Karuturi Rounds 78 > Identify this Involuntary Movement

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Permalink Reply by Charan thej reddy.Vegivinti on October 23, 2012 at 10:26pm

facial tics

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Permalink Reply by Sumanth Koppolu on October 24, 2012 at 1:40am

Tics i think.

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Permalink Reply by Jey on October 24, 2012 at 8:44am

Benign fasciculation syndrome ??

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Permalink Reply by Adel ElKady on October 24, 2012 at 8:40pm

Fasiculations

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Permalink Reply by S.UMA DEVI on October 28, 2012 at 3:06pm

?MYOKYMIA

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Permalink Reply by Maggie on October 28, 2012 at 6:30pm

facial tics

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Permalink Reply by Subrahmanyam Karuturi on November 2, 2012 at 9:44pm

The correct answer is Facial Myokymia.

Myokymia, a form of involuntary muscular movement, usually can be visualized on the skin as vermicular or continuous rippling movements.

Pathophysiology

The clinical phenomenon is characterized by its classic quivering movement of the involved muscle without movement of the joint. Myokymia can be seen in muscles innervated by cranial or spinal nerves. The distribution can be either regional or generalized, depending on the etiology. Also, it can be seen transiently in healthy subjects after strenuous exercise.

The exact mechanism(s) of myokymia is not well understood. Myokymia of the facial muscles is believed to originate from the facial nucleus or from some contribution by a supranucleus process; however, the presence of myokymia in polyradiculopathy indicates the possibility of a more distal generator.

Clinical Features

• Patients with myokymia may present with symptoms of pain, cramps, spasms, weakness, stiffness, or twitching.
• Sensory symptoms are reported rarely, unless the underlying etiology(ies) includes sensory nerve involvement.
• Typical myokymic discharges also can be seen in the EMGs of patients referred for totally unrelated complaints.
• Affected muscles show slow, undulating, fine movements on the surface of the skin due to activation of the most superficial muscle layers. Facial weakness can be present in the involved muscles.
• EMG study shows typical myokymic discharges of spontaneous, rhythmic/semirhythmic bursts of normal-appearing potentials of 30-60 Hz. The bursts of each group of potentials are followed by a period of silence, with subsequent repetition of grouped discharges of identical potentials. The spontaneous activities are not altered by voluntary activation of the muscles.

Treatment

Treatment of myokymia is focused largely on the underlying etiology. Most patients with facial or focal limb myokymia are not particularly disturbed by the myokymia itself. The accompanying symptoms of the particular neurological or medical conditions are the major concern to patients and their caretakers.

• For conditions secondary to thyrotoxicosis, poisoning, and alcoholic cramp syndrome, the myokymia disappears with resolution or improvement of the medical conditions.
• Patients with radiation plexopathy require no intervention.
• Myokymia seen in acute or chronic polyradiculoneuropathy usually improves with immunomodulatory therapy.
• Transient myokymia that develops after strenuous exercise resolves spontaneously over weeks to months.

Reference : emedicine

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Permalink Reply by Dindukurthi Sudhakar on November 3, 2012 at 3:31pm

Thank you, Dr.Karuturi.

You have mentioned that in myokymia ... "Affected muscles show slow, undulating, fine movements on the surface of the skin due to activation of the most superficial muscle layers."

But I noticed only "twitches" in the video. How do you differentiate between fasciculations and myokymia, clinically?

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Permalink Reply by RIZWAN AHMED on December 1, 2012 at 6:55pm

i think the most important dd is the motor neurone disease. if pt has features of bulbar and psuedobulbar palsy and umn or lmn signs in the limbs then we should think about MND.

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