An Overview of Dysdiadochokinesia in Multiple Sclerosis

Dysdiadochokinesia (DDK) refers to the inability to perform rapid, alternating movements, such as flipping one's hand from back to front on a flat surface, or screwing in a light bulb. DDK can cause problems with upper and lower extremities as well as with speech. This problem is often seen in patients with multiple sclerosis or other conditions that impair coordination.

DDK typically affects the muscles in the arms, hands, legs, and feet, as well as the muscles in the larynx that control speech. Dysdiadochokinesia is a symptom of a category of neurological problems known as ataxia. Patients with ataxia can present with the following symptoms:

• Problems with balance and walking, including slowness, or awkward or rigid movements
• Poor coordination of the arms, hands, or legs
• Inarticulate or incomprehensible speech, and difficulties with swallowing
• Difficulty stopping one movement and starting another in the opposite direction
• Tremors, weakness, spasticity, inability to move the eyes, and loss of sensitivity in the hands and feet

It's believed that dysdiadochokinesia is often caused by lesions in the cerebellum, a part of the brain that controls voluntary muscle movements, posture, and balance. Damage to the cerebellum can also result in hypotonia, or decrease in muscle tone, which can contribute to the problem.

In addition, dysdiadochokinesia can also be associated with a gene mutation that affects neurotransmitters—the chemicals that communicate information throughout our brain and body.

Typically, a neurologist will perform tests that lead to a diagnosis of dysdiadochokinesia. These tests include:

• Having the patient alternately flip each hand from palm side up to palm side down as quickly as possible on a stable surface like a table
• Asking the patient to demonstrate the movement of turning a doorknob or screwing in a lightbulb
• Having the patient tap their foot quickly on the floor or examiner’s hand
• Asking the patient to repeat syllables such as “papa”, “kaka”, “lala”

A person with dysdiadochokinesia will be unable to perform the above tests in a correct and coordinated fashion. Their movements may be slowed, unusual, or clumsy.

Treating dysdiadochokinesia and cerebellar ataxia, in general, is challenging, and there are no specific strategies that are scientifically supported at this time.

A 2014 study in the Journal of Neurology found that physical therapy and occupational therapy may provide some benefit. Strength training, balance exercises, treadmill walking and exercises to improve core strength may all be helpful; speech therapy may also be necessary.

Learning strategies for how to prevent falls and modifying the home (for example, installing grab rails, removing loose carpets, and placing nonskid mats) can keep someone safe if they continue to struggle with symptoms of DDK.

Living with dysdiadochokinesia can be frightening and unsettling. While there is no known “cure” for DDT, seeking out medical advice and working with physical and occupational therapists can help you keep symptoms down to a manageable level.