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Involuntary movements

MedGen UID:
140884
Concept ID:
C0427086
Sign or Symptom
Synonyms: Involuntary Movement; Involuntary Movements; Movement, Involuntary; Movements, Involuntary
SNOMED CT: Observation of involuntary movement (267078001); Involuntary movement (267078001)
 
HPO: HP:0004305

Definition

Involuntary contractions of muscle leading to involuntary movements of extremities, neck, trunk, or face. [from HPO]

Conditions with this feature

Infantile onset spinocerebellar ataxia
MedGen UID:
338613
Concept ID:
C1849096
Disease or Syndrome
Infantile-onset spinocerebellar ataxia (IOSCA) is a severe, progressive neurodegenerative disorder characterized by normal development until age one year, followed by onset of ataxia, muscle hypotonia, loss of deep-tendon reflexes, and athetosis. Ophthalmoplegia and sensorineural deafness develop by age seven years. By adolescence, affected individuals are profoundly deaf and no longer ambulatory; sensory axonal neuropathy, optic atrophy, autonomic nervous system dysfunction, and hypergonadotropic hypogonadism in females become evident. Epilepsy can develop into a serious and often fatal encephalopathy: myoclonic jerks or focal clonic seizures that progress to epilepsia partialis continua followed by status epilepticus with loss of consciousness.
Intellectual disability, autosomal recessive 6
MedGen UID:
370848
Concept ID:
C1970198
Mental or Behavioral Dysfunction
Any autosomal recessive non-syndromic intellectual disability in which the cause of the disease is a mutation in the GRIK2 gene.
Episodic kinesigenic dyskinesia 2
MedGen UID:
410022
Concept ID:
C1970238
Disease or Syndrome
A dystonia characterized by autosomal dominant inheritance of recurrent brief involuntary hyperkinesias triggered by sudden movements that has material basis in variation in the chromosome region 16q13-q22.1.
Dystonia 16
MedGen UID:
436979
Concept ID:
C2677567
Disease or Syndrome
Dystonia 16 is one of many forms of dystonia, which is a group of conditions characterized by involuntary movements, twisting (torsion) and tensing of various muscles, and unusual positioning of affected body parts. Dystonia 16 can appear at any age from infancy through adulthood, although it most often begins in childhood.\n\nThe signs and symptoms of dystonia 16 vary among people with the condition. In many affected individuals, the disorder first affects muscles in one or both arms or legs. Tensing (contraction) of the muscles often sets the affected limb in an abnormal position, which may be painful and can lead to difficulty performing tasks, such as walking. In others, muscles in the neck are affected first, causing the head to be pulled backward and positioned with the chin in the air (retrocollis).\n\nIn dystonia 16, muscles of the jaw, lips, and tongue are also commonly affected (oromandibular dystonia), causing difficulty opening and closing the mouth and problems with swallowing and speech. Speech can also be affected by involuntary tensing of the muscles that control the vocal cords (laryngeal dystonia), resulting in a quiet, breathy voice or an inability to speak clearly. Dystonia 16 gradually gets worse, eventually involving muscles in most parts of the body.\n\nSome people with dystonia 16 develop a pattern of movement abnormalities known as parkinsonism. These abnormalities include unusually slow movement (bradykinesia), muscle rigidity, tremors, and an inability to hold the body upright and balanced (postural instability). In dystonia 16, parkinsonism is relatively mild if it develops at all.\n\nThe signs and symptoms of dystonia 16 usually do not get better when treated with drugs that are typically used for movement disorders.
Severe X-linked mitochondrial encephalomyopathy
MedGen UID:
463103
Concept ID:
C3151753
Disease or Syndrome
Combined oxidative phosphorylation deficiency-6 (COXPD6) is an X-linked recessive severe encephalomyopathic disorder with onset in utero or in infancy. Affected patients have hypotonia and severely impaired psychomotor development associated with variably decreased enzymatic activity of mitochondrial respiratory complexes in skeletal muscle or fibroblasts. More variable features may include sensorimotor neuropathy, seizures, severe muscle weakness, abnormal signals in the basal ganglia, hypertrophic cardiomyopathy, deafness, swallowing difficulties, and respiratory insufficiency. Death in childhood may occur (summary by Berger et al., 2011). For a discussion of genetic heterogeneity of combined oxidative phosphorylation deficiency, see COXPD1 (609060).
Pontocerebellar hypoplasia type 8
MedGen UID:
767123
Concept ID:
C3554209
