STUDY - Technical - New Dacian's Medicine
Athetosis
(Classical / Allopathic Medicine)
Athetosis, an
extrapyramidal sign, is characterized by slow, continuous,
twisting, involuntary movements. Typically, these movements
involve the face, neck, and distal extremities, such as the
forearm, wrist, and hand. Facial grimaces, jaw and tongue
movements, and occasional phonation are associated with neck
movements. Athetosis worsens during stress and voluntary
activity, may subside during relaxation, and disappears during
sleep.
Commonly a
lifelong affliction, athetosis is sometimes difficult to
distinguish from chorea (hence the term choreoathetosis).
Typically, however, athetoid movements are slower than
choreiform movements.
Athetosis usually begins during childhood, resulting from hypoxia at birth, kernicterus, or a genetic disorder. In adults, athetosis usually results from a vascular or neoplastic lesion, a degenerative disease, drug toxicity, or hypoxia. (See Distinguishing athetosis from chorea.)
Athetosis usually begins during childhood, resulting from hypoxia at birth, kernicterus, or a genetic disorder. In adults, athetosis usually results from a vascular or neoplastic lesion, a degenerative disease, drug toxicity, or hypoxia. (See Distinguishing athetosis from chorea.)
Distinguishing
athetosis from chorea
With athetosis, movements are typically slow, twisting, and writhing. They're associated with spasticity and most commonly involve the face, neck, and distal extremities.
With chorea, movements are brief, rapid, jerky, and unpredictable. They can occur at rest or during normal movement. Typically, they involve the hands, lower arm, face, and head.
HISTORY:
Take a comprehensive prenatal and postnatal history, covering maternal and child health, labor and delivery, and possible trauma.
Obtain a family health history because many genetic disorders can cause athetosis.
Ask the patient about current drug therapy.
Ask the patient about the decline in his functional abilities: When was he last able to roll over, sit up, or carry out daily activities?
Ask the patient what problem - uncontrollable movements, mental deterioration, or a speech impediment - prompted him to seek medical help.
Ask the patient about the effects of rest, stress, and routine activity on his symptoms.
With athetosis, movements are typically slow, twisting, and writhing. They're associated with spasticity and most commonly involve the face, neck, and distal extremities.
With chorea, movements are brief, rapid, jerky, and unpredictable. They can occur at rest or during normal movement. Typically, they involve the hands, lower arm, face, and head.
HISTORY:
Take a comprehensive prenatal and postnatal history, covering maternal and child health, labor and delivery, and possible trauma.
Obtain a family health history because many genetic disorders can cause athetosis.
Ask the patient about current drug therapy.
Ask the patient about the decline in his functional abilities: When was he last able to roll over, sit up, or carry out daily activities?
Ask the patient what problem - uncontrollable movements, mental deterioration, or a speech impediment - prompted him to seek medical help.
Ask the patient about the effects of rest, stress, and routine activity on his symptoms.
PHYSICAL
ASSESSMENT:
Test muscle strength and tone, range of motion, fine muscle movements, and ability to perform rapidly alternating movements.
Observe the limb muscles during voluntary movements, noting the rhythm and duration of contraction and relaxation.
Test muscle strength and tone, range of motion, fine muscle movements, and ability to perform rapidly alternating movements.
Observe the limb muscles during voluntary movements, noting the rhythm and duration of contraction and relaxation.
SPECIAL
CONSIDERATIONS:
Occasionally, athetosis can be prevented or treated by decreasing body copper stores in Wilson's disease or by adjusting drug dosages. Typically, though, it has a lifelong impact on the patient's ability to carry out even routine activities.
Occasionally, athetosis can be prevented or treated by decreasing body copper stores in Wilson's disease or by adjusting drug dosages. Typically, though, it has a lifelong impact on the patient's ability to carry out even routine activities.
PEDIATRIC
POINTERS:
Childhood athetosis may be acquired or inherited. It can result from hypoxia at birth, which causes an athetoid cerebral palsy, kernicterus, Sydenham's chorea (in school-age children), and paroxysmal choreoathetosis. Inherited causes of athetosis include Lesch-Nyhan syndrome, Tay-Sachs disease, and phenylketonuria.
Childhood athetosis may be acquired or inherited. It can result from hypoxia at birth, which causes an athetoid cerebral palsy, kernicterus, Sydenham's chorea (in school-age children), and paroxysmal choreoathetosis. Inherited causes of athetosis include Lesch-Nyhan syndrome, Tay-Sachs disease, and phenylketonuria.
PATIENT
COUNSELING:
Help the patient develop self-esteem and a positive self-image. Encourage him and his family to set realistic goals. As appropriate, refer the patient to special education services, rehabilitation centers, and support services and groups. Provide him with emotional support during the frequent medical evaluations he'll be required to undergo.
Help the patient develop self-esteem and a positive self-image. Encourage him and his family to set realistic goals. As appropriate, refer the patient to special education services, rehabilitation centers, and support services and groups. Provide him with emotional support during the frequent medical evaluations he'll be required to undergo.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)