NeuroTeach 29 - Belly dancer's dyskinesia

Belly Dancer's Dyskinesia!!!

“first described by Antonie van Leeuwenhoek in 1723 when he himself experienced the symptoms”

2) Definition

“rhythmic, involuntary contractions of the diaphragm resulting in undulating, rhythmic movements of the abdomen resembling a belly dance” -bilateral, most freq -limited to axial musculature -sometimes painful -no suppress on breath holding -150 contraction/min

 

3) History

1723, Leeuwenhoek - 1st report - diaphragmatic flutter 1976, Nichols - 1st report - abdominal wall dyskinesia - phrenic palsy in a newborn 1990, Iliceto ≠ diaphragmatic flutter

4) Pathophysiology

- dysfunction of inhibitory interneurons (spinal interneurons) - structural reorganization of local neuronal circuit

5) Causes

Phrenic nerve injury Phrenic nerve irritation: pleurisy, peritonitis, cardiomegaly, post-CABG, abdominal surgery Spinal cord lesions Central causes: encephalitis, Extrapontine myelinolysis Drugs: galantamine, clebopride Functional Others: Vit B12 def

6) Clinical tips!

Phrenic nerve irritation - heart most common cause - flutter synchronous w/ systole Bilateral diaphragmatic flutter - central origin Sleep - continuous contractions in central - peripheral, subside Functional - breath hold test - only awake

7) Workup - fluoroscopy - diaphragmatic EMG - abdominal imaging - brain and spinal neuroimaging

8) Management

“some resolve spontaneously while others persist” - benzodiazepines - antipsychotics - phrenic nerve block

9) Belly dancer's dyskinesia

💡patient occasionally voluntarily shrugged her shoulders in response to her abdominal discomfort

10) Belly dancer's dyskinesia

11) Belly dancer's dyskinesia

💡chlordiazepoxide-responsive

12) Belly dancer's dyskinesia

💡pregnancy 💡recurrent

13) Belly dancer's dyskinesia

14) Belly dancer's dyskinesia

💡domperidone-cause 💡clonazepam & promethazine responsive

15) Belly dancer's dyskinesia

💡levodopa-induced

16) Belly dancer's dyskinesia

💡levodopa-induced

17) Belly dancer's dyskinesia

💡dystonia 💡GPi Pallidotomy-responsive

18) Belly dancer's dyskinesia

💡functional 💡EMG helpful to ≠

19) Belly dancer's dyskinesia

💡prochlorperazine-induced

20) Belly dancer's dyskinesia

💡haloperidol & clobazam-responsive

21) Belly dancer's dyskinesia

💡vit B12 def 💡clonazepam-responsive

22) ) Belly dancer's dyskinesia

💡vit B12 def 💡clonazepam-responsive

23) Belly dancer's dyskinesia

💡vit B12 def 💡clonazepam-responsive

24) Belly dancer's dyskinesia

💡US-guided BOTOX-responsive

25) Differ

Abdominal segmental myoclonus resembling belly dancer's dyskinesia 💡EMG 💡CASPR2 antibody