Geste antagoniste

ENTRY UNDER CONSTRUCTION

FROM ASTERIXIS ENTRY

Seen primarily in metabolic encephalopathy, particularly hepatic and renal encephalopathy, asterixis is an inability to sustain normal muscle tone.(1-3) With the arms outstretched and wrists extended, “like stopping traffic,” the lapse in postural tone may cause the hands to suddenly flop downward, then quickly recover, causing a slow and irregular flapping motion that led to the term “liver flap.” (Video) When severe, the entire arm may drop. Other body parts may exhibit the phenomenon (e.g., inability to keep the foot dorsiflexed [foot flap]).

NEW ENTRY GESTE ANTAGONISTE

The geste antagoniste (sensory trick, counterpressure sign, proprioceptive trick) is a maneuver done by patients to control dystonic movements and postures.(1-3) Many if not most patients with cervical dystonia learn they can straighten their head by placing a hand or finger somewhere on the face, chin or back of the head or performing some other maneuver to provide sensory stimulation or light counterpressure. Many patients have multiple sensory tricks and sometimes merely the thought of executing the trick may reduce the dystonia. In one study, 54% of patients demonstrated more than one geste antagoniste, and clinically significant reduction of head deviation occurred in 82%.(4)

The paper by Broussolle, et al features many vintage photographs from papers written around the turn of the 20th century.(5) Authors from that era argued that a geste antagoniste proved cervical dystonia was psychogenic. It seemed too bizarre to be real. Decades passed before others pointed out the error of this thinking. In a complete reversal, the presence of a geste antagoniste is now seen as evidence for rather than against organicity.

For video of a geste antagoniste in oromandibular dystonia see http://www.youtube.com/watch?v=b9roso9B1F0.

References

1. Poisson, A, Krack, P, Thobois, S, et al. History of the 'geste antagoniste' sign in cervical dystonia. J Neurol. 2012; 259:1580-1584.

2. Campbell WW. Barohn RJ. DeJong's the neurologic examination, 8th ed. Philadelphia: Wolters Kluwer, 2020.

3. Campbell WW. Clinical signs in neurology: a compendium. Philadelphia: Wolters Kluwer Health, 2016.

4. Müller J, Wissel J, Masuhr F, Ebersbach G. Clinical characteristics of the geste antagoniste in cervical dystonia. J Neurol. 2001 Jun;248(6):478-82. doi: 10.1007/s004150170156. PMID: 11499637.

5. Broussolle E, Laurencin C, Bernard E, et al. Early Illustrations of Geste Antagoniste in Cervical and Generalized Dystonia. Tremor Other Hyperkinet Mov (N Y). 2015 Sep 21;5:332. doi: 10.7916/D8KD1X74. PMID: 26417535; PMCID: PMC4582593.