Abnormal Involuntary Movements

Abnormal movements can present across all ages. While the core approach to history, examination, and classification is similar, certain causes and management priorities differ between adults and children. This guide integrates both perspectives under each domain.

📝 History Taking

• Onset & Duration ⏱️
  • Adults: often insidious onset with neurodegeneration (e.g., Parkinson’s, Huntington’s) or drug exposure.
  • Children: may follow infection (e.g., Sydenham’s chorea), metabolic crises, or manifest from birth (cerebral palsy).
• Character of Movement 🌀
  • Tremor, chorea, dystonia, myoclonus, tics, or athetosis.
  • Children may show benign stereotypies or regression of milestones.
• Triggers & Relieving Factors ⚡
  • Stress, caffeine, sleep deprivation, alcohol, medication changes.
  • In children, ask about febrile episodes and stimulant medication use.
• Associated Features 🤝
  • Adults: weakness, sensory loss, cognitive decline.
  • Children: behavioural changes, school performance, seizures, developmental delay.
• Family History 👨‍👩‍👧
  • Inherited disorders (Huntington’s, Wilson’s, dystonias, Tourette’s).
  • Ask about consanguinity and metabolic disorders in paediatrics.
• Medication & Substances 💊
  • Adults: antipsychotics, lithium, antiemetics, alcohol, drugs.
  • Children: note ADHD medications, anticonvulsants, toxins.

🩺 Physical Examination

• Observation 👀
  • Adults: look at rest and with activity; assess symmetry and distribution.
  • Children: observe during play, where abnormal movements may become more obvious.
• Neurological Examination 🧪
  • Tone, power, reflexes, coordination in both groups.
  • Adults: parkinsonian, cerebellar, or pyramidal signs.
  • Children: signs of cerebral palsy, developmental coordination problems.
• Posture & Gait 🚶
  • Adults: dystonic postures, shuffling gait, ataxia.
  • Children: toe-walking, scissoring gait, hypotonia or spasticity.

🔎 Common Abnormal Movements

• 🫨 Tremor: Essential tremor, Parkinson’s (adults); Wilson’s disease, enhanced physiologic tremor (children).
• 💃 Chorea: Huntington’s, stroke, drug-induced (adults); Sydenham’s chorea, lupus, metabolic/genetic causes (children).
• 🧷 Dystonia: Focal dystonias like torticollis (adults); cerebral palsy, Wilson’s disease, genetic dystonias (children).
• ⚡ Myoclonus: Epileptic, post-hypoxic, metabolic (adults); juvenile myoclonic epilepsy, metabolic encephalopathies (children).
• 🤏 Tics: Tourette syndrome in both; in children often linked to ADHD/OCD.
• 🌀 Athetosis: Rare in adults (stroke, basal ganglia damage); common in cerebral palsy (especially kernicterus).

🧪 Investigations

• Blood tests: CBC, U&E, LFTs, TFTs, glucose, calcium. Add ceruloplasmin/urinary copper for Wilson’s (especially in children/young adults).
• Imaging: MRI or CT to exclude structural lesions in both groups.
• Genetics: Huntington’s, dystonia genes (adults); broader metabolic/genetic testing in children.
• Electrophysiology: EEG for epilepsy/myoclonus; EMG for tremor characterisation.

💊 Management Principles

• Treat underlying cause 🎯 — e.g., thyrotoxicosis, Wilson’s, drug-induced movements, infection.
• Symptomatic therapy 💉 —
  • Adults: levodopa (Parkinson’s), propranolol (tremor), tetrabenazine (chorea), botulinum toxin (dystonia).
  • Children: antiepileptics (myoclonus), antibiotics ± steroids (Sydenham’s chorea), chelation (Wilson’s).
• Non-pharmacological 🧘 — physio, OT, CBT for functional or tic disorders.
• Surgery 🔧 — deep brain stimulation (DBS) in severe/refractory adult cases; rarely used in children but possible for dystonia.
• Family & Developmental Support 👨‍👩‍👧 — essential in children: school support, genetic counselling, early intervention programmes.

✨ Key Points

• Abnormal movements may be benign, genetic, or acquired — context is key.
• In adults, degenerative and drug-induced causes dominate.
• In children, congenital, metabolic, and post-infectious causes are common.
• Management requires both symptom control and age-appropriate support.