroscience frameworks, particularly ideomotor principles, and their influential modern derivatives. Using these frameworks, the wealth of data on altered perception‐action integration in the different MDs can be explained and systematized using the mechanism‐oriented concept of perception‐action binding. According to this concept, MDs can be understood as phenomena requiring and fostering flexible modifications of perception‐action associations. Consequently, although conceived as being caught in a (trough) state of deficits, given their high flexibility, people with MDs also have high potential to switch to (adaptive) peak activity that can be conceptualized as hidden potentials. Currently, clinical practice and research in MDs are concerned with deficits and thus the “deep and wide troughs,” whereas “scattered narrow peaks” reflecting hidden potentials are neglected. To better delineate and utilize the latter to alleviate the burden of affected people, and destigmatize their conditions, we suggest some measures, including computational modeling combined with neurophysiological methods and tailored treatment. © 2024 International Parkinson and Movement Disorder Society.

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“…16 Voluntary suppression of chorea on demand in some people with chorea. 17,18 Flexible use of proactive and reactive inhibition.…”

Section: Dystoniamentioning

confidence: 99%

Rethinking Movement Disorders

Münchau,

Klein,

Beste

2024

Movement Disorders

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“…2. Tic Disorders: Unlike chorea, tic disorders are characterized by typical premonitory urges and the ability to suppress tics for a short time [8]. 3.…”

Section: Important Differential Diagnoses For the Syndrome Chorea Inc...mentioning

confidence: 99%

“…In general, chorea is often more noticeable during conversations, especially when emotionally charged, such as during discussions of stressful topics or during neuropsychological testing. However, during the actual neurological examination, chorea may be less pronounced [8].…”

Section: Important Differential Diagnoses For the Syndrome Chorea Inc...mentioning

confidence: 99%

Differential diagnosis of chorea (guidelines of the German Neurological Society)

Saft,

Burgunder,

Dose

et al. 2023

Neurol. Res. Pract.

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Introduction Choreiform movement disorders are characterized by involuntary, rapid, irregular, and unpredictable movements of the limbs, face, neck, and trunk. These movements often initially go unnoticed by the affected individuals and may blend together with seemingly intended, random motions. Choreiform movements can occur both at rest and during voluntary movements. They typically increase in intensity with stress and physical activity and essentially cease during deep sleep stages. In particularly in advanced stages of Huntington disease (HD), choreiform hyperkinesia occurs alongside with dystonic postures of the limbs or trunk before they typically decrease in intensity. Summary or definition of the topic The differential diagnosis of HD can be complex. Here, the authors aim to provide guidance for the diagnostic process. This guidance was prepared for the German Neurological Society (DGN) for German-speaking countries. Recommendations Hereditary (inherited) and non-hereditary (non-inherited) forms of chorea can be distinguished. Therefore, the family history is crucial. However, even in conditions with autosomal-dominant transmission such as HD, unremarkable family histories do not necessarily rule out a hereditary form (e.g., in cases of early deceased or unknown parents, uncertainties in familial relationships, as well as in offspring of parents with CAG repeats in the expandable range (27–35 CAG repeats) which may display expansions into the pathogenic range). Conclusions The differential diagnosis of chorea can be challenging. This guidance prepared for the German Neurological Society (DGN) reflects the state of the art as of 2023.

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“…76 Half of patients with chorea and 20% of patients with dystonia can also voluntarily reduce their movements. 75,77 Tics are the prototypical hyperkinetic movement disorders that may be suppressed voluntarily. 75…”

Section: Volitional Suppression Of Involuntary Movementsmentioning

confidence: 99%

Variability of Movement Disorders: The Influence of Sensation, Action, Cognition, and Emotions

et al. 2020

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A BS TRACT: Patients with movement disorders experience fluctuations unrelated to disease progression or treatment. Extrinsic factors that contribute to the variable expression of movement disorders are environment related. They influence the expression of movement disorders through sensory-motor interactions and include somatosensory, visual, and auditory stimuli. Examples of somatosensory effects are stimulus sensitivity of myoclonus on touch and sensory amelioration in dystonia but also some less-appreciated effects on parkinsonian tremor and gait. Changes in visual input may affect practically all types of movement disorders, either by loss of its compensatory role or by disease-related alterations in the pathways subserving visuomotor integration. The interaction between auditory input and motor function is reflected in simple protective reflexes and in complex behaviors such as singing or dancing. Various expressions range from the effect of music on parkinsonian bradykinesia to tics. Changes in body position affect muscle tone and may result in marked fluctuations of rigidity or may affect dystonic manifestations. Factors intrinsic to the patient are related to their voluntary activity and cognitive, motivational, and emotional states. Depending on the situation or disease, they may improve or worsen movement disorders. We discuss various factors that can influence the phenotypic variability of movement disorders, highlighting the potential mechanisms underlying these manifestations. We also describe how motor fluctuations can be provoked during the clinical assessment to help reach the diagnosis and appreciated to understand complaints that seem discrepant with objective findings. We summarize advice and interventions based on the variability of movement disorders that may improve patients' functioning in everyday life.

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Voluntary Inhibitory Control of Chorea: A Case Series

Cited by 7 publications

References 9 publications

Rethinking Movement Disorders

Rethinking Movement Disorders

Differential diagnosis of chorea (guidelines of the German Neurological Society)

Variability of Movement Disorders: The Influence of Sensation, Action, Cognition, and Emotions

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