Neurology diagnoses and treats disorders of the nervous system, including the brain, spinal cord, and nerves, as well as thought and memory.
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Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions that cause abnormal, often repetitive, movements or postures. In children, this often shows up as an abnormal twisting of the foot while walking or a cramping of the hand while writing. It is typically triggered or worsened by voluntary action.
A key feature of dystonia is “overflow,” where the attempt to move one body part causes involuntary movement in another. For example, asking a child to tap their right hand might cause their left hand to curl involuntarily. Dystonia can be painful and can lead to permanent bone and joint deformities if the postures become fixed over time.
Tics are sudden, rapid, recurrent, non rhythmic motor movements or vocalizations. Motor tics can be simple (eye blinking, shoulder shrugging) or complex (jumping, touching objects). Vocal tics range from throat clearing and sniffing to complex words or phrases.
Tourette Syndrome is defined by the presence of both multiple motor tics and at least one vocal tic persisting for more than a year. A hallmark of tics is the “premonitory urge”—a sensation of building tension that is relieved by performing the tic. Unlike other movement disorders, tics can often be temporarily suppressed by the child, though this requires significant mental effort.
Chorea comes from the Greek word for “dance,” describing the brief, irregular, and flowing movements that travel from one body part to another. In children, this can look like fidgeting, clumsiness, or an inability to sit still. The movements are unpredictable and cannot be suppressed.
Athetosis refers to slower, writhing movements, typically affecting the distal extremities like the fingers and toes. It is frequently seen in dyskinetic cerebral palsy. When chorea and athetosis occur together, the condition is termed choreoathetosis, presenting as a continuous stream of writhing and jerking movements that disrupt all voluntary activity.
Ataxia refers to a lack of coordination and order in movement, typically resulting from dysfunction in the cerebellum. Children with ataxia may have a wide based, unsteady gait, often described as walking like a sailor on a rolling ship. They may stumble frequently and have difficulty with tandem walking.
In the upper limbs, ataxia manifests as “dysmetria,” which is the inability to judge distance. When reaching for a toy, the child may overshoot or undershoot the target. An “intention tremor” may develop, where the hand shakes more violently as it gets closer to the object it is trying to reach.
Stereotypies are repetitive, rhythmic, purposeless movements that typically begin in early childhood. Common examples include hand flapping, body rocking, or head nodding. Unlike tics, stereotypies usually have a fixed pattern and are often triggered by excitement, stress, or boredom.
Crucially, children can usually stop a stereotypy immediately upon distraction or when their name is called, without the build up of tension seen in tics. While often associated with Autism Spectrum Disorder, “primary motor stereotypies” occur frequently in typically developing children and are generally benign.
The most significant risk factor for non progressive movement disorders like cerebral palsy is injury to the developing brain during the perinatal period. Prematurity, low birth weight, and hypoxic ischemic encephalopathy (lack of oxygen at birth) damage the sensitive basal ganglia and motor tracts.
Kernicterus, caused by dangerously high levels of bilirubin (jaundice) in a newborn, specifically targets the globus pallidus, leading to severe choreoathetoid cerebral palsy and hearing loss. This is a preventable but devastating cause of pediatric movement disorders.
Genetic factors are increasingly recognized. A family history of tremors, dystonia, or early onset Parkinson’s suggests a hereditary etiology. Consanguinity (parents who are related) increases the risk of autosomal recessive metabolic conditions that affect the motor system.
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Yes, nearly all hyperkinetic movement disorders, including tics and dystonia, are exacerbated by stress, anxiety, excitement, and fatigue.
Overflow is when a child tries to move one specific muscle group (like the right hand to write) but involuntary muscle contractions spread to adjacent muscles or the opposite hand.
No, growing pains are unrelated, but children with spasticity or dystonia may experience muscle pain and cramping that can be mistaken for growing pains.
Many children experience “provisional tics” that resolve on their own; even in Tourette syndrome, symptoms often peak in early adolescence and improve significantly by adulthood.
Hand flapping is a common stereotypy in autism, but it also occurs in many neurotypical children when they are excited and does not automatically mean a child has autism.
