What Is Hemiballismus ?
Hemiballismus Definition
Hemiballismus is a rare hyperkinetic movement disorder. It refers to an involuntary movement characterized by sudden movements of both arm and leg on the same side of the body [1, 2].
Hemiballismus is a disorder related to the dysfunction of the central nervous system, specifically the subthalamic nucleus of the basal ganglia [3].
It is a rare condition which can accompany several disorders.
Hemiballismus Symptoms
The symptoms of hemiballismus consist of involuntary, violent flinging movements. These are wide-amplitude movements that usually affect the upper and lower limbs on one side of the body.
Symptoms of hemiballismus can be accompanied by slurred speech, agitation and other abnormal movements of the limbs. Hemiballismus affects movement and the patients are often bound to bed.
Interestingly, the symptoms of hemiballismus disappear while sleeping and increase in severity with anxiety [3].
Hemiballismus leg refers to a leg executing these involuntary movements due to hemiballismus.
What Causes Hemiballismus ?
Hemiballismus is caused by disruption of the pathways of the basal ganglia [1, 2]. There are several ways in which the pathways of the basal ganglia can be damaged. The causes of hemiballismus are:
Stroke
Stroke is the most common cause of hemiballismus. Specifically ischemic stroke in the basal ganglia.
Neoplasm in the brain
This refers to an abnormal growth of tissue in the brain. This abnormality can either be noncancerous or cancerous.
Neuroinflections
Neuroinfections are usually present in younger patients and result in temporary hemiballismus.
Head trauma
Head trauma can lead to hemiballismus by causing damage to the subthalamic nucleus or connections to the subthalamic nucleus.
Neuroinflammatory diseases
An example of neuroinflammatory disease resulting in hemiballismus is Multiple Sclerosis, which can damage the connections to the subthalamic nucleus.
Nonketotic hyperglycaemia
Nonketotic hyperglycaemia can lead to focal lesions in the basal ganglia resulting in hemiballismus [4].
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Treatment of Hemiballismus
Treatment of Hemiballismus involves treating the underlying aetiology [1]. There are several options one can seek to in order to ameliorate the symptoms of hemiballismus.
Medical Treatment
Medical treatment focuses on, relieving the modernity of the hyperkinetic movements.
The possible medical treatment consists of antidopaminergic drugs, such as risperidone, haloperidol, etc which target D2 receptors. Further benzodiazepines, such as clonazepam, ani-epileptics such as topiramate and tetrabenazine [3, 5]. However, chronic use of these drugs can elicit many side effects and is not recommended.
Additionally, GABAergic neurotransmission-increasing drugs have also been shown to reduce hemiballismus. Examples of such drugs are progabide, sodium valproate and gabapentine [3].
Surgical Treatment
This includes deep brain stimulation of the globus pallidus internus [6]. Deep brain stimulation is a neurosurgical procedure in which the patient gets implanted electrodes in a specific brain area. These electrodes then deliver electrical impulses and modulate abnormal brain circuitry [7].
Hemiballismus Physiotherapy
Another option which can ameliorate the symptoms of hemiballismus is physiotherapy. Coordinated limb movements under the supervision of a specialist have been linked to an improvement of ballismus [8].
Hemiballismus vs Chorea
What is Chorea?
Chorea is a hyperkinetic movement disorder presenting as excessive, uncoordinated, and involuntary movement of the body. It is the hallmark symptom of Huntington's disease.
Chorea vs Hemiballismus
Hemiballismus and chorea appear to be very similar. Oftentimes, people are unaware of the differences. So let’s break it down together.
Both chorea and hemiballismus are hyperkinetic movement disorders resulting from basal ganglia dysfunction.
While the symptoms of hemiballismus include involuntary high-amplitude flinging movements of the limbs chorea manifests as involuntary and irregular muscle contractions in all muscles of the body. The muscle contractions observed in patients with chorea are less forceful than those observed in hemiballismus [7, 8].
Chorea and hemiballismus often coexist and can occur together, but it's also common to see just one of these conditions in a patient.
Diseases accompanied by hemiballismus
Hemiballismus is a movement disorder which can be part of the symptoms of various diseases.
Hemiballismus and Parkinson’s Disease
Hemiballismus is a parkinsonism-related disorder. It can occur in Parkinson’s disease patients. Although it is rare, the symptoms of hemiballismus in Parkinson’s disease patients can often be ameliorated by deep brain stimulation [9].
Hemiballismus and Diabetes
Hemiballismus and Diabetes Mellitus have been associated [8]. Oftentimes, we observe hemichorea-hemiballismus in poorly controlled diabetes in elderly patients. Hemichorea-hemiballismus refers to a rare syndrome manifesting involuntary non-rhythmic movements and involuntary violent high-amplitude movements of the limbs on one side of the body. These occur simultaneously and have been linked to hyperglycaemia related to diabetes [10, 9].