Disease or Syndrome
Pontocerebellar hypoplasia type 8 is an autosomal recessive neurodevelopmental disorder characterized by severe psychomotor retardation, abnormal movements, hypotonia, spasticity, and variable visual defects. Brain MRI shows pontocerebellar hypoplasia, decreased cerebral white matter, and a thin corpus callosum (summary by Mochida et al., 2012). For a general phenotypic description and a discussion of genetic heterogeneity of PCH, see PCH1 (607596).
Early-onset Parkinson disease 20
MedGen UID:
816154
Concept ID:
C3809824
Disease or Syndrome
Parkinson disease-20 is an autosomal recessive neurodegenerative disorder characterized by young adult-onset of parkinsonism. Additional features may include seizures, cognitive decline, abnormal eye movements, and dystonia (summary by Krebs et al., 2013 and Quadri et al., 2013). For a phenotypic description and a discussion of genetic heterogeneity of Parkinson disease, see PD (168600).
Hyperphosphatasia with intellectual disability syndrome 4
MedGen UID:
816684
Concept ID:
C3810354
Disease or Syndrome
Hyperphosphatasia with impaired intellectual development syndrome-4 (HPMRS4) is an autosomal recessive neurologic disorder characterized by severely delayed psychomotor development, impaired intellectual development, lack of speech acquisition, seizures, and dysmorphic facial features. Laboratory studies show increased serum alkaline phosphatase (summary by Howard et al., 2014). The disorder is caused by a defect in glycosylphosphatidylinositol (GPI) biosynthesis. For a discussion of genetic heterogeneity of HPMRS, see HPMRS1 (239300). For a discussion of genetic heterogeneity of GPI biosynthesis defects, see GPIBD1 (610293).
Developmental and epileptic encephalopathy, 25
MedGen UID:
863058
Concept ID:
C4014621
Disease or Syndrome
Developmental and epileptic encephalopathy-25 with amelogenesis imperfecta (DEE25) is an autosomal recessive neurologic disorder characterized by the onset of refractory seizures in early infancy. Most patients present with seizures in the neonatal period, which is often associated with status epilepticus. However, there is phenotypic variability, and some patients have onset of seizures later in infancy. Affected individuals show global developmental delay with intellectual disability and poor speech and communication. The seizures may remit somewhat with age, but there are persistent neurologic symptoms, including ataxia, spasticity, and abnormal involuntary movements. In addition to neurologic deficits, patients also have dental anomalies with amelogenesis imperfecta (summary by Thevenon et al., 2014 and Schossig et al., 2017). For a general phenotypic description and a discussion of genetic heterogeneity of DEE, see 308350.
Basal ganglia calcification, idiopathic, 6
MedGen UID:
901404
Concept ID:
C4225335
Disease or Syndrome
Primary familial brain calcification (PFBC) is a neurodegenerative disorder with characteristic calcium deposits in the basal ganglia and other brain areas visualized on neuroimaging. Most affected individuals are in good health during childhood and young adulthood and typically present in the fourth to fifth decade with a gradually progressive movement disorder and neuropsychiatric symptoms. The movement disorder first manifests as clumsiness, fatigability, unsteady gait, slow or slurred speech, dysphagia, involuntary movements, or muscle cramping. Neuropsychiatric symptoms, often the first or most prominent manifestations, range from mild difficulty with concentration and memory to changes in personality and/or behavior, to psychosis and dementia. Seizures of various types occur frequently, some individuals experience chronic headache and vertigo; urinary urgency or incontinence may be present.
Dystonia, childhood-onset, with optic atrophy and basal ganglia abnormalities
MedGen UID:
934601
Concept ID:
C4310634
Disease or Syndrome
MECR-related neurologic disorder is characterized by a progressive childhood-onset movement disorder and optic atrophy; intellect is often – but not always – preserved. The movement disorder typically presents between ages one and 6.5 years and is mainly dystonia that can be accompanied by chorea and/or ataxia. Over time some affected individuals require assistive devices for mobility. Speech fluency and intelligibility are progressively impaired due to dysarthria. Optic atrophy typically develops between ages four and 12 years and manifests as reduced visual acuity, which can include functional blindness (also known as legal blindness) in adulthood. Because only 13 affected individuals are known to the authors, and because nearly half of them were diagnosed retrospectively as adults, the natural history of disease progression and other aspects of the phenotype have not yet been completely defined.
