Abnormal Involuntary Movements: Types, Causes and Treatment

What involuntary movement is called

The medical term for the whole group is movement disorders. When a movement is too much or unwanted, it is called a hyperkinetic movement or, loosely, a dyskinesia. Specific names describe what the movement looks like.

Types of abnormal involuntary movements

Tremor

Tremor is the most common involuntary movement. Its main types (rest, postural, intention) are described on that page, along with essential tremor and Parkinson's tremor.

Myoclonus

Myoclonus is a sudden jerk caused by a brief muscle contraction or relaxation. Hiccups and the jerk you get falling asleep are normal forms. Abnormal myoclonus occurs with kidney or liver failure, low oxygen after cardiac arrest, some epilepsies, medicine toxicity (for example opioids, gabapentin, lithium) and rare brain diseases such as Creutzfeldt-Jakob disease.

Dystonia

Dystonia causes muscles to contract for long periods, twisting a body part into an abnormal posture. It can affect one area (the neck in cervical dystonia, the eyelids in blepharospasm, the hand in writer's cramp) or the whole body. An acute dystonic reaction after antipsychotics or anti-nausea medicines causes sudden neck twisting, jaw spasm or eyes rolling up and is treated urgently.

Chorea

Chorea produces unpredictable, fidgety movements that flow from one body part to another, often looking like restlessness. Causes include Huntington's disease, too much levodopa in Parkinson's disease, an overactive thyroid, very high blood sugar, lupus, pregnancy (chorea gravidarum) and Sydenham chorea after strep infection in children.

Tics

Tics are quick, repeated movements (blinking, shrugging, grimacing) or sounds (sniffing, throat clearing) preceded by an urge that is relieved by doing them. They can be held back for a while. They are common in childhood and usually fade by adulthood. Tics lasting more than a year with both motor and vocal tics are Tourette syndrome.

Tardive dyskinesia

Tardive dyskinesia develops after months or years of medicines that block dopamine, mainly antipsychotics and metoclopramide. It causes lip smacking, chewing, tongue thrusting, grimacing and sometimes rocking or finger movements. It can become permanent, so early recognition matters.

Causes of involuntary movements

Medicines and substances

Medicines are one of the most common and most reversible causes:

• antipsychotics and anti-nausea drugs (dystonia, parkinsonism, tardive dyskinesia, restlessness called akathisia)
• levodopa for Parkinson's disease (dyskinesia, chorea)
• stimulants, caffeine and some asthma medicines (tremor)
• lithium, valproate, some antidepressants (tremor, myoclonus)
• withdrawal from alcohol or benzodiazepines (tremor, jerks)
• cocaine and amphetamines (chorea, tics)

Metabolic and hormonal problems

Low blood sugar, very high blood sugar, low calcium or magnesium, an overactive thyroid, and kidney or liver failure can all cause tremor, jerks or chorea.

Brain disorders

• Parkinson's disease and related conditions
• stroke, particularly in the deep brain structures (basal ganglia)
• multiple sclerosis
• brain injury and cerebral palsy
• infections and autoimmune encephalitis
• epilepsy: some seizures appear as jerking of one limb

Genetic conditions

Huntington's disease, Wilson disease (copper build-up, in young people), inherited dystonias and some ataxias.

Functional movement disorder

A real, common cause in which movements come from a problem in how the brain controls movement, not from structural damage. Movements often start suddenly, vary over time and reduce when you are distracted. Specialized physiotherapy helps.

When to see a doctor

See a doctor about any involuntary movement that is new and persistent, getting worse, affecting daily life, or causing embarrassment or distress. Bring a list of all your medicines, including recent changes. A video of the movement on your phone is extremely helpful, because movements may not happen during the appointment.

How doctors diagnose the cause

A neurologist will ask when the movements started, what triggers or relieves them, whether you can suppress them, family history and medicine use. They will observe the movements at rest, while holding positions and during tasks, and check strength, reflexes, tone and walking. Depending on the type, tests may include:

• blood tests: glucose, calcium, magnesium, thyroid, kidney and liver function, copper and ceruloplasmin
• MRI of the brain
• EEG if seizures are possible
• genetic tests for suspected inherited conditions
• DaTscan in uncertain parkinsonism

Treatment

• Remove the trigger: reduce or switch an offending medicine with your doctor's guidance; correct blood sugar, salts or thyroid levels. Do not stop prescribed medicines on your own.
• Medicines for specific types: beta-blockers or primidone for tremor; levodopa for Parkinson's disease; VMAT2 inhibitors for tardive dyskinesia and Huntington's chorea; clonazepam or levetiracetam for some myoclonus; certain medicines for tics.
• Botulinum toxin injections: first choice for focal dystonia such as cervical dystonia and blepharospasm.
• Deep brain stimulation: for severe tremor, Parkinson's disease and some dystonias.
• Therapy: behavioral therapy (CBIT) for tics; physiotherapy for functional movement disorder; occupational therapy for daily tasks.

Frequently asked questions

What is involuntary movement called?

The general term is a movement disorder. Specific names include tremor (rhythmic shaking), myoclonus (sudden jerks), dystonia (twisting postures), chorea (dance-like movements), tics (repeated movements with an urge) and dyskinesia (a broad term for unwanted movements, often caused by medicines).

Can anxiety cause involuntary movements?

Anxiety can amplify the body's normal tremor and cause muscle twitches, fidgeting and restlessness. It can also worsen existing tics. It does not cause dystonia or chorea. Functional movement disorder, which is sometimes linked with stress, causes real involuntary movements that improve with targeted therapy.

Are involuntary movements a sign of Parkinson's disease?

Sometimes. Parkinson's disease typically causes a rest tremor in one hand along with slowness and stiffness. Many other causes are more common, including medicines, caffeine, essential tremor and benign twitches. A doctor can tell them apart by examining you.

Which medicines cause involuntary movements?

Antipsychotics and the anti-nausea drug metoclopramide are the best-known causes, producing dystonia, parkinsonism and tardive dyskinesia. Levodopa, stimulants, lithium, valproate, some antidepressants and asthma inhalers can cause tremor, jerks or chorea. Report any new movements after a medicine change.

Can involuntary movements go away?

Many do. Twitches from caffeine or tiredness settle quickly. Movements caused by medicines or metabolic problems often improve once the cause is fixed, though tardive dyskinesia can persist. Childhood tics usually fade by adulthood. Chronic conditions can be controlled with medicines, injections or surgery.