- Ballizm's symptoms
- Ballizm's reasons
- Ballizm's treatment
Ballizm (Greek ballismos — jumping, throwing) is characterized by the sharp, broskovy, krupnoamplitudny movements in proximal departments of extremities with a rotary component.
In view of a certain phenomenological similarity of ballistic motive pushes and choreic twitchings, and also the combination of data which is observed in some cases violent the movement and their similar clinical dynamics, some authors consider a ballizm as a special kind of a choreic hyperkinesia. Hemiballism combination cases to a distal choreoathetosis in the affected extremity are described.
In most cases this type of an extrapyramidal hyperkinesia happens unilateral (hemiballism). When involving both parties, what is much more rare, speak about a paraballyzma. Involvement in a hyperkinesia of one extremity (monoballizm), and also a generalized form of a hyperkinesia is possible (biballizm).
Ballizm is characterized by the sharp wide movements happening, mainly, in humeral (less often) coxofemoral joints. Slightly more often the left side of a body is involved in a hyperkinesia. Sometimes the powerful broskovy movements lead to disturbance of balance and falling of the patient, injury of skin and hypodermic fabrics. Patients are not able to hold spontaneously a hyperkinesia even for a short time. As well as at a classical chorea, the emotional pressure promotes strengthening of expressiveness of a ballizm. The hyperkinesia completely disappears in a dream.
More than at a half of patients along with ballistic pushes of extremities the hyperkinesias of facial muscles which are often followed by an alalia and swallowing are observed; also involvement of axial muscles of a trunk and neck can be noted. Existence or lack of other neurologic symptoms (a hemiparesis, a gemigipesteziya, changes of a muscle tone, cognitive frustration, etc.) depends on specific localization and size of the polusharny center.
Dynamics of a hyperkinesia is defined by its etiology. In the typical cases caused by an ischemic or hemorrhagic stroke the acute beginning of a hemiballism, with the subsequent gradual regress of symptomatology (is observed up to disappearance) within 3 — 6 months; slightly more rare at such patients the hemiballism remains as a resistant residual symptom. More gradual beginning and slow increase of expressiveness of a hyperkinesia is characteristic of a ballizm of the infectious and tumoral nature.
At inflammatory processes (such as system lupus erythematosus, etc.) the repeated, recurrent attacks of a ballizm, including with change of the half of a body involved in a hyperkinesia can be observed.
In absolute majority of cases of a ballizm when carrying out a MP tomography (especially with use of high power of magnetic field) it is possible to visualize the center of defeat in contralateral area basal ганглиев (a subthalamic kernel, a shell, a kernel having a tail, a pale sphere).
Ischemic is the most frequent reason of a hemiballism, the hemorrhagic stroke in a contralateral parencephalon affecting area of a subthalamic kernel is more rare. According to a number of authors, received at inspection of extensive selections of patients with a hemiballism, in 50 — 100% of cases of this syndrome the stroke was the cornerstone of its development. The Tranzitorny ischemic attacks in the relevant departments of a parencephalon can lead to emergence of short-term and passing episodes of a hemiballism.
Among accessory etiological factors of a hemiballism of the vascular nature it is necessary to call a venous angioma and an arteriovenous malformation.
Other reasons of a ballistic hyperkinesia are extremely rare. Treat them:
— primary or metastatic tumoral defeats;
— neuroinfections (SPID-assotsirovanny toksoplazmenny abscess, tuberkulom, herpetic encephalitis, cryptococcal meningitis);
— a craniocereberal injury (including an extra-and subdural hematoma);
— general diseases of connecting fabric and primary anti-phospholipidic syndrome;
— multiple sclerosis;
— complications of neurosurgical operations (a talamotomiya, stimulation of thalamic and subthalamic kernels at Parkinson's disease, imposing of the ventrikuloperitonealny shunt);
— metabolic frustration (hyper - and a hypoglycemia);
— side effect of some medicines (oral contraceptives, Phenytoinum, levodopa, ibuprofen).
Ballizm is caused by defeat of a subthalamic kernel of Lyuis and his bonds with an outside segment of a pale sphere and involves contralateral to the extremity center. It is considered that for clinical manifestation of a ballizm the volume of the destructive center has to make, at least, 20% of its total amount of a subthalamic kernel. At the same time, at exceeding of the specified critical volume of accurate correlation between the size of the center and expressiveness of a hyperkinesia it is not observed.
Normal Lyuis's kernel exerts exciting impact on an internal segment of a pale sphere; the last, in turn, possesses brake action on neurons of a ventrolateralny kernel of a thalamus, originative to the ascending talamo-cortical way. Thus, from the pathophysiological point of view damage of a kernel of Lyuis leads to a disinhibition of talamokortikalny bonds, as is the cornerstone of a ballistic hyperkinesia.
The pharmacotherapy of a ballizm is based on use of blockers of dopamine receptors from group of neuroleptics (a haloperidol in a dose of 1 — 3 mg a day, Pimozidum, 1 — 10 mg/days, тиаприд, 200 — 400 mg/days, etc.), and also Reserpinum (1,5 — 2,5 mg a day) which mechanism of action is connected with reduction of release of dopamine from presynaptic bombways. Very often purpose of anti-dopamine drugs has "drama" effect and leads to noticeable regress of a ballizm in 2 — 7 days after an initiation of treatment. At some patients reduction of expressiveness of a hyperkinesia at purpose of Gamkergichesky drugs — Valproatum of sodium and a progabid is described.
In the most hard and resistant cases with success surgical treatment is applied, at the same time method of the choice is stereotaxic destruction of a ventrolateralny kernel of a thalamus. In recent years for the purpose of surgical treatment of a hemiballism high-frequency electric stimulation of thalamic kernels of ventral group is offered.
Special attention when maintaining the patient with balliz-megohm should be paid to prevention of the physical damages and various medical complications connected with extraordinary sharp, wide and exhausting character of this hyperkinesia. It is important to equip as appropriate a bed and chamber of the patient, to remove or cover with foam rubber the acting parts of furniture, to provide in necessary cases a possibility of fixing of an extremity to a body or a special outside frame, to provide the necessary caloric content of food with adequate compensation of a metabolic cost.