Movement disorders induced by peripheral trauma

Abstract

-Movement disorders induced by central nervous system trauma are well recognized. However, over the last few years, attention has been drawn to the role of peripherally induced movement disorders. We describe three patients presenting respectively dystonia, tremor and choreoathetosis associated with tremor and dystonia of the body parts previously exposed to traumatic injuries. Pathophysiological mechanisms underlying these phenomena are not entirely known, but functional changes in afferent neuronal input to the spinal cord and secondary affection of higher brain stem and subcortical centers are probably involved.KEY WORDS: movement disorders, peripheral trauma, chorea.Distúrbios do movimento induzidos por traumatismo periférico Distúrbios do movimento induzidos por traumatismo periférico Distúrbios do movimento induzidos por traumatismo periférico Distúrbios do movimento induzidos por traumatismo periférico Distúrbios do movimento induzidos por traumatismo periférico RESUMO -Distúrbios do movimento induzidos por traumatismo de sistema nervoso central já são conhecidos. Entretanto, nos últimos anos tem se dado maior atenção ao traumatismo periférico como indutor desses distúrbios. Relatamos três pacientes que apresentaram respectivamente distonia, tremor e coreoatetose com tremor e distonia em partes do corpo previamente traumatizadas. Os mecanismos fisiopatológicos que explicam esse fenômeno não são totalmente conhecidos, mas alterações nos impulsos neuronais aferentes para a medula interferindo secundariamente no funcionamento de estruturas corticais e subcorticais estão provavelmente envolvidas. PALAVRAS-CHAVE: distúrbios do movimento, trauma periférico, coréia. Movement disorders after traumatic events are usually related to central nervous system injuries, but sometimes may result from peripheral lesions. The association between peripheral trauma and movement disorders was first described by Gowers in 1888 who observed a patient with cervical dystonia after a local neck injury and noted that a patient with writer's cramp had previously sprained his thumb 1 . Despite those first descriptions, only recently attention has been drawn to peripheral trauma as a possible predisposing factor for movement disorders and growing scientific support for this concept has developed. Although temporal and topographic relationships have been closely established, including the concomitant occurrence of reflex sympathetic dystrophy in some cases, the pathophysiologic mechanisms underlying these phenomena are not well understood 2-8 .We report three patients presenting a variety of movement disorders which developed few weeks after peripheral injuries nearby to the sites of the abnormal movements. CASESPatient 1. A 23-year-old man had been diagnosed with paranoid schizophrenia since 13. He had been treated with haloperidol, periciazine and biperidene for approximately 12 years. Three years before the present evaluation he suffered a blunt trauma on his left shoulder and two weeks later he noticed involuntary contract...

Possible Functional Moving Toes Syndrome

“… 4 However, the association between peripheral nerve injuries and movement disorders has become a controversial matter. 5 …”

Possible Functional Moving Toes Syndrome

“…4 However, the association between peripheral nerve injuries and movement disorders has become a controversial matter. 5 MTS has typically been described as an organic disorder linked to various types of peripheral nerve injuries. Typically, no clear association of MTS with signs of functional movement disorders has been made.…”

Case series of painful legs and moving toes: Clinical and electrophysiologic observations

“…Peripheral injury can certainly lead to changes in neurotransmitter levels in the basal ganglia 20. Various movement disorders have been described after peripheral injury or trauma, including tremor, dystonia, and choreoathetosis 21, 22. In those with clinical or electrophysiologic evidence of a peripheral nerve or root problem, these lesions may lead to functional changes in the afferent neuronal input to the spinal cord, with secondary upstream effects on higher brainstem and subcortical centers.…”