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Hemiballism–Hemichorea

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Movement Disorder Emergencies

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Hemiballism is an uncommon movement disorder that presents with unilateral flinging movements of the limbs. It varies considerably in intensity and severity—often in its acute phase it can be of sufficient severity to present as a true emergency. It is most classically associated with ischemic lesions to the subthalamic nucleus (STN), although the majority of cases involve basal ganglia structures outside the STN. An important recently described association is with diabetes, during crises of severe non-ketotic hyperosmolar hyperglycemia. Pathophysiology is related to abnormal firing patterns in the globus pallidus interna, with intermittent firing bursts followed by pauses during which movements occur. The key treatment is anti-dopaminergic therapy, either with dopamine blockers such as neuroleptics or with dopamine depleters such as tetrabenazine. In extreme cases, functional neurosurgery can be performed; either lesioning or deep brain stimulation of the globus pallidus can be considered the treatments of choice. Most patients respond well to medical treatment and spontaneous resolution is common.

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Author information

Authors and Affiliations

  1. Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada

    Ronald B. Postuma M.D., M.Sc.

  2. Morton and Gloria Shulman Movement Disorders Center and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

    Anthony E. Lang M.D., FRCPC

Authors
  1. Ronald B. Postuma M.D., M.Sc.
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  2. Anthony E. Lang M.D., FRCPC
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Corresponding authors

Correspondence to Ronald B. Postuma M.D., M.Sc. or Anthony E. Lang M.D., FRCPC .

Editor information

Editors and Affiliations

  1. , Neurology, Columbia University Medical Center, West 168th St. Suite 310 710, New York, 10032, USA

    Steven J. Frucht

Electronic Supplementary Material

Movement_Disorders_Emergencies_C12.mov (77,617 KB)

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Postuma, R.B., Lang, A.E. (2013). Hemiballism–Hemichorea. In: Frucht, S. (eds) Movement Disorder Emergencies. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-835-5_12

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  • DOI: https://doi.org/10.1007/978-1-60761-835-5_12

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-834-8

  • Online ISBN: 978-1-60761-835-5

  • eBook Packages: MedicineMedicine (R0)

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