Many people may have seen patients with abnormal movement, such as symptoms of twisting back and forth out of rhythm, or repeated twitching of the muscles, particularly in those who have been treated for Parkinson's disease for a long time. These symptoms may be a signal of a state called "Dyskinesia", which is an abnormality of the nervous system that has a bearing on the control of the movement of the body. This article will take you to understand the state of Dyskinesia in detail, and the suitable approach to treatment.
Understanding the state of Dyskinesia
Before we go deeply into the causes and the treatment, the important thing is to understand first what Dyskinesia really is, and what the character of its symptoms is, so that the symptoms can be observed and assessed correctly.
What is Dyskinesia?
Dyskinesia, or what is called in Thai "the state of abnormal movement", is a state of the nervous system that gives rise to movement of the muscles that is abnormal and cannot be controlled. The word "Dyskinesia" comes from Greek, "dys" meaning "abnormal" and "kinesis" meaning "movement". The symptoms that arise will differ in each individual, from mild symptoms that can barely be noticed, through to severe ones that have a bearing on the living of daily life.
The important characteristics of the symptoms
The symptoms of Dyskinesia are wide in variety, but the important distinguishing characteristic is movement that cannot be controlled by oneself. The symptoms may appear as twisting back and forth of the trunk, twitching of the arms and legs, movement as though dancing, or abnormally frequent blinking of the eyes. Sometimes the symptoms may proceed slowly and continuously, or sometimes may be a rapid twitching out of rhythm. Patients usually feel uncomfortable and ill at ease, particularly when the symptoms arise in a public place.
The positions where the symptoms arise often
Dyskinesia can arise in several areas of the body. The area met most often is the area of the face, such as repeated chewing of the mouth, frequent blinking of the eyes, or pursing the lips. Besides this, symptoms are also met in the arms and the legs, such as waving the arms back and forth, moving the fingers without purpose, or lifting the feet up and down repeatedly. As for the area of the trunk, there may be symptoms of twisting back and forth, or leaning to the left and right abnormally, which results in the routines of daily life being difficult to carry out.
What causes can Dyskinesia arise from?
Understanding the causes of Dyskinesia is important in planning suitable treatment, because each cause may require a different method of management. The main causes of Dyskinesia are as follows.
The long-term side effect from the use of medicine to treat Parkinson's disease (Levodopa-induced Dyskinesia)
The cause of Dyskinesia met most often is the side effect from the use of the medicine Levodopa, which is the main medicine in treating Parkinson's disease. When the patient uses this medicine for many years, the brain may respond to the medicine abnormally, giving rise to movement that cannot be controlled, particularly during the period when the level of the medicine in the blood is highest. The symptoms usually arise after using the medicine Levodopa for at least 5-10 years, and are met in about 40-90% of Parkinson's patients, depending on the length of time and the dose of medicine used.
The side effect from psychiatric medicines (Tardive Dyskinesia)
Tardive Dyskinesia is another important cause, arising from the use of antipsychotic drugs in the long term, particularly medicines in the group of typical antipsychotics, such as Haloperidol or Chlorpromazine. The symptoms usually arise in the area of the face, the mouth, and the tongue, such as repeated chewing of the mouth, pursing the lips, or sticking out the tongue. This state may arise even after the medicine has been stopped, and sometimes may not be able to be treated so that it heals completely.
Genetic diseases and other abnormalities of movement
Some kinds of Dyskinesia arise from genetic diseases or other states of the nervous system, such as Huntington's disease, which is a disease that causes the brain to degenerate and has symptoms of abnormal movement as an important component. Besides this there are also other states, such as Cerebral palsy, Wilson's disease, or Dystonia, that can give rise to symptoms similar to Dyskinesia as well.
Injury of the brain
Injury of the brain, whether from an accident, cerebrovascular disease, or a lack of oxygen, may cause damage to the part of the brain that controls movement, resulting in Dyskinesia, particularly if the damage occurs at the basal ganglia, which is the part that is important in controlling the movement of the body.
Dyskinesia vs sannibat luk nok: how do they differ?
