Athetosis - Causes and Symptoms

Introduction

Athetosis is an unusual involuntary movement in individuals with underlying medical conditions. It is characterized by prominent slow writhing-type movements involving the extremities. These typical movements are called athetoid movements. In athetosis, the slowly progressing writhing movements are seen in body parts like hands, fingers, feet, and toes. However, it can also sometimes involve the tongue, arms, neck, and legs. Brain lesions are considered the most important cause of athetosis. In most affected people, the symptoms are accompanied by other symptoms related to underlying medical conditions (cerebral palsy). The treatment options for athetosis primarily aim to manage uncontrollable movement rather than the cause.

What Is Athetosis?

Athetosis involves abnormal muscle movements that may occur in association with underlying medical conditions. The movements are slow, involuntary, and not rhythmic. Athetosis appears as slowly progressing, fluid, rotating motions that usually involve the distal extremities, hands, and arms below the elbows, fingers, and neck. Individuals with athetosis show mild to severe forms of motor dysfunction. It mainly involves involuntary muscle movements, unbalanced muscle activity, and the inability to maintain a symmetric posture. Athetosis usually appears around 18 months after birth, with initial signs including spasms, feeding difficulties, hypotonia, and involuntary movements involving the feet, hands, and face that progressively worsen as the child grows and reaches adolescence. The affected individuals usually show hearing loss, speech impairment, communication problems, and loss of balance with normal intelligence.

What Are the Causes of Athetosis?

Athetosis usually results from complications during childbirth and neurological diseases. The most significant causes of athetosis are the following.

• Basal Ganglia Diseases - Damage or diseases involving the brain's basal ganglia may cause athetosis symptoms. The brain's basal ganglia are involved in coordinating posture and smoothing out muscle movements. Uncoordinated and abnormal muscle movements may occur when the brain cannot control nerve impulses. Genetic diseases like Wilson's disease and Huntington's disease affect the brain's basal ganglia, resulting in athetosis.

• Birth Difficulties - Reduced oxygen levels during birth increase the risk of athetosis in the baby. Lack of significant levels of oxygen may cause brain damage and reduce the supply of essential nutrients to the brain tissues. Increased dopamine levels and brain damage affect the basal ganglia and result in athetosis.

• Stroke - Sometimes, athetosis occurs in adult individuals after trauma or stroke. Brain damage due to trauma or stroke interferes with the movement of neurons and leads to movement disorders and athetosis.

• Cerebral Palsy - It results from brain damage or abnormal brain development. The child may be unable to control muscle movements. Cerebral palsy and basal ganglia damage are termed athetoid cerebral palsy.

• Drug Toxicity - The use of drugs that increase the brain's dopamine levels can cause damage to the basal ganglia and lead to symptoms related to athetosis.

• Jaundice - Newborn babies with abnormally high bilirubin levels may have basal ganglia damaged basal ganglia. Thus bilirubin penetrates the brain cells and causes brain damage. Treatment methods to reduce bilirubin levels are less effective than the child needs to develop the blood-brain barrier.

What Are the Symptoms of Athetosis?

• Tremors.

• Writhing muscle movements.

• Irregular movements.

• Abnormal muscle contractions.

• Speech difficulties.

• Inability to maintain posture.

• Random and abrupt muscle movements.

• Worsening of symptoms when tried to control.

• Unsteadiness.

• Poor standing posture.

• Grimacing.

• Muscle overflow.

How Can We Diagnose Athetosis?

Athetosis usually occurs in an individual as a symptom associated with a disorder. The diagnosis of the underlying cause is very significant in confirming athetosis. The diagnostic methods that are used for athetosis are the following.

• Detailed medical history.

• Physical examination.

• Blood tests.

• Brain imaging tests.

• Motor function tests.

• Neurological examination.

• Magnetic resonance imaging (MRI).

• Genetic testing.

How Can We Manage Athetosis?

Several treatment strategies are implemented for the management of athetosis. There is no specific treatment. The accepted strategies involve the management of abnormal movements and medications.

The most effective treatment options are the following.

Use of Drugs - There is no specific drug to treat athetosis. However, different drugs are used in patients to improve their condition. The symptoms can be reduced to a certain extent in athetosis using drugs if they are mild to moderate symptoms. The commonly used drugs for the management of athetosis are:

• Artane.

• Diazepam.

• Cogentin.

• Haloperidol.

• Curare.

• Thiopropazate.

• Tetrabenazine.

Surgical Intervention - Treatment of athetosis by surgical intervention has an immediate impact and outcome. However, these surgical interventions cannot be used as a permanent cure for athetosis. Subthalamotomy is done in athetosis patients with cerebral palsy to relieve the severity of athetosis to a certain extent. Studies have concluded that subthalamotomy helps to relieve the severity of athetosis in nearly half of the patients. Other surgeries involving the cerebral motor cortex and posterior spinal roots are also effective in athetosis patients. Surgical treatment has shown significant improvement in establishing control over limbs and digits in athetosis patients. However, surgical management in athetosis has short-term effects and cannot establish a long-lasting cure for the patient.

Occupational Therapy - It is done in patients with athetosis to regain muscle control.

Injections - Anti-dopamine and botox injections can be used in patients to improve the symptoms of athetosis.

Conclusion

Athetosis consists of slow writhing-like involuntary movements that usually occur with an underlying medical condition. The affected individuals may have abnormal movements, mostly involving the hands, fingers, feet, and toes, and in some cases, it may also affect the tongue, neck, legs, and arms. In most patients with athetosis, the characteristic symptoms are seen along with other symptoms related to the underlying medical defect. The underlying defect is in the brain for most individuals with athetosis. Brain damage involving the basal ganglia is the common etiology behind athetosis.