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Ivan Donaldson

, C. David Marsden

, Susanne A. Schneider

, and Kailash P. Bhatia

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date: 22 October 2020

Ballism or ballismus consists of repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs. This activity is almost ceaseless and movements are often complex and combined (Meyers 1968). Involvement of a single limb has been termed ‘monoballism’ (Whittier 1947 ), both limbs on the same side excluding the head and face ‘biballism’ (Martin and Alcock 1934 ), the whole of one half of the body ‘hemiballism’, and both sides of the body ‘paraballism’. The term biballism has largely disappeared from the literature and most cases to which it could be applied are now simply referred to as hemiballism.

The relationship between chorea and ballism has been hotly debated. The difference is really quantitative and there are no absolute criteria by which these movement disturbances can be distinguished. Chorea mainly involves more distal limb muscles and movements are not as vigorous or large in amplitude as those of ballism. Some authors maintain that they are two bascially separate conditions in which the clinical expressions tend to merge, whereas others take the view that ballism is only a severe form of proximal chorea (Meyers 1968, Cooper 1969). There is no doubt that in many cases both types of movements coexist and that as ballism resolves it often goes through a phase that is identical with chorea (Klawans et al. 1976). In addition, Sydenham’s chorea may be manifest as hemiballism. Confusion also arises because the literature does not distinguish between these conditions or terminology may be inaccurate. Thus cases may be described in one category which fit equally well, or better, into the other. However, although there are many similarities, historically, clinically, and aetiologically hemiballism has certain features that distinguish it from other forms of chorea.

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