Many people usually misunderstand the difference between Dyskinesia and the trembling symptom of Parkinson's disease (Tremor), or what is called "sannibat luk nok". Although both are symptoms met in Parkinson's patients, they differ clearly.
Dyskinesia
Dyskinesia has the character of movement that is complex, out of rhythm, and usually twisting back and forth or moving as though dancing. The symptoms usually arise when the Parkinson's medicine is at a high level in the blood, and decrease when the effect of the medicine wears off. These movements may look like dancing or like rocking back and forth without purpose.
Sannibat luk nok (the trembling symptom)
On the contrary, the trembling symptom of Parkinson's disease has the character of trembling that is rhythmic and regular, usually arising when the muscles are at rest, such as while sitting or standing still, and decreasing when there is movement. The trembling usually begins from one hand or the other, and may spread to the other limbs later.
A table comparing the important differences
The character of the movement:
- Dyskinesia: twisting back and forth, out of rhythm, like dancing
- Sannibat luk nok: trembling in rhythm, regular
The time when the symptoms arise:
- Dyskinesia: arising when the level of the medicine in the blood is high, usually arising after taking the Parkinson's medicine
- Sannibat luk nok: arising when the muscles are at rest, decreasing while moving
The relation to medicine:
- Dyskinesia: arising from the side effect of the medicine Levodopa in the long term
- Sannibat luk nok: a main symptom of Parkinson's disease, improving when the treating medicine is received
The diagnosis and assessment of the symptoms of Dyskinesia
Diagnosing Dyskinesia correctly is the important first step in planning treatment. The doctor will use several methods together in order to assess the symptoms and find the true cause.
Taking the history of medicine use and the history of illness
The doctor will begin from taking a detailed history, particularly about the medicines the patient is using, the length of time the medicine has been used, and the dose. Besides this they will also ask about the history of illness in the area of the nervous system, the history of injury of the brain, and the family history concerning diseases of the nervous system. This information will help the doctor be able to identify the cause of the Dyskinesia more precisely.
The neurological physical examination by the doctor
The doctor will carry out a detailed neurological physical examination, observing the character of the abnormal movement, the frequency and the severity of the symptoms, as well as the area where the symptoms arise. Besides this there may be further examination, such as imaging of the brain with MRI or CT Scan in order to detect structural abnormality of the brain, or laboratory examination in order to assess the level of the medicine in the blood and the working of the brain.
The approach to treating and managing the state of Dyskinesia
Treating Dyskinesia depends on the cause and the severity of the symptoms. The main goal is to reduce the symptoms that interfere with the living of daily life, while preserving the quality of life of the patient as well as possible.
Adjusting the medicine that gives rise to the symptoms
For Dyskinesia arising from medicine, the doctor may consider adjusting the dose of the medicine, changing the time at which the medicine is given, or changing the kind of medicine, such as reducing the dose of Levodopa but increasing the frequency with which the medicine is given, or changing to using medicines in the group of dopamine agonists, which have fewer side effects. However, adjusting the medicine must be done carefully, so that the symptoms of Parkinson's disease do not come back worse.
The use of medicine to reduce the symptoms of Dyskinesia in particular
At present there are medicines developed in order to reduce the symptoms of Dyskinesia in particular, such as Amantadine, which has received approval from the FDA in the United States for treating Levodopa-induced Dyskinesia. This medicine helps reduce the severity and the frequency of the symptoms effectively, without making the symptoms of Parkinson's disease worse.
Doing physiotherapy
Physiotherapy is an important part in managing Dyskinesia. The physiotherapist will design a suitable programme of exercise in order to help increase the strength of the muscles, improve balance, and reduce the severity of the symptoms. Training the control of movement and the relaxation of the muscles can help the patient manage the symptoms better. At PYONG Rehabilitation Clinic we have a team of specialist physicians in rehabilitation medicine and physiotherapists with experience, ready to serve with modern technology in order to help restore and relieve the symptoms.
