Basal Ganglia Epilepsy?/Paroxysmal dyskinesias

Overview of Dyskinesias (Paroxysmal)

Paroxysmaldyskinesias are neurologic conditions characterized by sudden episodes of abnormal involuntary movements (hyperkinesias). These may include any combination of involuntary, rapid, randomly irregular jerky movements (chorea); relatively slow, writhing motions that appear to flow into one another (athetosis); increased muscle tone with repetitive, twisting, patterned movements and distorted posturing (dystonia); and uncontrollable flinging movements of an arm, a leg, or both (ballismus).

... In contrast, in those with non-kinesigenic dyskinesia, the attacks may occur spontaneously while at rest or out of a background of normal motor activity, but may be exacerbated by alcohol or caffeine consumption, stress, fatigue, or other factors. Other types of paroxysmal dyskinesias include episodes precipitated by prolonged exertion (paroxysmal exertion-induced dyskinesia) or sleep (paroxysmal hypnogenic dyskinesia).

The transient attacks associated with PKD primarily affect muscles of thearms and legs; however, muscles of the face, neck, and/or trunk may also be involved. PKD episodes may affect muscle groups on one (unilateral) or both sides (bilateral) of the body, but even if bilateral they are usually asymmetrical. Involvement of facial or oromandibular muscles often results in transient facial grimacing, difficulties speaking (dysarthria), or even muteness; however, the episodes are not accompanied by altered consciousness. When leg and trunk muscles are affected, falls may occur, causing a risk of injury. PKD may interfere with walking or standing or conducting other activities of daily living (ADLs), potentially resulting in severe disability.

In addition to sudden movement, some episodes may also be provoked by unexpected stimuli (startle), yawning, talking, hyperventilation, anticipation of movement, or light (photic) stimulation. Attacks may be worsened by certain factors, such as stress,cold, heat, or menstruation.

Before the onset of such episodes, some patients may experience unusual warning or "premonitory" sensations, such as prickling, tingling, or crawling (paresthesias); dizziness; or muscle tension.