Ballismus Treatment in Delhi, India

Ballismus is a serious movement disorder that is characterised by sudden and involuntary movements, muscle weakness, and incoordination of proximal limb movements. The movements are generally spontaneous, continuous, repetitive, and of large amplitude. If it is not treated on time, it can continue damage and may lead to permanent dysfunction. Ballism is also known to affect the muscles of the face. The upper and the lower limbs are affected equally. However, if the person relaxes or takes some rest, the movements tend to decrease.

Types of Ballismus

Monoballismus

Monoballismus generally affects only the one-sided lower limb or upper limb. It is usually a mild form of ballismus.

Biballism

In this type of ballismus, either both the upper limbs or lower limbs are involved. This is a bit deeper form of ballismus.

Hemiballismus

Hemiballismus is a type of ballismus where one complete side of the body is affected. This leads to the development of random involuntary muscle actions in one side of the body (including both the upper limb and the lower limb).

Symptoms

Ballism is typically determined by the occurrence of the following symptoms in arms or legs -

• Abnormal involuntary movements.
• Irregular muscle tweaks.
• Frequent violent movements.

Causes

Stroke

A stroke occurs when the blood supply to the brain is blocked due to various underlying reasons such as arteriosclerosis, atherosclerosis, high LDL, etc. Due to stroke, the blood supply to other parts of the brain is also blocked. If basal ganglia get damaged, motor functions of the body are severely damaged. The body starts performing irregular, continuous, high-amplitude involuntary movements.

Traumatic brain injury

Ballismus is also known to occur due to certain traumatic brain injuries. Cases have been recorded where people have developed ballismus or ballism after an assault, violence, or any accident. Due to this, the patient suffers from random involuntary movements.

Amyotrophic lateral sclerosis

This is a type of brain damage that causes gliosis and neuronal loss. Gliosis is a non-specific change in the glial cells due to damage to the CNS. This disease can also damage the sub-thalamic nucleus and various other parts of the brain. This is a serious disease that may lead to the potential development of ballismus.

Non-ketotic hyperglycemia

Patients suffering from non-ketotic hyperglycemia can develop ballism as one of the complications. This occurs due to the development of lesions in the subthalamic nucleus. This is the second most common cause of ballismus. It is majorly found in the elderly, located particularly in the Eastern side of Asia. This is also related to genetic predisposition, as only a specific area is affected. Decreased production of GABA and acetylcholine have led to the development of hyperglycemia.

Neoplasms

Neoplasms are an abnormal growth of the body cells. If this growth happens to be in the basal ganglia, the body tends to develop ballismus.

Tuberculomas

Tuberculomas are tumours caused due to tuberculous meningitis, a type of brain infection. If this tumour occurs in the basal ganglia, it can lead to the development of ballism or ballismus.

Vascular malformations

Many times, due to Malformations of vascular structure, the blood supply to a part of the brain is hindered. This results in a stroke and, ultimately, ballismus.

Demyelinating plaques

Demyelinating Plaques affect the conductive capacity of the neuron as these affect myelin sheaths. The functioning impairment of the neurons results in weak signals to the basal ganglia, ultimately leading to ballismus or hemiballismus.

Post-viral infection complications

Sometimes, ballismus also occurs as a complication of immunocompromising viral infections such as HIV AIDS. It typically occurs as a result of secondary infection due to the lost immunity power. The most common infection is toxoplasma infection, resulting in the formation of lesions around the basal ganglia.

Diagnosis

Diagnosis of ballismus is clinical and is based on clinical signs and symptoms. The doctor/physician looks out for possible signs and symptoms to confirm the diagnosis of ballismus. He/she notices some sudden, flinging movements present on the limbs and maybe on the face.

Sometimes confusion may arise between athetosis, chorea, and akathisia, as all of these are associated with random involuntary movements. However, the only difference is that in the above-mentioned movement disorders, the muscle actions are less violent and of lower amplitude.

Treatment

The treatment of ballismus is based on the underlying issue that caused the appearance of ballismus. The neurology doctor determines the exact cause of ballismus, such as neoplasm, hyperglycemia, various infections, lesions, plaques, etc. Some of the patients may also not need treatment because of the severity of the disorder. Given below are some treatment options for ballismus-

• Dopamine Blockers

While opting for pharmacological treatment, one should go for dopamine blockers or antidopaminergic drugs. This is effective in 9 out of 10 patients suffering from ballismus.

• Anticonvulsants

Topiramate, an anticonvulsant, is known to affect patients suffering from ballismus.

• ITB Therapy

Intrathecal baclofen (ITB) therapy is an effective solution for ballismus or hemiballismus. It is also a treatment option for various disorders such as cerebral palsy and multiple sclerosis.

• Botulinum Injections

Injections of botulinum are known to cure some levels of ballismus. However, it is more recent research, and its outcomes are yet to be discovered.

• Antipsychotics

Antipsychotic drugs are also prescribed to the patient suffering from ballismus. The usage of this drug is also under research, and its consequences are also observed.

• Neurosurgery

Functional neurosurgery is the last treatment option for patients suffering from ballismus. These are the patients who have not responded to other treatment options. Lesioning of the globus pallidus or deep brain stimulation of the globus pallidus are the surgical options employed to treat ballismus. Amongst the two, the former option is considered better as the stimulation required for the brain is continuous and effective.

Prognosis

Patients with this disease have had a very poor prognosis in the past. Many patients are seriously injured or die. Patients are currently responding very well to ongoing treatment, and most of them have spontaneous remission.

Review

Review by Dr. Vivek Kumar, Senior Director, Neurology.