Intellectual disability-epilepsy-extrapyramidal syndrome
MedGen UID:
934650
Concept ID:
C4310683
Disease or Syndrome
Neurodevelopmental disorder with hypotonia and impaired expressive language and with or without seizures (NEDHELS) is an autosomal recessive disorder characterized by hypotonia, poor feeding, and global developmental delay apparent from infancy. Most patients have poor overall growth, poor eye contact, sleep disturbances, and severely impaired expressive language. Affected individuals also tend to have behavioral problems, microcephaly, and variable dysmorphic features; many develop seizures. Brain imaging may show enlarged ventricles, thin corpus callosum and brainstem, and white matter abnormalities. The phenotype is variable (summary by Nabais Sa et al., 2019).
Chorea, childhood-onset, with psychomotor retardation
MedGen UID:
934754
Concept ID:
C4310787
Disease or Syndrome
Neurodevelopmental disorder with involuntary movements
MedGen UID:
1374697
Concept ID:
C4479569
Disease or Syndrome
NEDIM is a neurodevelopmental and neurodegenerative disorder characterized by delayed psychomotor development and infantile or childhood onset of hyperkinetic involuntary movements, including chorea and athetosis. The abnormal movements can be severe, sometimes resulting in inability to sit, walk, speak, or eat. Hyperkinetic movements can be exacerbated by specific triggers, such as stress, illness, or high temperature. Some patients have brain abnormalities, such as cerebral atrophy or thin corpus callosum, and some patients may develop seizures (summary by Ananth et al., 2016 and Danti et al., 2017).
Intellectual disability, autosomal dominant 53
MedGen UID:
1623344
Concept ID:
C4540481
Mental or Behavioral Dysfunction
Neurodevelopmental disorder with severe motor impairment and absent language
MedGen UID:
1622162
Concept ID:
C4540496
Mental or Behavioral Dysfunction
NEDMIAL is a neurodevelopmental disorder characterized by delayed psychomotor development and hypotonia apparent from early infancy, resulting in feeding difficulties, ataxic gait or inability to walk, delayed or absent speech development, and impaired intellectual development, sometimes with behavioral abnormalities, such as hand-flapping. Additional common features may include sleep disorder, nonspecific dysmorphic facial features, and joint hyperlaxity (summary by Lessel et al., 2017 and Mannucci et al., 2021).
Neurodevelopmental disorder with or without hyperkinetic movements and seizures, autosomal recessive
MedGen UID:
1646665
Concept ID:
C4693325
Disease or Syndrome
GRIN1-related neurodevelopmental disorder (GRIN1-NDD) is characterized by mild-to-profound developmental delay / intellectual disability (DD/ID) in all affected individuals. Other common manifestations are epilepsy, muscular hypotonia, movement disorders, spasticity, feeding difficulties, and behavior problems. A subset of individuals show a malformation of cortical development consisting of extensive and diffuse bilateral polymicrogyria. To date, 72 individuals with GRIN1-NDD have been reported.
Infantile hypotonia-oculomotor anomalies-hyperkinetic movements-developmental delay syndrome
MedGen UID:
1648431
Concept ID:
C4748715
Disease or Syndrome
Baker-Gordon syndrome (BAGOS) is a neurodevelopmental disorder characterized by infantile hypotonia, ophthalmic abnormalities, moderate to profound global developmental delay, poor or absent speech, behavioral abnormalities, hyperkinetic movements, and EEG abnormalities in the absence of overt seizures (summary by Baker et al., 2018).
Lissencephaly 9 with complex brainstem malformation
MedGen UID:
1681109
Concept ID:
C5193029
Disease or Syndrome
Lissencephaly-9 with complex brainstem malformation (LIS9) is an autosomal dominant neurologic disorder characterized by global developmental delay apparent since infancy, impaired intellectual development with poor or absent speech, and sometimes abnormal or involuntary movements associated with abnormal brain imaging that typically shows pachygyria, lissencephaly, and malformation of the brainstem consistent with a neuronal migration defect (summary by Dobyns et al., 2018). For a general description and a discussion of genetic heterogeneity of lissencephaly, see LIS1 (607432).
Combined oxidative phosphorylation deficiency 39
MedGen UID:
1683958
Concept ID:
C5193075
Disease or Syndrome
