Hemiballismus vs Chorea

Introduction

Hemiballismus is an involuntary movement of high amplitude that affects the limbs of one side of the body. At the same time, chorea is a movement disorder seen in various diseases and conditions. The movements become as if a person is dancing. Hemibellismus is a type of chorea.

What Is Hemiballismus?

Hemiballismus is an irregular, involuntary, large-amplitude flinging movement by the limbs at one side of the body. As per the areas of the brain affected, patients can be seen with certain common clinical features as per the area involved. For example, if a patient has an infarction of the motor cortex, hemiplegia or paralysis is frequently present on one side of the body. Infarctions involving other areas of the brain will present with aphasia or impairment of language. This affects speech production or comprehension and the ability to read and write.

Hemiballismus was first described by Dr. J.R. Whittier while studying the subthalamic nucleus of rhesus monkeys. He noted that when a minimum of 20 percent area was affected, hemiballismus would be induced in the contralateral limbs. Hemiballismus, traditionally considered a direct result of subthalamic nucleus infarction, originates from his work.

What Are the Symptoms Seen in Hemiballismus?

The symptoms associated with hemiballismus can have a wide variety. Some of these are listed below:

• Involuntary movement.

• Jerky movement

• Appendicular movements on the contralateral side.

• Affects one side of the body.

What Is the Treatment of Hemiballismus?

Hemiballismus can be dangerous to the patient as these movements are violent, high amplitude, jerky, etc. It can be treated with certain medications such as:

• Neuroleptics.

• Valproic acid.

• Topiramate.

• Gabapentin.

• Dopamine-depleting drugs.

Patients severely affected by this disease might require certain therapies with or without medication, like deep brain stimulation, pallidotomy, etc.

What Is Chorea?

Chorea is a disorder of movement that causes involuntary, irregular, unpredictable muscle movements. The disorder can make a person seem like they are dancing. The word chorea originated from the Greek word for dance or appear restless or fidgety. Chorea is a movement issue seen in many different diseases and conditions. It is not a life-threatening condition, but it is a possible indicator of a neurological condition such as Huntington's disease. Doctors prescribe medication to limit abnormal muscle movements. As per the underlying cause, the chorea might be temporary or permanent and worsen over time. It is seen that two other movements related to chorea are seen in neurological diseases. These movements are:

• Athetosis: It is a stream of slow, twisting, or squirming-like motions frequently seen in the hands and feet.

• Ballimus: This frequently involves more vigorous movements like the wild flinging of one arm or leg. Frequently, the movements only affect one side of the body (hemiballism).

What Are the Symptoms of Chorea?

The symptoms of chorea are similar only despite having different causative factors. The most usual symptoms of chorea are:

• Involuntary Muscle Movements: These are also fidgety or dancing-like movements frequently seen in the hands, feet, and face. They can affect the way a person walks, swallow and talk. These movements might be jerky. They can make it look like a person is dancing, playing the piano, or writhing in pain. The movements often worsen stress or anxiety and fade away when sleeping.

• Milkmaid's Grip: In this condition, the hands remain steady when someone tries to shake a hand. They might grip and release the fingers over and over again. Doctors call This symptom a milkmaid's grip, as it looks like a person is milking a cow.

• Jack-in-the-box Tongue: When a person tries to stick out their tongue, it may slide in and out of the mouth. This sign is sometimes known as jack-in-the-box tongue or harlequin tongue.

• Speech Difficulties: Children and adults might experience slurred speech as the muscles responsible for making a speech cannot be coordinated.

• Headaches and seizures: Children who get chorea after rheumatic fever can have seizures and headaches. Few children also have behavioral and emotional issues.

What Is the Treatment of Chorea?

Some people might remain unaware of their chorea, while others might see their mild symptoms as nothing serious or a social embarrassment. However, if the chorea is severe or disabling or intervenes with the quality of a person's life, they consult the doctor.

The type of treatment depends on the causative factor for the movement disorder. The treatment as per the causative agents are:

• In cases where chorea is seen due to Huntington's disease (although doctors cannot cure the disease), medications that might be able to control the movements are advised. These include Deutetrabenazine or Tetrabenazine to control muscle movements in Huntington's chorea.

• If chorea is part of a tardive dyskinesia syndrome, Valbenazine and Deutetrabenazine are usually prescribed medications.

• Amantadine is sometimes considered if Levodopa (Parkinson's medication) is the reason for the chorea. Antipsychotic drugs are sometimes advised if a person has both chorea and psychiatric conditions like agitation, irritability, anxiety, depression, suicide, and apathy.

• Children who suffer from Sydenham chorea can feel improvement in less than two years without treatment. If the chorea is critical, doctors prescribe medication like corticosteroids to help in controlling the movements. Antibiotics are also prescribed to treat the rheumatic fever infection.

• If chorea occurs due to a medication, quitting the medication is advised to reduce abnormal muscle movements.

• If chorea occurs due to endocrine or metabolic disorders (such as Hyperthyroidism, Hypoglycemia, Hypoparathyroidism, Hypocalcemia, and Hypomagnesemia), treating those conditions frequently reduces abnormal muscle movements.

• Deep brain stimulation therapy to reduce chorea has been applied in some patients but is considered an experimental treatment for this disease. Deep brain stimulation might be considered for severe chorea and other failed treatments.

Conclusion:

Hemiballismus and chorea are both disorders in which involuntary movements are seen. Hebellismus is a type of chorea. These movements can occur due to any pre-existing condition. These can be treated by treating the underlying cause or with the help of medications or a few therapies as per the cause.