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Athetosis

Athetosis Treatment in Delhi, India

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Overview

Athetosis is a neurological disorder that causes slow, irregular, involuntary, writhing, and rolling movements, particularly in the distal limbs. The movements may be continuous or discontinuous.

Athetosis-associated movements make it tough for the person to maintain a stable and erect posture. The affected body parts are the face, neck, limbs, trunk, tongue, fingers, and other body parts. The fingers are affected negatively by their flexion happening separately and irregularly. The hands and the feet also move in a similar manner.

For instance, while driving or writing, the person suffering from athetosis has no idea about where the steering would rotate or the pen would go! This is a serious movement disorder that can lead to many associated deformities.

Individuals with athetosis find it very difficult to control these random movements. Even if they try to control it, they may find the situation getting worse, even to a stage where they are not at all able to control any movement.

Causes

Athetosis is often caused by a birth disorder or some neurological problem in the case of adults. Another rare cause of athetosis includes stroke or trauma. Given below are some of the major causes behind the development of athetosis.

Basal Ganglia Disease

Any injury to the basal ganglia may lead to the appearance of irregular and involuntary movements, such as athetosis.

A basal ganglion is a group of subcortical nuclei present within the brain and primarily responsible for controlling motor functions and easing out coordinated movements. Any injury to the basal ganglia or a particular part of the brain leads to impaired motor functions, such as the appearance of dystonic movements like athetosis. Other functions of the basal ganglia include executive functions, motor learning, emotional behaviours, habit formation, addictive behaviours, etc.

What happens when the basal ganglia gets injured?

In case of injury to the basal ganglia or associated brain part, the person is likely to develop symptoms of athetosis. The person’s brain loses its ability to support the muscle movements or perform coordinated movements. A child/person with basal ganglia dysfunction may face difficulty in walking, starting or ending any movement, etc., as in the case of Parkinsonism and cerebral palsy. The person may show abnormal movements, abnormal posture, and abnormal tone.

Diseases of Basal Ganglia

Some of the diseases which affect basal ganglia are Huntington’s disease and Wilson’s disease. Huntington's disease is a rare, inherited progressive degeneration of the brain’s nerve cells. The person suffering from this disease shows mixed symptoms, such as movement-associated impairments, psychological disorders, and cognitive disorders.

Wilson’s disease is also a rare and inherited disorder that leads to copper accumulation in the brain, liver, and other organs of the body. This results in copper poisoning in the human body.

Birth-related problems

When the fetus doesn't get enough oxygen supply, the chances of developing athetosis become higher. Lack of oxygen in the body or asphyxia can lead to brain damage. It also leads to reduced nutrient supply to the brain and increased dopamine levels in the brain. Such changes may impact the basal ganglia and lead to its impairment.

Cerebral Palsy

Cerebral Palsy is a birth-related disorder caused due to abnormal development or damage to the brain while growing. This leads to impaired motor skills and reduced ability of the child to perform coordinated movements. Cerebral Palsy, which is caused due to damage to the basal ganglia, is called athetoid cerebral palsy. It is usually caused due to low oxygen levels and/or high bilirubin levels in the infant’s body. The CP child exhibits athetosis-related movement impairment.

Jaundice

Jaundice in newborns can damage basal ganglia due to high levels of bilirubin. Although treatments are available, they are not very effective. They may only lower the levels of bilirubin, while the efficacy of the body against the infection is not high as the blood-brain barrier is not properly functional at such a young age. Therefore, toxins enter the infant’s body and damage the basal ganglia. This further leads to the appearance of athetosis.

Drug toxicity

If a person consumes drugs that lead to increased levels of dopamine in the body, the chances of basal ganglia damage increase further, leading to athetosis.

Stroke

Stroke can also lead to the occurrence of athetosis as it leads to brain damage or dysfunction.

Symptoms

The major signs and symptoms of athetosis include-

  • Difficulty in walking properly.
  • Difficulty in maintaining an erect posture.
  • Writing, slow, and involuntary movements.
  • Abrupt and unpredictable muscle movements.
  • The situation gets worse while attempting to improve posture or movement.
  • Uncontrolled movements.
  • Uncontrolled movements in another muscle group while attempting to control movements in one muscle group.
  • Tremors.
  • Torso twisting.
  • Grimacing (to make an expression of pain).

Difference between athetosis and chorea

Sometimes, confusion between athetosis and chorea can arise due to the fact that they are actually very similar. In fact, the two can even occur together. When they occur jointly, the condition is referred to as choreoathetosis. Athetosis is even sometimes called slow chorea. However, in chorea, the movements are very brief, dancelike, and rhythmic. Such movements may start at any point and end at any point all of a sudden.

Difference between athetosis and dystonia

Another similar condition that may be confusing is dystonia. The latter is also a movement-related disorder leading to involuntary, repetitive, and usually persistent muscle contractions. Even in dystonia, 'overflow' happens. Overflow is a term used to demonstrate a situation where a person feels immense pressure in a muscle group while attempting to control the movements of another muscle group. The major difference between dystonia and athetosis includes the formation of more sustained body postures in the former.

Diagnosis

Athetosis is usually considered one of the symptoms of an underlying disorder. It is not considered a disorder by itself. It happens due to the damage/overactivity of the basal ganglia. Therefore, for treating athetosis, it is very important to first diagnose the root cause of the affecting disease. To eliminate the root cause or underlying issue, the neurologist or physician will undertake the following steps-

  • Learning about the medical history of the patient.
  • Running a physical exam to determine the power of muscle contractions.
  • Conducting some blood tests to know about the haematological status of the patient.
  • Running some brain imaging tests to view the insides of the brain (in case of brain injury or damage).
  • Conducting gross motor function tests to test motor abilities and coordinated movements of the patient.

Since these tests are not definitive tests, the doctor may take some time to reach a confirmed diagnosis of the problem.

Treatment

Once the root cause or underlying issue is determined, it becomes easier to treat athetosis.

Sometimes, due to the severity of the issue, specific and symptomatic treatment might be prescribed to the patient, such as-

  • Anti-dopamine drugs- These are the drugs that help in lowering the levels of dopamine and thereby reducing its effects.
  • Botox therapy- Injections of botox are given to the patient to slow down the involuntary actions of the muscles.
  • Physical Therapy- Physiotherapist-assisted exercises and therapy should be taught to the patient.
  • Lifestyle Management- Changing your lifestyle, eating healthier, and exercising regularly for muscle strengthening can help improve the complications.

Complications

Athetosis is a long-term effect of a chronic disorder. So, determining the underlying cause is important to eliminate the possible complications of athetosis. The possible complications of athetosis include-

  • Uncontrolled walking.
  • Inability to speak properly.
  • Permanent posture deformity.
  • Difficulty in performing day-to-day activities.

Review

Reviewed by Dr. Vivek Kumar, Senior Director, Neurology.


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