Combined oxidative phosphorylation deficiency-39 (COXPD39) is an autosomal recessive multisystem disorder resulting from a defect in mitochondrial energy metabolism. Affected individuals show global developmental delay, sometimes with regression after normal early development, axial hypotonia with limb spasticity or abnormal involuntary movements, and impaired intellectual development with poor speech. More variable features may include hypotonia, seizures, and features of Leigh syndrome (256000) on brain imaging. There are variable deficiencies of the mitochondrial respiratory chain enzyme complexes in patient tissues (summary by Glasgow et al., 2017). For a discussion of genetic heterogeneity of combined oxidative phosphorylation deficiency, see COXPD1 (609060).
Dyskinesia with orofacial involvement, autosomal dominant
MedGen UID:
1790407
Concept ID:
C5551343
Disease or Syndrome
ADCY5 dyskinesia is a hyperkinetic movement disorder (more prominent in the face and arms than the legs) characterized by infantile to late-adolescent onset of chorea, athetosis, dystonia, myoclonus, or a combination of these. To date, affected individuals have had overlapping (but not identical) manifestations with wide-ranging severity. The facial movements are typically periorbital and perioral. The dyskinesia is prone to episodic or paroxysmal exacerbation lasting minutes to hours, and may occur during sleep. Precipitating factors in some persons have included emotional stress, intercurrent illness, sneezing, or caffeine; in others, no precipitating factors have been identified. In some children, severe infantile axial hypotonia results in gross motor delays accompanied by chorea, sometimes with language delays. The overall tendency is for the abnormal movements to stabilize in early middle age, at which point they may improve in some individuals; less commonly, the abnormal movements are slowly progressive, increasing in severity and frequency.
Mitochondrial DNA depletion syndrome 20 (mngie type)
MedGen UID:
1804209
Concept ID:
C5676934
Disease or Syndrome
Mitochondrial DNA depletion syndrome-20 (MTDPS20) is an autosomal recessive multisystem disorder with variable manifestations and severity. Most patients develop symptoms in childhood, although the onset can range from infancy to the teenage years. Prominent features include severe gastrointestinal dysmotility often requiring parenteral nutrition, neurogenic bladder, and muscle weakness and atrophy. Neurologic involvement manifests as headaches, stroke-like episodes, seizures, pyramidal signs, and learning difficulties or cognitive decline. Brain imaging usually shows diffuse leukoencephalopathy and may show cerebellar atrophy. The disorder results from a defect in the maintenance and repair of mitochondrial DNA, resulting in mtDNA depletion and impaired mitochondrial function (summary by Bonora et al., 2021). For a discussion of genetic heterogeneity of mtDNA depletion syndromes, see MTDPS1 (603041).
Episodic kinesigenic dyskinesia 3
MedGen UID:
1840916
Concept ID:
C5830280
Disease or Syndrome
Episodic kinesigenic dyskinesia-3 (EKD3) is an autosomal dominant form of paroxysmal kinesigenic dyskinesia (PKD), an episodic involuntary movement disorder characterized by dystonia, chorea, athetosis, and other hyperkinetic movements. The age at onset is around 9 to 12 years of age and symptoms are usually triggered by sudden movement or stress. Most patients have spontaneous resolution of episodes in their early twenties or later. Brain imaging is normal. There is a favorable response to treatment with carbamazepine (Li et al., 2021; Tian et al., 2022; Wang et al., 2022). For a general phenotypic description and a discussion of genetic heterogeneity of episodic kinesigenic dyskinesia (EKD), see EKD1 (128200).
Developmental and epileptic encephalopathy 31B
MedGen UID:
1841095
Concept ID:
C5830459
Disease or Syndrome
Developmental and epileptic encephalopathy-31B (DEE31B) is an autosomal recessive neurologic disorder with early-onset epilepsy, generalized muscular hypotonia, visual impairment, and severe neurodevelopmental delay (Yigit et al., 2022).
Congenital disorder of deglycosylation 1
MedGen UID:
989503
Concept ID:
CN306977
Disease or Syndrome
Individuals with NGLY1-related congenital disorder of deglycosylation (NGLY1-CDDG) typically display a clinical tetrad of developmental delay / intellectual disability in the mild to profound range, hypo- or alacrima, elevated liver transaminases that may spontaneously resolve in childhood, and a complex hyperkinetic movement disorder that can include choreiform, athetoid, dystonic, myoclonic, action tremor, and dysmetric movements. About half of affected individuals will develop clinical seizures. Other findings may include obstructive and/or central sleep apnea, oral motor defects that affect feeding ability, auditory neuropathy, constipation, scoliosis, and peripheral neuropathy.

