Unusual focal dyskinesias

Unraveling belly dancer's dyskinesia and other puzzling diagnostic contortions: A narrative literature review

Belly dancer's dyskinesia (BDD) is characterized by involuntary abdominal wall movements that are rhythmic, repetitive, and dyskinetic. The present study aims to review BDD's etiology, pathophysiology, and management. We searched six databases to locate existing reports on BDD published from 1990 to October 2023 in electronic form. A total of 47 articles containing 59 cases were found. The majority of the patients affected by BDD were female, accounting for 61.01% (36/59) of the cases. The mean and median ages were 49.8 (standard deviation: 21.85) and 52 years (range: 7-85), respectively. The BDD was unilateral in only 3.38% (2/59). The most commonly reported causes associated with BDD were 17 idiopathic, 11 drug-induced, 11 postsurgical procedures, 5 pregnancies, and 4 Vitamin B12 deficiencies. BDD is a diagnosis of exclusion, and other more common pathologies with similar presentation should be ruled out initially. Differential diagnostic reasoning should include diaphragmatic myoclonus, cardiac conditions, truncal dystonia, abdominal motor seizures, propriospinal myoclonus, and functional or psychiatric disorders.

Scar Dancing Syndrome: Peripheral Trauma Induced Involuntary Hyperkinesia around Surgical Incision

Background

Peripherally induced movement disorders represent a rare and debated complication of peripheral trauma. It is difficult to determine a causal relationship between peripheral injuries and subsequent movement disorders.

Cases

Here, we introduce and characterize four patients with post-surgical scar-associated movement disorders, a peripherally-induced rippling movement disorder confined to the muscles just under a long surgical incision scar, appearing weeks to months after surgery. This novel 'scar dancing' syndrome does not spread to adjacent muscles and persists during sleep.

Conclusion

Scar dancing syndrome expands the phenotypic spectrum of peripherally induced movement disorders, in which movement disorder is confined to a long surgical incision site.

Abdominal Wall Dyskinesia: Case Report

The clinical presentation of repetitive choreiform involuntary movements of the anterior abdominal wall was first introduced as “belly dancer's dyskinesia.” Etiologies of this rare condition include idiopathic causes, medication inducement, or post-abdominal surgery. We report a case of orobuccal stereotypic movements and abdominal wall dyskinesia secondary to prochlorperazine intake. The movements began 2 weeks after cessation of prochlorperazine. The patient took this dopamine receptor-blocking medication for 6 months to treat nausea due to chemotherapy. To our knowledge, abdominal wall dyskinesia as a tardive syndrome of prochlorperazine has not been previously reported.

Dancing Dorsal Quadrilaterals: A Novel Peripherally Induced Movement Disorder

Importance

Recognized peripherally induced movement disorders include the painful legs moving toes syndrome, postamputation dyskinesias, and belly dancer dyskinesias.

Objective

To introduce and characterize the dancing dorsal quadrilaterals, a novel peripherally induced movement disorder that predominantly affects dorsal quadrilateral muscles (trapezius and rhomboids) after upper spine instrumentation.

Design, Setting, and Participants

Between 1990 and 2015, a total of 4 patients who developed abnormal movements of the dorsal quadrilateral muscles after upper spine instrumentation were referred to movement disorders clinics at 3 academic medical centers in the United States, Canada, and Argentina. A prospective and retrospective analysis of the clinical and electrophysiologic characteristics of their abnormal movements is presented in this brief report. Data were analyzed between July 2015 and January 2018.

Exposures

Extensive upper spine instrumentation complicated with misalignment and prolonged postsurgical neuropathic pain.

Main Outcomes and Measures

Video documentation of clinical and electrophysiologic characteristics of dancing dorsal quadrilaterals.

Results

Four patients with upper spine disease (2 women and 2 men, ranging in age from early 30s to early 70s) required extensive surgical manipulation and instrumentation that was complicated by misalignment, prolonged dorsal neuropathic pain, and unusual abnormal movements. These movements consisted of semirhythmic, repetitive writhing, and jerky movements of the scapular region with distinctive rotatory motions. They are referred to as the dancing dorsal quadrilaterals because they predominantly affected the bilateral trapezius and rhomboids (dorsal quadrilateral muscles) but could spread to adjacent muscles, and they are similar in appearance and possibly pathogenesis to "belly dancer" dyskinetic movements. The movements of the dancing dorsal quadrilaterals occur when upright but not when lying down or during voluntary muscle activation. Sensory stimulation also diminishes the movements. Long-duration bursts of normal motor unit potentials with normal recruitment pattern were evidenced.

Conclusions and Relevance

The dancing dorsal quadrilaterals syndrome represents a further example of a peripherally induced movement disorder characterized by neuropathic pain preceding a regional movement disorder following soft-tissue or nerve injury.

Something that Touches your Heart: an Unusual Case of Abdominal Clonic Movements

Background

Rarely, cardiac pacemaker implant can lead to the development of involuntary hyperkinetic movement disorders localized to the abdominal wall or the diaphragm.

Phenomenology Shown

We report a case of a 79-year-old female who developed rhythmic continuous clonic right abdominal movements caused by cardiac pacemaker lead dislodgement.

Educational Value

Our case highlights that, in the differential diagnosis of hyperkinetic abdominal movement disorder, the presence and the possible pathogenic role of a cardiac pacemaker should be kept in mind.

Acute Onset of Abdominal Muscle Dyskinesia ('Belly Dancer Syndrome') From Quetiapine Exposure: A Case Report

Belly dancer syndrome, also called belly dance syndrome or belly dancer dyskinesia, is a kind of abdominal dyskinesia with painful sensation. Its etiology is still unclear and there are few studies reporting its association with antipsychotics. Quetiapine is an atypical antipsychotic that causes lower risk of extrapyramidal symptoms than typical antipsychotics. Here, we presented the first case of belly dancer syndrome in a 71-year-old woman with major depressive disorder after short-term use of quetiapine.

Post-traumatic shoulder movement disorders: A challenging differential diagnosis between organic and functional

Peripheral trauma may be a trigger for the development of various movement disorders though the pathophysiology remains controversial and some of these patients have a functional (psychogenic) disorder. We report 3 cases of shoulder movement disorders following trauma to the shoulder region. Physiology was done in all the patients to extend the physical examination. Two patients had history of recurrent shoulder dislocation and were diagnosed with Ehlers-Danlos syndrome. One patient had shoulder injury following repeated falls while performing as a cheerleader. In two patients there were some clinical features suggesting a functional etiology, but physiological studies in all three failed to produce objective evidence of a functional nature. Shoulder movement following trauma is uncommon. Diagnosis in such cases is challenging considering the complex pathophysiology. The movements can be associated with prolonged pain and handicap, and once established they appear resistant to treatment.