Now let's talk about
Ballismus or Ballism.
This is another hyperkinetic
So there's extra movement characterized
by involuntary, irregular,
wide-amplitude, flinging, violent,
coarse and poorly patterned movements
due to contraction of the proximal
limb and associated axial muscles.
So the limbs move and they
start proximally and move out.
And this is a large, wide,
high-amplitude movement of a proximal limb.
When we think about ballism,
we can classify it in a number of ways.
Monobalism is confined
to one extremity.
Hemiballism is confined to one side
of the body upper and lower extremity.
Paraballism is ballism in the lower
extremities which is quite rare
and bilateral ballism a ballism
on both sides of the body,
which is also extremely rare.
Typically when we're dealing with
ballism, we will see hemiballism,
one side of the body
with large movements of
the arm or of the leg.
In terms of etiology,
we think about structural lesions,
and classically lesions
affecting the subthalamic nucleus
will contribute to
hemiballism or ballism.
Ischemic lesions either ischemic
strokes or hemorrhagic strokes
can contribute to the
sudden onset of hemiballism.
various infections that affect
the subcortical basal ganglia,
and then some metabolic disorders
like nonketotic hyperglycemia.
This is a metabolic derangement that
results in dysfunction of the neurons
in the subcortical structures
and in patients presenting
with sudden onset of hyperglycemia,
we can see hemiballism.
And that improves and resolves with
management of the hyperglycemia.
Other clinical features that
we can see in these patients
jerking, flinging, flailing,
kicking of the ipsilateral leg and arm,
it's mainly proximal,
there's large proximal movement.
We can see large rotary
displacement of the extremities,
and in some cases,
it can be so violent that the patients
have damage of the
limbs or dislocation,
they can fall and
And this is absent during sleep.
And that's very important when
patients sleep, the ballism goes away.
And when they're awake,
the movement comes back
and that's because the basal ganglia
is involved in modulation of movement,
not automatic movement or autonomous
movement that would occur during sleep.
At sleep, the basal ganglia is shut down
and we don't see these movements at sleep.
So here we can see an example of the types
of movements that we see with ballism.
You can see it's proximal,
can involve the upper and lower extremity
and we see those large
amplitude movements of a limb.
How is Hemiballism treated?
Well this resolves
typically over time
and after a stroke we see
improvement after a stroke.
After a metabolic
derangement is corrected,
we see improvement and sometimes
no treatment is necessary.
But occasionally, movements are quite
severe and debilitating for patients
and we will attempt to neuroleptics
or dopamine depleting agents
for movement reduction.