Professional guidelines

PubMed

Tater P, Pandey S
Neurol India 2021 Mar-Apr;69(2):272-283. doi: 10.4103/0028-3886.314574. PMID: 33904435
Cao L, Huang X, Wang N, Wu Z, Zhang C, Gu W, Cong S, Ma J, Wei L, Deng Y, Fang Q, Niu Q, Wang J, Wang Z, Yin Y, Tian J, Tian S, Bi H, Jiang H, Liu X, Lü Y, Sun M, Wu J, Xu E, Chen T, Chen T, Chen X, Li W, Li S, Li Q, Song X, Tang Y, Yang P, Yang Y, Zhang M, Zhang X, Zhang Y, Zhang R, Ouyang Y, Yu J, Hu Q, Ke Q, Yao Y, Zhao Z, Zhao X, Zhao G, Liang F, Cheng N, Han J, Peng R, Chen S, Tang B
Transl Neurodegener 2021 Feb 16;10(1):7. doi: 10.1186/s40035-021-00231-8. PMID: 33588936Free PMC Article
Aradi SD, Hauser RA
Neurotherapeutics 2020 Oct;17(4):1339-1365. doi: 10.1007/s13311-020-00889-4. PMID: 32761324Free PMC Article

Curated

UK NICE Guideline (NG127), Suspected neurological conditions: recognition and referral, 2023

Recent clinical studies

Etiology

Aradi SD, Hauser RA
Neurotherapeutics 2020 Oct;17(4):1339-1365. doi: 10.1007/s13311-020-00889-4. PMID: 32761324Free PMC Article
Ugawa Y
Neurosci Res 2020 Jul;156:80-87. Epub 2019 Oct 18 doi: 10.1016/j.neures.2019.10.001. PMID: 31634500
Popkirov S, Asadi-Pooya AA, Duncan R, Gigineishvili D, Hingray C, Miguel Kanner A, LaFrance WC Jr, Pretorius C, Reuber M
Epileptic Disord 2019 Dec 1;21(6):529-547. doi: 10.1684/epd.2019.1107. PMID: 31843732
Balint B, Mencacci NE, Valente EM, Pisani A, Rothwell J, Jankovic J, Vidailhet M, Bhatia KP
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Diagnosis

Pandey S, Pitakpatapee Y, Saengphatrachai W, Chouksey A, Tripathi M, Srivanitchapoom P
Semin Neurol 2023 Feb;43(1):35-47. Epub 2023 Feb 24 doi: 10.1055/s-0043-1763510. PMID: 36828011
Winkel D, Bernstein L
Med Clin North Am 2022 May;106(3):519-525. Epub 2022 Apr 4 doi: 10.1016/j.mcna.2022.02.002. PMID: 35491071
Zutt R, Elting JW, Tijssen MAJ
Handb Clin Neurol 2019;161:149-165. doi: 10.1016/B978-0-444-64142-7.00046-1. PMID: 31307597
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Therapy

