Movement - unpredictable or jerky

Alternative Names

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

Considerations

This condition can affect one or both sides of the body. Typical movements of chorea include:

• Bending and straightening the fingers and toes
• Grimacing in the face
• Raising and lowering the shoulders

These movements do not usually repeat. They can look like they are being done on purpose. But the movements are not under the person's control. A person with chorea may look jittery or restless.

Common Causes

There are many possible causes of unpredictable, jerky movements, including:

• Anti-cardiolipin antibody syndrome
• Benign hereditary chorea (a rare inherited condition)
• Disorders of calcium, glucose, or sodium metabolism
• Huntington's disease
• Medicines (such as levodopa, antidepressants, anticonvulsants)
• Polycythemia rubra vera
• Sydenham chorea
• Wilson disease
• Pregnancy (chorea gravidarum)
• Stroke
• Systemic lupus erythematosus
• Tardive dyskinesia (a condition that can be caused by medications such as antipsychotic drugs)
• Thyroid disease
• Other rare disorders

What to expect at your health care provider's office

The doctor will perform a physical exam. This may include a detailed examination of the nervous and muscle systems.

The doctor will ask about your medical history and symptoms, including:

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

Tests that may be ordered include:

• Blood tests such as metabolic panel , complete blood count (CBC), blood differential
• CT scan of the head or affected area
• EEG (in rare cases)
• EMG and nerve conduction velocity (in rare cases)
• Genetic studies
• Lumbar puncture
• MRI of the head or affected area
• Urinalysis

Treatment

Treatment is based on the type of chorea the person has. If medicines are used, the health care provider will decide which medicine to prescribe based on the person’s symptoms and signs.

Home Care

Treatment is aimed at the cause of the movements.

• If the movements are due to a medicine, the medicine should be stopped, if possible.
• If the movements are due to a disease, the disorder should be treated.
• For people with Huntington disease, if the movements are severe and affect the person's life, medicines such as  tetrabenazine may help control them.

Excitement and fatigue can make chorea worse. Rest improves chorea. Try to reduce emotional stress.

Safety measures should also be taken to prevent injury from the involuntary movements.

Call your health care provider if

Call your health care provider if you have unexplained body motions that are unpredictable and do not go away.

References

Griggs RC, Jozefowicz RF, Aminoff MJ. Approach to the patient with neurologic disease. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 403.

Lang AE. Other movement disorders. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 417.