Loading…

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...

Full description

Saved in:

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
Citations:	Items that this one cites
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

cited_by
cites	cdi_FETCH-LOGICAL-c511t-5406398b28dde95c2e7b537954c09094efac440bde0cf82035c22dd44e4aeb983
container_end_page
container_issue	3
container_start_page	362
container_title	Medicina (Kaunas, Lithuania)
container_volume	60
creator	Rissardo, Jamir Pitton Muhammad, Sara Yatakarla, Venkatesh Vora, Nilofar Murtaza Paras, Paras Caprara, Ana Letícia Fornari
description	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.
doi_str_mv	10.3390/medicina60030362
format	article
fullrecord	<record><control><sourceid>gale_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_12ecd07da2d54073a645218ac89a9c28</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A788250699</galeid><doaj_id>oai_doaj_org_article_12ecd07da2d54073a645218ac89a9c28</doaj_id><sourcerecordid>A788250699</sourcerecordid><originalsourceid>FETCH-LOGICAL-c511t-5406398b28dde95c2e7b537954c09094efac440bde0cf82035c22dd44e4aeb983</originalsourceid><addsrcrecordid>eNptks1vEzEQxVcIREvhzglF4sJly_hr1-aCoopCpQok1J6tWXs2ONqsg71J4b_HaUppKuSDreffe6MZTVW9ZnAqhIH3K_LBhREbAAGi4U-qY9ZIXRsm5dMH76PqRc7LAnHV8ufVkdBKMtD6uNLnA67XYVzMrhKtYvowux4TbmnYSfM8UQq_Qq7ns6-YEk5hS7PvtA1087J61uOQ6dXdfVJdn3-6OvtSX377fHE2v6ydYmyqlYRGGN1x7T0Z5Ti1nRKtUdKBASOpRycldJ7A9ZqDKAj3XkqSSJ3R4qS62Of6iEu7TmGF6beNGOytENPCYpqCG8gyTs5D65H7UrYV2EjFmUanDRrHd1kf91nrTVdG52icEg4HoYc_Y_hhF3FrGZiWy9uEd3cJKf7cUJ7sKmRHw4AjxU22ApgExoxSBX37CF3GTRrLrAoFQkghpf5HLbB0EMY-lsJuF2rnrdZcQWNMoU7_Q5XjaRVcHKkPRT8wwN7gUsw5UX_fJAO7Wx37eHWK5c3D4dwb_u6K-ANvGb3-</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3003343448</pqid></control><display><type>article</type><title>Flapping Tremor: Unraveling Asterixis-A Narrative Review</title><source>Publicly Available Content Database (Proquest) (PQ_SDU_P3)</source><source>PubMed Central Free</source><creator>Rissardo, Jamir Pitton ; Muhammad, Sara ; Yatakarla, Venkatesh ; Vora, Nilofar Murtaza ; Paras, Paras ; Caprara, Ana Letícia Fornari</creator><creatorcontrib>Rissardo, Jamir Pitton ; Muhammad, Sara ; Yatakarla, Venkatesh ; Vora, Nilofar Murtaza ; Paras, Paras ; Caprara, Ana Letícia Fornari</creatorcontrib><description>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.</description><identifier>ISSN: 1648-9144</identifier><identifier>ISSN: 1010-660X</identifier><identifier>EISSN: 1648-9144</identifier><identifier>DOI: 10.3390/medicina60030362</identifier><identifier>PMID: 38541088</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>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</subject><ispartof>Medicina (Kaunas, Lithuania), 2024-02, Vol.60 (3), p.362</ispartof><rights>COPYRIGHT 2024 MDPI AG</rights><rights>2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2024 by the authors. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c511t-5406398b28dde95c2e7b537954c09094efac440bde0cf82035c22dd44e4aeb983</cites><orcidid>0000-0002-8024-2354 ; 0000-0001-6179-2177</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/3003343448/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/3003343448?