Head injury and posttraumatic movement disorders

Joachim K. Krauss, Joseph Jankovic, Philip Starr, Christoph Ostertag, Andres M. Lozano, Robert G. Grossman

Research output: Contribution to journalReview article

100 Scopus citations

Abstract

WE REVIEW THE phenomenology, pathophysiology, pathological anatomy, and therapy of posttraumatic movement disorders with special emphasis on neurosurgical treatment options. We also explore possible links between craniocerebral trauma and parkinsonism. The cause-effect relationship between head injury and subsequent movement disorder is not fully appreciated. This may be related partially to the delayed appearance of the movement disorder. Movement disorders after severe head injury have been reported in 13 to 66% of patients. Although movement disorders after mild or moderate head injury are frequently transient and, in general, do not result in additional disability, kinetic tremors and dystonia may be a source of marked disability in survivors of severe head injury. Functional stereotactic surgery provides long-term symptomatic and functional benefits in the majority of patients. Thalamic radiofrequency lesioning, although beneficial in some patients, frequently is associated with side effects such as increased dysarthria or gait disturbance, particularly in patients with kinetic tremor secondary to diffuse axonal injury. Deep brain stimulation is used increasingly as an option in such patients. It remains unclear whether pallidal or thalamic targets are more beneficial for treatment of posttraumatic dystonia. Trauma to the central nervous system is an important causative factor in a variety of movement disorders. The mediation of the effects of trauma and the pathophysiology of the development of posttraumatic movement disorders require further study. Functional stereotactic surgery should be considered in patients with disabling movement disorders refractory to medical treatment.

Original languageEnglish (US)
Pages (from-to)927-940
Number of pages14
JournalNeurosurgery
Volume50
Issue number5
DOIs
StatePublished - May 1 2002

Keywords

  • Dystonia
  • Head trauma
  • Injury
  • Movement disorders
  • Parkinsonism
  • Stereotactic surgery
  • Tremor

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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