Flapping Tremor: Unraveling Asterixis-A Narrative Review

Asterixis is a subtype of negative myoclonus characterized by brief, arrhythmic lapses of sustained posture due to involuntary pauses in muscle contraction. We performed a narrative review to characterize further asterixis regarding nomenclature, historical aspects, etiology, pathophysiology, classi...

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Bibliographic Details
Published in:Medicina (Kaunas, Lithuania) Lithuania), 2024-02, Vol.60 (3), p.362
Main Authors: Rissardo, Jamir Pitton, Muhammad, Sara, Yatakarla, Venkatesh, Vora, Nilofar Murtaza, Paras, Paras, Caprara, Ana Letícia Fornari
Format: Article
Language:English
Subjects:
anisosterixis
asterixis
Brain Diseases
Carbamazepine
Carbamazepine - therapeutic use
Development and progression
Diagnosis
Divalproex
Dyskinesias
encephalopathy
Gravity
Hematoma
Humans
hyperkinetic
Legs
Metabolism
mini-asterixis
myoclonus
Myoclonus - diagnosis
Neomycin
Pathophysiology
Patients
Posture
Respiratory failure
Review
Rifaximin
Tremor
Tremor - diagnosis
Tremor - etiology
Valproic acid
Wrist
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Summary:Asterixis is a subtype of negative myoclonus characterized by brief, arrhythmic lapses of sustained posture due to involuntary pauses in muscle contraction. We performed a narrative review to characterize further asterixis regarding nomenclature, historical aspects, etiology, pathophysiology, classification, diagnosis, and treatment. Asterixis has been classically used as a synonym for negative myoclonus across the literature and in previous articles. However, it is important to distinguish asterixis from other subtypes of negative myoclonus, for example, epileptic negative myoclonus, because management could change. Asterixis is not specific to any pathophysiological process, but it is more commonly reported in hepatic encephalopathy, renal and respiratory failure, cerebrovascular diseases, as well as associated with drugs that could potentially lead to hyperammonemia, such as valproic acid, carbamazepine, and phenytoin. Asterixis is usually asymptomatic and not spontaneously reported by patients. This highlights the importance of actively searching for this sign in the physical exam of encephalopathic patients because it could indicate an underlying toxic or metabolic cause. Asterixis is usually reversible upon treatment of the underlying cause.
ISSN:1648-9144
1010-660X
1648-9144
DOI:10.3390/medicina60030362