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38541088$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rissardo, Jamir Pitton</creatorcontrib><creatorcontrib>Muhammad, Sara</creatorcontrib><creatorcontrib>Yatakarla, Venkatesh</creatorcontrib><creatorcontrib>Vora, Nilofar Murtaza</creatorcontrib><creatorcontrib>Paras, Paras</creatorcontrib><creatorcontrib>Caprara, Ana Letícia Fornari</creatorcontrib><title>Flapping Tremor: Unraveling Asterixis-A Narrative Review</title><title>Medicina (Kaunas, Lithuania)</title><addtitle>Medicina (Kaunas)</addtitle><description>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.</description><subject>anisosterixis</subject><subject>asterixis</subject><subject>Brain Diseases</subject><subject>Carbamazepine</subject><subject>Carbamazepine - therapeutic use</subject><subject>Development and progression</subject><subject>Diagnosis</subject><subject>Divalproex</subject><subject>Dyskinesias</subject><subject>encephalopathy</subject><subject>Gravity</subject><subject>Hematoma</subject><subject>Humans</subject><subject>hyperkinetic</subject><subject>Legs</subject><subject>Metabolism</subject><subject>mini-asterixis</subject><subject>myoclonus</subject><subject>Myoclonus - diagnosis</subject><subject>Neomycin</subject><subject>Pathophysiology</subject><subject>Patients</subject><subject>Posture</subject><subject>Respiratory failure</subject><subject>Review</subject><subject>Rifaximin</subject><subject>Tremor</subject><subject>Tremor - diagnosis</subject><subject>Tremor - etiology</subject><subject>Valproic acid</subject><subject>Wrist</subject><issn>1648-9144</issn><issn>1010-660X</issn><issn>1648-9144</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptks1vEzEQxVcIREvhzglF4sJly_hr1-aCoopCpQok1J6tWXs2ONqsg71J4b_HaUppKuSDreffe6MZTVW9ZnAqhIH3K_LBhREbAAGi4U-qY9ZIXRsm5dMH76PqRc7LAnHV8ufVkdBKMtD6uNLnA67XYVzMrhKtYvowux4TbmnYSfM8UQq_Qq7ns6-YEk5hS7PvtA1087J61uOQ6dXdfVJdn3-6OvtSX377fHE2v6ydYmyqlYRGGN1x7T0Z5Ti1nRKtUdKBASOpRycldJ7A9ZqDKAj3XkqSSJ3R4qS62Of6iEu7TmGF6beNGOytENPCYpqCG8gyTs5D65H7UrYV2EjFmUanDRrHd1kf91nrTVdG52icEg4HoYc_Y_hhF3FrGZiWy9uEd3cJKf7cUJ7sKmRHw4AjxU22ApgExoxSBX37CF3GTRrLrAoFQkghpf5HLbB0EMY-lsJuF2rnrdZcQWNMoU7_Q5XjaRVcHKkPRT8wwN7gUsw5UX_fJAO7Wx37eHWK5c3D4dwb_u6K-ANvGb3-</recordid><startdate>20240221</startdate><enddate>20240221</enddate><creator>Rissardo, Jamir Pitton</creator><creator>Muhammad, Sara</creator><creator>Yatakarla, Venkatesh</creator><creator>Vora, Nilofar Murtaza</creator><creator>Paras, Paras</creator><creator>Caprara, Ana Letícia Fornari</creator><general>MDPI AG</general><general>MDPI</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-8024-2354</orcidid><orcidid>https://orcid.org/0000-0001-6179-2177</orcidid></search><sort><creationdate>20240221</creationdate><title>Flapping Tremor: Unraveling Asterixis-A Narrative Review</title><author>Rissardo, Jamir Pitton ; Muhammad, Sara ; Yatakarla, Venkatesh ; Vora, Nilofar Murtaza ; Paras, Paras ; Caprara, Ana Letícia Fornari</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-5406398b28dde95c2e7b537954c09094efac440bde0cf82035c22dd44e4aeb983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>anisosterixis</topic><topic>asterixis</topic><topic>Brain Diseases</topic><topic>Carbamazepine</topic><topic>Carbamazepine - therapeutic