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Let's talk about the various types of movement

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disorders that we see in individuals

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and begin with Chorea.

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Chorea is defined as a syndrome

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characterized by abrupt,

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involuntary movements, resulting from a continuous

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flow of random muscle contractions.

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And I emphasize random.

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The pattern of movement can sometimes seem playful

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and convey a feeling of restlessness

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to the observer.

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When choreic movements are more severe,

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they can assume a flinging movement,

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almost like hemiballismus,

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and they're sometimes violent.

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This violent character is often addressed

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by the synonym ballism.

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The unpredictable nature of Chorea is a feature

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that distinguishes it from tremor and dystonia.

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Tremor is a repetitive,

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small movement of a muscle, such as the hand

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or a group of muscles in the hand,

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and that tremor can be broken down into intention

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tremor where you try and point at something and

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develop a tremor versus a resting tremor,

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which you know is more classic

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for Parkinson's syndrome.

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And then you've got this entity known as dystonia.

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Now,

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Chorea is characterized by rhythmic and oscillatory

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movements of body parts, although it can be random

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in any body part, where the hallmark of dystonia is

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the presence of a sustained muscular contraction

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resulting in abnormal postures

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or torsion movements.

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So the patient may get into a movement like this

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and get stuck there, whereas they don't get stuck in Chorea.

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It's a constant flow of motion.

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That's a very important distinguishing feature.

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Unlike Chorea,

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the resulting movements mimic complex motor

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behaviors in dystonia that are part

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of the normal human repertoire.

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So the patient can have the appearance that

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they're reaching for something and then get

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stuck in that reaching-type position.

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Whereas the Chorea movements are totally random

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they may not mimic normal human

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voluntary movement.

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Tics.

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Tics can be readily differentiated from

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Chorea because they also reproduce normal human

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movements as well.

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Sometimes, vocalizations,

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they're commonly preceded by a local unpleasant

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sensation, a sensory tic, or a prodrome,

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almost like a migraine.

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They can be voluntarily suppressed

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by the individual, if so desired

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in most of the cases.

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Myoclonic jerks, these are brief,

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and I mean brief, less than one fifth of a second

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or 200 milliseconds, shock-like muscular

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contractions that lack the continuous random

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flow of movement typical of Chorea.

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Don't confuse these for those little

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fasciculations you get under your eyes when

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you're tired. Everybody has those.

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So with that, we'll stop.

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Those are some of the major movement abnormalities

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that we're going to be dealing with.

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Of course,

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one of the most important will be tremor,

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intention tremor and especially pill rolling,

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resting tremor that is seen with

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PD or Parkinson's disease.