Ballism

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Ballism is a rare movement disorder characterized by involuntary, skidding movements. The cause is the damage to a nerve cell area in the diencephalon. Drugs for epilepsy are used for treatment. Read everything about symptoms, diagnosis and therapy of ballism here!

Ballism: description

The word ballism comes from the Greek and means "to throw" or "to hurl".

Ballism manifests itself as a far-reaching, rapid and flinging sequence of movements that occur in a pulse-like manner. The hurling is also known as jaktation. This movement disorder is particularly pronounced in the sections of the arms and legs near the trunk, i.e. the upper arms and thighs. During the ballism attacks, which usually occur in bursts, there is a high risk of injury for the person affected, as the movements cannot be controlled.

Ballism is one of the so-called hyperkinetic movement disorders. Hyperkinetic means: with "excessive energy".

Often the ballism occurs unilaterally. In this case one speaks of hemiballism. Similar excessive movements occur in chorea or athetosis. Ballism is also partly understood as a form of chorea. This is used to describe rapid and uncontrollable movements of the face and the sections of the arms and legs away from the trunk.

Ballism: causes and possible diseases

Ballism is caused by damage to the brain's movement control area (including globus pallidus, putamen or caudate nucleus). Often it is a special brain region, the so-called nucleus subthalamicus. This nucleus of gray matter belongs to the so-called diencephalon. It is located in a central position in the brain below an important switching point for incoming and outgoing nerve signals, the thalamus.

The subthalamic nucleus is part of an important control circuit for movement control and regulation and has an inhibitory function. Since the brain is made up of two halves, it exists twice. If it only fails on one side, the movement disorder occurs only on one side (hemiballism). Overactivity of the subthalamic nucleus, on the other hand, leads to hypokinetic movement disorders, which means that those affected are particularly sedentary.

In most cases, a (temporary) undersupply of blood to this subthalamic nucleus due to bleeding or a vascular occlusion is responsible for the symptoms of ballism. Infections (e.g. syphilis or tuberculosis) as well as tumors and metastases can also damage the subthalamic nucleus. In rare cases, brain injuries are responsible for ballism. While sleep leads to an alleviation of the symptoms, ballism increases with psychological arousal.

Ballism: When Should You See a Doctor?

Ballism is always a serious symptom that needs to be clarified by a neurologist.

Ballism: what does the doctor do?

The specialist in the diagnosis and therapy of ballism or hemiballism is the neurologist, a specialist in diseases of the nervous system. Usually the diagnosis can already be made through the typical description or an observed attack. However, it is not easy to distinguish the three similar movement disorders chorea, athetosis and ballism.

A precise description of the attacks is important for differentiation. First of all, the doctor will therefore ask the following questions, among others:

How long does the movement disorder last?
How common are ballism episodes?
Are there factors that trigger ballism?
Does the movement disorder occur during rest or when moving?

Then the doctor will perform a detailed neurological examination of the patient. To do this, he checks the function of the twelve cranial nerves, individual brain areas and the sensitivity and motor skills.

In addition, it may be necessary to examine blood and also brain water. In order to gain brain water, a so-called liquor or lumbar puncture must be performed. To do this, a needle is inserted between the lower lumbar vertebrae to draw some cerebrospinal fluid from the space around the spinal cord.

So-called imaging examinations such as computed tomography (CT) or magnetic resonance tomography (MRT) can also be helpful in making the correct diagnosis. This can show calcifications or infarcts in the area of the subthalamic nucleus.

In certain cases, a recording of the brain waves (electroencephalogram) is carried out.

Ballism: treatment

In order to interrupt a ballism attack, the antiepileptic (anticonvulsant) valproate or so-called neuroleptics are usually used. The so-called benzodiazepines are used less frequently. During a ballism attack, the person affected must be protected from injuries caused by the swinging movements.

In severe cases, neurosurgical intervention in the form of electrical stimulation or the removal of certain areas of the brain (stereotactic brain surgery) can be considered as long-term treatment.