use</topic><topic>Development and progression</topic><topic>Diagnosis</topic><topic>Divalproex</topic><topic>Dyskinesias</topic><topic>encephalopathy</topic><topic>Gravity</topic><topic>Hematoma</topic><topic>Humans</topic><topic>hyperkinetic</topic><topic>Legs</topic><topic>Metabolism</topic><topic>mini-asterixis</topic><topic>myoclonus</topic><topic>Myoclonus - diagnosis</topic><topic>Neomycin</topic><topic>Pathophysiology</topic><topic>Patients</topic><topic>Posture</topic><topic>Respiratory failure</topic><topic>Review</topic><topic>Rifaximin</topic><topic>Tremor</topic><topic>Tremor - diagnosis</topic><topic>Tremor - etiology</topic><topic>Valproic acid</topic><topic>Wrist</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rissardo, Jamir Pitton</creatorcontrib><creatorcontrib>Muhammad, Sara</creatorcontrib><creatorcontrib>Yatakarla, Venkatesh</creatorcontrib><creatorcontrib>Vora, Nilofar Murtaza</creatorcontrib><creatorcontrib>Paras, Paras</creatorcontrib><creatorcontrib>Caprara, Ana Letícia Fornari</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection (ProQuest Medical & Health Databases)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Medicina (Kaunas, Lithuania)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rissardo, Jamir Pitton</au><au>Muhammad, Sara</au><au>Yatakarla, Venkatesh</au><au>Vora, Nilofar Murtaza</au><au>Paras, Paras</au><au>Caprara, Ana Letícia Fornari</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Flapping Tremor: Unraveling Asterixis-A Narrative Review</atitle><jtitle>Medicina (Kaunas, Lithuania)</jtitle><addtitle>Medicina (Kaunas)</addtitle><date>2024-02-21</date><risdate>2024</risdate><volume>60</volume><issue>3</issue><spage>362</spage><pages>362-</pages><issn>1648-9144</issn><issn>1010-660X</issn><eissn>1648-9144</eissn><abstract>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.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>38541088</pmid><doi>10.3390/medicina60030362</doi><orcidid>https://orcid.org/0000-0002-8024-2354</orcidid><orcidid>https://orcid.org/0000-0001-6179-2177</orcidid><oa>free_for_read</oa></addata></record>
fulltext	fulltext
identifier	ISSN: 1648-9144
ispartof	Medicina (Kaunas, Lithuania), 2024-02, Vol.60 (3), p.362
issn	1648-9144 1010-660X 1648-9144
language	eng
recordid	cdi_doaj_primary_oai_doaj_org_article_12ecd07da2d54073a645218ac89a9c28
source	Publicly Available Content Database (Proquest) (PQ_SDU_P3); PubMed Central Free
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
title	Flapping Tremor: Unraveling Asterixis-A Narrative Review
url	http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-02T16%3A27%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Flapping%20Tremor:%20Unraveling%20Asterixis-A%20Narrative%20Review&rft.jtitle=Medicina%20(Kaunas,%20Lithuania)&rft.au=Rissardo,%20Jamir%20Pitton&rft.date=2024-02-21&rft.volume=60&rft.issue=3&rft.spage=362&rft.pages=362-&rft.issn=1648-9144&rft.eissn=1648-9144&rft_id=info:doi/10.3390/medicina60030362&rft_dat=%3Cgale_doaj_%3EA788250699%3C/gale_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c511t-5406398b28dde95c2e7b537954c09094efac440bde0cf82035c22dd44e4aeb983%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=3003343448&rft_id=info:pmid/38541088&rft_galeid=A788250699&rfr_iscdi=true