Movement - unpredictable or jerky

• Alternative Names

  Jerky body movements; Chorea; Muscle - jerky movements (uncontrolled); Hyperkinetic movements

• Considerations

  Typical movements of chorea (called tics) include facial grimacing, raising and lowering the shoulders, bending and extending the fingers and toes. The condition can affect one or both sides of the body.

  These involuntary movements are generally not repetitive and can appear purposeful even though they are involuntary and uncontrollable. A person with chorea may be viewed as jittery or restless.

• Common Causes

  There are many possible causes of unpredictable, jerky movements, including Sydenham's chorea, Huntington's disease, Wilson's disease, and other rare disorders. Some medical illnesses that can cause chorea include anti-cardiolipin antibody syndrome, systemic lupus erythematosus, polycythemia rubra vera, stroke, thyroid disease, and disorders of calcium, glucose or sodium metabolism.

  Some medications such as anti-psychotic drugs, may cause tardive dyskinesia, a movement disorder which may include choreic movements. Rarely, it is inherited in the syndrome called benign hereditary chorea. Some women may develop chorea when pregnant. This is called chorea gravidarum.

• Home Care

  Therapy is aimed at identifying and treating the underlying cause. If it is due to medication, the drug should be discontinued if possible. If it is due to medical disease, the disorder should be treated. If the movements are severe and disruptive, medications such as amantadine or tetrabenazine may help control the movements.

  Rest helps improve chorea, which can be aggravated by excitement or fatigue. Emotional stress should be minimized.

  Safety measures should also be taken to decrease the likelihood of injury from the involuntary movements.

• Call your health care provider if

  Call your provider if there is any persistent, unexplained, and unpredictable bodily motions.

• What to expect at your health care provider's office

  The medical history will be obtained and a physical examination performed.

  Medical history questions documenting this symptom in detail may include:

  • What kind of movement occurs?
  • What part of the body is affected?
  • What other symptoms are also present?
  • Is there irritability?
  • Is there weakness or paralysis?
  • Is there restlessness?
  • Is there emotional instability?
  • Are there facial tics?

  The physical exam may include detailed examination of both the nervous and the muscular systems. It will be performed with emphasis on the neurological exam. A careful eye examination is also needed to look for some kinds of disease that can affect the eye and movements. Diagnostic tests that may be performed include:

  • Blood work such as a complete blood count (CBC) or blood differential
  • CT scan or MRI of the head or affected area
  • EEG (rarely)
  • Lumbar puncture
  • Urinalysis

  Unpredictable movements may be treated with various medications. This will be decided by your health care provider based on your symptoms and signs.

• References

  Fahn S. Hypokinesia and hyperkinesia. In: Goetz, CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 16.

  Lang A. Other movement disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 434.

Review Date: 3/26/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.