Extrapyramidal Syndromes After Traumatic Brain Injury

Traumatic brain injury (TBI) is an important cause of a variety of extrapyramidal movement disorders such as tremors, dystonia, parkinsonism, myoclonus, chorea, and tics. The occurrence of movement disorders after severe head injury has been reported in 13–66% of patients. The most common and persistent disorder is tremor followed by dystonia. Parkinsonism has been observed after TBI or as part of chronic traumatic encephalopathy. However, trauma has also been reported triggering a neurodegenerative process increasing the risk for the onset of Parkinson’s disease (PD). The symptoms of all these abnormal movements may vary depending on the severity and the damaged brain structures after the trauma. This chapter reviews the phenomenology, pathophysiology, clinical-neuroanatomic correlations, as well as the appropriate management of posttraumatic movement disorders already described in the literature. Treatment includes mainly oral medication and botulinum toxin injections, and, in some cases, stereotactic brain surgery, such as deep brain stimulation (DBS) or ablative lesions, is indicated.