Pandey S, Pitakpatapee Y, Saengphatrachai W, Chouksey A, Tripathi M, Srivanitchapoom P
Semin Neurol 2023 Feb;43(1):35-47. Epub 2023 Feb 24 doi: 10.1055/s-0043-1763510. PMID: 36828011
Yilmaz S, Mink JW
Pediatr Neurol 2020 Jan;102:10-19. Epub 2019 Sep 7 doi: 10.1016/j.pediatrneurol.2019.08.013. PMID: 31604647
Kremens DE
J Clin Psychiatry 2019 Dec 24;81(1) doi: 10.4088/JCP.NU18041BR4C. PMID: 31880872
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Prognosis

Kulisevsky J
Rev Neurol 2022 Oct 31;75(s04):S1-S10. doi: 10.33588/rn.75s04.2022217. PMID: 36342310Free PMC Article
Tater P, Pandey S
Neurol India 2021 Mar-Apr;69(2):272-283. doi: 10.4103/0028-3886.314574. PMID: 33904435
Vuong K, Canning CG, Menant JC, Loy CT
Handb Clin Neurol 2018;159:251-260. doi: 10.1016/B978-0-444-63916-5.00016-1. PMID: 30482318
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Clinical prediction guides

Kang Q, Liao H, Yang L, Fang H, Ning Z, Liao C, Gan S, Wu L
Front Immunol 2023;14:1140872. Epub 2023 Apr 21 doi: 10.3389/fimmu.2023.1140872. PMID: 37153594Free PMC Article
Al-Kassmy J, Sun C, Huot P
Neurodegener Dis Manag 2023 Apr;13(2):101-112. Epub 2023 May 4 doi: 10.2217/nmt-2022-0039. PMID: 37140165
Bologna M, Valls-Solè J, Kamble N, Pal PK, Conte A, Guerra A, Belvisi D, Berardelli A
Clin Neurophysiol 2022 Aug;140:110-125. Epub 2022 Jun 8 doi: 10.1016/j.clinph.2022.05.014. PMID: 35785630
Ganos C, Rothwell J, Haggard P
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Recent systematic reviews

Martino D, Karnik V, Bhidayasiri R, Hall DA, Hauser RA, Macerollo A, Pringsheim TM, Truong D, Factor SA, Skorvanek M, Schrag A; Members of the IPMDS Rating Scales Review Committee
Mov Disord 2023 Jun;38(6):1008-1026. Epub 2023 Apr 20 doi: 10.1002/mds.29392. PMID: 37081740
de Jongh FW, Schaeffers AWMA, Kooreman ZE, Ingels KJAO, van Heerbeek N, Beurskens C, Monstrey SJ, Pouwels S
Eur Arch Otorhinolaryngol 2023 Apr;280(4):1581-1592. Epub 2022 Dec 22 doi: 10.1007/s00405-022-07796-8. PMID: 36544062
Wong J, Pang T, Cheuk NKW, Liao Y, Bastiampillai T, Chan SKW
Psychopharmacology (Berl) 2022 Nov;239(11):3393-3420. Epub 2022 Sep 30 doi: 10.1007/s00213-022-06241-2. PMID: 36180741
Soares-Weiser K, Rathbone J, Ogawa Y, Shinohara K, Bergman H
Cochrane Database Syst Rev 2018 Mar 19;3(3):CD000208. doi: 10.1002/14651858.CD000208.pub2. PMID: 29552749Free PMC Article
Soares-Weiser K, Maayan N, Bergman H
Cochrane Database Syst Rev 2018 Jan 17;1(1):CD000209. doi: 10.1002/14651858.CD000209.pub3. PMID: 29341067Free PMC Article

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    • NICE, 2023
      UK NICE Guideline (NG127), Suspected neurological conditions: recognition and referral, 2023

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