It has been universally remarked that athetotic movements of the face
reproduce the expression of emotions, such as admiration, astonishment,
sorrow, gaiety, etc. Of course the same may be said of the grimaces of
chorea; the latter, however, are usually more abrupt and pass less
readily one into the other. The gesticulations of athetosis are
undulatory, so to speak, and their excess leads to deformities
principally in the direction of forced extension. The musculature is
often rigid, and the reflexes are increased in activity. Sometimes there
is a considerable degree of mental disturbance.
Now, it is precisely in cases where mental deterioration is a prominent
feature that "nervous movements" have been described resembling those of
athetosis, for which the term pseudo-athetosis has been coined. Two
examples may be quoted from Noir.
E. is a girl of eleven years. Her expression is grimacing; her
tongue is often protruded, but never bitten; her head is regularly
flexed or extended, or rotated rhythmically to left or right. The
arms are moved spasmodically at shoulder and elbow, while the hands
are the seat of athetotic movements. She walks curiously, throwing
her feet out in advance without bending her knees. She has a silly
smile, and her mouth almost invariably hangs open. On request she
can keep her hands quite steady, but one observes at once the
effort this entails in the sudden seriousness of her expression.
The ordinary acts of every-day life are performed satisfactorily
enough: she can dress and undress, use a knife and fork, thread a
needle, sew, etc.
J. is eleven years old also. She puckers her lips, contracts her
eyebrows, elevates her alæ nasi; at the same time she exhibits
pseudo-athetotic movements of her fingers which are entirely under
voluntary control.
The question may indeed be asked whether pseudo-athetosis and variable
chorea are not really identical. Further, all sorts of combinations of
athetosis and myotonia have been noted,[188] but more light must be
shed on the subject before any further classification can be attempted.
The following case has recently been published by Marina[189]:
A blacksmith, aged seventeen years, already treated three times for
recurrent chorea, suffered from slow contractions of the shoulder
muscles, involving the elevators and internal and external rotators
successively, and accompanied by movements of the head and arm, and
by twitches of the quadriceps. Nothing seemed to have any influence
over these movements except sleep. The faradic excitability of the
shoulder muscles was augmented, the galvanic excitability
diminished. Application of the constant current to the head and
back sufficed to effect a cure in three weeks.
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