Treatment with modern technology at PYONG Rehabilitation Clinic
Besides treatment with medicine and traditional physiotherapy, at PYONG Rehabilitation Clinic we also bring advanced treatment technology to use in managing the symptoms of Dyskinesia patients and other states of the nervous system. With the concept of "Best in Class Technology" and selection by experts (Curated by Experts), we are therefore confident that every technology brought to use will truly help increase the effectiveness of the treatment.
Transcranial Magnetic Stimulation (TMS) - stimulating the brain with magnetic waves
Treatment with TMS is a technique that is non-invasive and safe, using magnetic waves to stimulate the area of the brain connected with the control of movement. This technology has received acceptance in the medical field at the world level for treating several kinds of state of the nervous system. For Dyskinesia patients, stimulation with TMS may help reduce the severity of the symptoms and improve the working of the part of the brain that controls movement.
Peripheral Magnetic Stimulation (PMS) - stimulating the peripheral muscles and nerves
The technology of PMS helps reduce the pain and tightness of the muscles arising from abnormal movement. The PMS device works by stimulating with electromagnetic waves to the muscles and the peripheral nerves, helping the muscles release, improving the circulation of blood, and reducing the pain arising from the twisting and spasm.
Neuromuscular Electrical Stimulation (NMES) - stimulating the muscles with electricity
Treatment with NMES helps restore the strength of muscles that are weak from a state of the nervous system. This technique uses a low-frequency electrical current to stimulate the muscles to contract in a controlled way, helping train the working of the muscles and improve the coordination between the brain and the muscles.
Diagnostic Ultrasound - examination with high-frequency sound waves
At PYONG Rehabilitation Clinic we have the technology of examination with high-frequency sound waves (Diagnostic Ultrasound) that lets the doctor examine and assess the condition of the muscles, the tendons, and the tissue in detail in real time. This examination lets the doctor plan the treatment more precisely and follow up the result of the treatment continuously.
A programme of restoration specific to the individual by a multidisciplinary team
Treating Dyskinesia patients at PYONG Rehabilitation Clinic is not merely treating according to the symptoms, but we are directed at holistic restoration designed specifically for each individual. The team of rehabilitation physicians, physicians of neurological internal medicine, physiotherapists, and occupational therapists work together closely in order to plan the most suitable treatment. We understand that each person has different needs and goals, and so we adjust the programme of treatment so that it corresponds to the lifestyle and the needs of each patient.
Frequently asked questions (FAQ)
Is Dyskinesia dangerous?
Dyskinesia itself is not directly dangerous to life, but severe symptoms can have a great bearing on the quality of life, for example making the doing of daily activities difficult — eating food, putting on clothes, or walking. Besides this it may also increase the risk of falling and of injury. Therefore, treating and managing the symptoms suitably is important.
Can this state be prevented?
For Dyskinesia arising from medicine, using the medicine at a suitable dose and not beyond what is necessary may help reduce the risk. The doctor will consider using the lowest dose that can control the symptoms, and may avoid using certain medicines in patients at high risk. However, for Dyskinesia arising from a genetic disease or from injury of the brain, it may not be possible to prevent it.
If there are symptoms, which field of doctor should be consulted?
If you suspect that you or someone in your family has symptoms of Dyskinesia, you should consult a neurologist or a physician of physical medicine and rehabilitation (Physical Medicine and Rehabilitation Specialist), who has expertise in diagnosing and treating states of the nervous system. At PYONG Rehabilitation Clinic we have expert rehabilitation physicians ready to give advice and plan the treatment that suits you.
In summary
Dyskinesia is a state of abnormal movement arising from abnormality of the nervous system. It has a wide variety of causes, being met often from the side effect of medicines treating Parkinson's disease and of psychiatric medicines. The clearly distinguishing symptom is movement that cannot be controlled, twisting back and forth out of rhythm, which differs from the trembling symptom of Parkinson's disease, which has a rhythmic and regular character. Correct diagnosis and treatment by expert physicians can help reduce the symptoms and improve the quality of life of the patient effectively.
If you or someone in your family has symptoms similar to Dyskinesia, or pain and other abnormality of the muscular and skeletal system, the team of rehabilitation physicians at PYONG Rehabilitation Clinic is ready to give advice and treatment with modern technology. You may contact us to make an appointment at