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Bringing order to higher order motor disorders.

Maja Kojović1, Kailash P Bhatia2

  • 1Department of Neurology, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia. maja.kojovic@kclj.si.

Journal of Neurology
|July 21, 2018
PubMed
Summary

Higher order motor disorders are complex abnormal movements resulting from disrupted cortical processes before action. This review details their clinical and pathophysiological aspects, aiding in diagnosis and understanding of these neurological conditions.

Keywords:
Alien limbFrontal lobe syndromesMirror movementsMotor impersistenceMotor neglectParatonia

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Area of Science:

  • Neuroscience
  • Neurology
  • Motor Control

Background:

  • Complex everyday movements involve volition, planning, and motor program selection prior to execution.
  • Higher order motor disorders arise from disruptions in cortical processes preceding motor acts.
  • These disorders are prevalent in neurodegenerative diseases, psychiatric conditions, and structural brain lesions, often overlooked clinically.

Purpose of the Study:

  • To discuss the clinical and pathophysiological aspects of higher order motor disorders.
  • To provide insight into the pathophysiology of various motor control disruptions.
  • To enhance clinical recognition and understanding of these often-subtle neurological conditions.

Main Methods:

  • Review of clinical presentations and pathophysiological mechanisms of higher order motor disorders.
  • Categorization of disorders into groups: disinhibition, motor intention, alien limb syndrome, and motor overflow.
  • Integration of recent neurophysiological findings with motor control theories.

Main Results:

  • Detailed description of disorders of disinhibition (grasp reflex, utilization behavior, paratonia).
  • Explanation of disorders of motor intention (motor neglect, motor impersistence).
  • Discussion of alien limb syndrome and motor overflow phenomena (mirror movements, synkinesias).

Conclusions:

  • Higher order motor disorders represent a significant challenge in clinical neurology, requiring specific examination techniques.
  • Understanding the underlying pathophysiology, informed by neurophysiology and motor control theories, is crucial for diagnosis and management.
  • Video illustrations aid in recognizing these complex motor behaviors.