Stereotypy miasms

Clinic

• Stereotypies are abnormal involuntary non-goal-directed movement patterns.
• They are Ritualistic movement/ Posture or Vocalizations/ Utterance which repeat continuously in the same fashion on multiple occasions.
• They are Simple or Complex
• Stereotypies or perseveration are the most Prominent / Special feature of NMDR encephalitis comparetive to Basal Ganglion encepahlitis and Sydenham's chorea.

Related diseases

Stereotypies are found in

• NMDR encephalitis. In an recent research 85% of children with this autoimune encephalitis have stereotyped movements.

• ASD: Stereotypy is sometimes called stimming in autism, under the hypothesis that it self-stimulates one or more senses.
• Visually impaired children
• Intellectual disabilities
• Tardive dyskinesia
• Stereotypic movement disorder
• Schizophrenia
• Frontotemporal dementia: Among people with frontotemporal lobar degeneration, more than half (60%) had stereotypies. The time to onset of stereotypies in people with frontotemporal lobar degeneration may be years (average 2.1 years).
• Catatonia

• Leg stereotypy syndrome (LSS)

Related entities

• Chorea: Stereotypy is often confused with chorea, which, in contrast to stereotypy, is a random movement.
• Tic
• Hyper reflexia

Stereotypy vs Tics

• Like tics, stereotypies are
  • Patterned and periodic
  • Agg by fatigue, stress, and anxiety.
  • Begin before the age of three
  • Involve more of the body
  • More rhythmic and less random
  • Associated more with engrossment in another activity rather than premonitory urges
• Unlike tics, stereotypies are
  • Remain constant for years but tics usually have the ever-changing, waxing and waning nature
  • Children rarely consciously attempt to control a stereotypy, but Tics are usually suppressible for brief periods
• Examples of early tics are things like blinking and throat clearing, while arm flapping is a more common stereotypy

Etiology

• Spontaneous stereotypic behaviour (SB) is the result of a dysfunctional action selection system that may reflect dysregulation of excitatory (direct) and inhibitory (indirect and hyperdirect) pathways as well as alterations in mechanisms of behavioural switching.
• Encephalitis may involve thalamus or basal ganglia and cause SB. In One review study T/BG neuroimaging abnormalities were reported in 6% of 3236 Encephalitis cases.
• The most common infectious agents were respiratory viruses.
• Other infections included CJD, Arbovirus (DHF, JE, RVF, WNE, TBE, YF), and MTB.

Viral encephalitis

• Viral encephalitis is known to cause various hypokinetic and hyperkinetic abnormal movements as a result of frequent involvement of thalamus, basal ganglia, substantia nigra, and brainstem.
• However stereotypic movements have been reported in only one case of post viral encephalitis. (HSV encephalitis with bilateral temporal lobe involvement) She had repetitive, involuntary movements of the right arm, with scratching causing abrasions on the right side of her face. At one-month follow up she was still having these stereotypic movements.This case was proposed to be a partial form of Kluver-Bucy syndrome with involvement of bilateral temporal lobes and stereotypic movements occurring as a result of disruption of dopaminergic transmission in basal ganglia, medial temporal lobe, amygdala and hippocampus.
• Another infectious encephalitis associated with stereoypical movements is ‘encephalitis lethargica
• Encephalitis lethargica is associated with complex stereotypical movements along with other clinical features like dystonia, parkinsonism, irritability, psychiatric behaviour, agitation, oculogyric crisis, and autonomic instability.

• Stereotypies occur more often in the upper limbs in the form of gripping both hands, placing hands on the waist, combing hands through hair, and fiddling with a nasogastric tube
• All abnormal movements i.e. parkinsonism, dystonia, and stereotypy respond to dopaminergic drugs (levodopa and D2 agonists) while they do not show any improvement with other classes of drugs.This suggests that these abnormal movements result from limited disruption of dopaminergic neurons in the substantia nigra pars compacta acting via D2 receptors causing a dopaminergic deficiency in the striatum

Associated terms

• Punding is a term that was coined originally to describe complex prolonged, purposeless, and stereotyped behavior in chronic amphetamine users; it was later described in Parkinson's disease.
• Punding is a compulsion to perform repetitive mechanical tasks, such as sorting, collecting, or assembling and disassembling common items.
• Punding may occur in individuals with Parkinson's disease treated with dopaminergic agents such as L-DOPA.
• Tweaking is a slang term for compulsive or repetitive behavior; it refers to someone exhibiting pronounced symptoms of methamphetamine or amphetamine use.
• Another type of stereotypic movement observed was perseverations.

Miasms

• HSV
• JE

Common physiological stereotypies in adults

Simple	Complex	Utterance
Leg shaking Face touching Playing with pens / hair Nail biting Hand tapping Foot tapping Body rocking teeth grinding,	Hand waving Playing with hands or repeatedly opening and closing hands Hand posturing Head nodding Headbanging Sitting down and getting up from a chair Finger wagging, pacing Lip smacking Chewing Mouth opening Self-biting and other self-injurious behaviours	Humming Moaning Repeating words and phrase