This disorder is characterized by involuntary flailing movements that are large-amplitude, often proximal, and may affect facial muscles. They can also be described as "violent", but they are involuntary.
These movements are worse with activity and improve with rest. This is probably related to the underlying pathophysiology of ballismus wherein planning and execution of motor movements via the basal ganglia motor loop is implicated.
Neuroimaging typically shows signal changes in the basal ganglia. In hemiballismus, the contralateral basal ganglia is affected.
Although the subthalamic nucleus' role (STN) dominates the literature, this disorder can occur with a lesion in any part of the basal ganglia, including the putamen, globus pallidus, caudate nucleus and others.
Stroke, both hemorrhagic and ischemic, is the most common underlying cause leading to damage and dysfunction of the basal ganglia.
There is a somewhat high correlation between elderly patients with diabetes and ballismus. This may be due to the higher prevalence of comorbidities in the elderly.
Several infections, particularly those that affect the CNS, can cause ballismus. Bacterial, viral, parasitic, and fungal etiologies are all implicated.
Structural lesions such as neoplasms of the brain may cause dysfunction of the basal ganglia and/or subthalamic nucleus leading to hemiballismus.
Dopamine-blocking medications such as haloperidol have been shown to reduce symptoms. Other medications that can help include baclofen and anticonvulsants.
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