What is the Biliary Dyskinesia?

Dyskinesia is a disorder of uncontrolled movements that can arise as a medication side effect or neurological condition, can significantly impair function, and requires adjusting treatment regimens for management.

What is the Dyskinesia?

Dyskinesia refers to involuntary, uncontrolled movements that can occur as a side effect of certain medications or medical conditions. Some key points about dyskinesia include:

• It involves abnormal, uncontrollable body movements like twitching, writhing, or jerking motions. These movements can affect any part of the body such as the face, arms, legs, or boot.
• Dyskinesia is commonly caused by medications that impact dopamine signalling in the brain, especially Parkinson's drugs like levodopa. But it can also result from certain underlying neurological conditions.
• In the case of medication-induced dyskinesia, it tends to happen after long-term use as doses increase and the drug effects become less stable. The movements are very disruptive and can severely impact a person's quality of life.
• Treatment focuses on adjusting medications to stabilize dopamine signals. Other options include adding medications to dampen overall movement, deep brain stimulation, or helping the person cope with functional impacts in their daily living.
• Distinguishing medication-induced dyskinesia from other movement disorders can be challenging early on, but observation of the involuntary, erratic nature of motions tends to make dyskinesia fairly recognizable.

Examples of Dyskinesia

Here are some common examples of dyskinesia:

1. Levodopa-induced dyskinesia in Parkinson's disease: After prolonged levodopa therapy, patients may develop involuntary writhing or “peak dose” and “wearing off” choreiform movements.
2. Tardive dyskinesia: Abnormal movements, often of the tongue, face, boot, or limbs, associated with antipsychotic medication use in psychiatric conditions like schizophrenia. These may involve repetitive, writhing motions.
3. Hemiballismus: Flinging/flailing motions of one side of the body caused by a stroke or brain injury affecting the subthalamic nucleus.
4. Oral-facial dyskinesia: Involuntary movements of the face and tongue muscles, resulting from neurological conditions like Huntington's disease. This may present as grimacing.
5. Stereotypic movement disorder: Repetitive, rhythmic, fixed movements like body rocking or waving, typically of childhood onset associated with neurodevelopmental conditions like autism.
6. Myoclonus: Sudden, shock-like jerks caused by diseases like epilepsy or liver failure, or side effects of medication withdrawal.
7. Dystonia: Sustained twisting, repetitive movements and abnormal postures brought on during voluntary movement, seen with certain inherited mutations or secondary to other disorders.

What is the Biliary Dyskinesia?

Biliary dyskinesia refers to impaired function or contractions of the gallbladder and bile ducts. Some key points about biliary dyskinesia include:

• It causes symptoms like abdominal pain after eating fatty foods, nausea, vomiting, bloating, and indigestion. The pain may be in the upper right quadrant of the abdomen, where the gallbladder is located.
• The underlying problem is that the gallbladder does not contract and empty bile properly due to blocked bile ducts, thickened bile, or other gallbladder motility issues. The impaired bile flow can cause pain and digestive distress.
• It is often initially suspected in patients, especially younger women, who have typical gallstone symptoms but no stones seen on ultrasound. Other tests like HIDA scans measuring gallbladder ejection fraction can help confirm impaired emptying.
• Treatment usually involves removing the dysfunctional gallbladder by a surgery called laparoscopic cholecystectomy. This resolves the dyskinesia and commonly leads to improvement in symptoms. Sometimes medications may help prior to surgery.
• If left untreated, the condition can lead to gallbladder inflammation, bile build-up, and worsening symptoms over time. So surgery is typically recommended even in milder cases that fail medical therapy.

Biliary dyskinesia refers to gallbladder contraction issues leading to abdominal pain and digestive symptoms, and patients typically require cholecystectomy for curative treatment.

Dyskinesia vs Biliary Dyskinesia

The main differences between dyskinesia and biliary dyskinesia are:

1. Cause: Dyskinesia refers to any involuntary movement disorder. It is commonly caused by medications, such as levodopa or antipsychotics. Biliary dyskinesia specifically refers to impaired gallbladder contraction that affects bile flow.
2. Location: Dyskinesia can occur in any part of the body exhibiting abnormal movements, such as the limbs, face, or boot. Biliary dyskinesia impacts the gallbladder and biliary tract, located in the right upper abdomen.
3. Diagnosis: Dyskinesia is diagnosed through clinical observation of abnormal involuntary motions. Biliary dyskinesia is usually suspected based on symptoms and then confirmed with a HIDA scan showing reduced gallbladder ejection fraction.
4. Treatment: Dyskinesia treatment targets the underlying cause, like stopping or changing medications. Biliary dyskinesia is typically treated with cholecystectomy: surgical removal of the gallbladder.
5. Associations: Dyskinesia is associated with Parkinson's disease, Huntington's, antipsychotic drugs, or brain injuries. Biliary dyskinesia is associated with gallstones, biliary obstruction, circulatory disorders of the gallbladder, and digestive conditions.

Dyskinesia is a broad term for uncontrollable movements caused by various neurological or medication-related issues, while biliary dyskinesia refers specifically to impaired gallbladder motor function leading to abdominal pain and digestive symptoms.

How to Test for Biliary Dyskinesia?

The main lab tests used to help diagnose biliary dyskinesia include:

1. Liver function tests (LFTs): Levels of liver enzymes like ALT, AST, GGT, ALP, and bilirubin may be elevated if biliary dyskinesia is causing bile flow impairment and mild liver irritation.
2. Complete blood count (CBC):Inflammation can lead to abnormalities in blood cell counts. A CBC checks for signs of infection or inflammation.
3. Lipase/amylase: Levels of these digestive enzymes may rise if the biliary system is blocked and causing pancreatitis.
4. Hepatitis virus serology: Ruling out viral hepatitis helps support a biliary cause of liver test abnormalities.

In addition to lab tests, the key diagnostic test for confirming biliary dyskinesia is:

5. HIDA scan: HIDA (hydroxyl-iminodiacetic acid) scans directly evaluate gallbladder ejection fraction and check if the gallbladder contracts normally in response to a fatty meal. An ejection fraction < 35% is consistent with biliary dyskinesia.

While labs may hint at the issue, a HIDA scan can definitively diagnose impaired gallbladder emptying. If results are equivocal, an endoscopic ultrasound or MRCP may also visualize structural biliary abnormalities contributing to dyskinesia.

What is the difference between dyskinesia and biliary dyskinesia?

Dyskinesia refers to impaired ability to control voluntary muscle movement and most often occurs with Parkinson’s disease. Biliary dyskinesia refers to abnormal function of the gallbladder and bile ducts.

What causes biliary dyskinesia?

The exact cause is unknown, but it results from the gallbladder failing to properly contract and empty bile, leading to symptoms like abdominal pain after eating fatty foods along with nausea, vomiting or reflux.

How is biliary dyskinesia diagnosed?

Diagnosis involves blood tests, imaging like ultrasound or HIDA scan to check gallbladder emptying function, and ruling out gallstones/inflammation. Often diagnosis is challenging without removal and examination of the gallbladder.

What is the treatment for biliary dyskinesia?

Lifestyle changes and medications to improve digestion bring partial relief in mild cases. If recurrent symptoms impair quality of life, surgical removal of the gallbladder (cholecystectomy) may be necessary.

What are the symptoms of Parkinson’s disease dyskinesia?

Parkinson’s patients develop increasingly uncontrolled random muscle movements over time like twitching, writhing, clenching, due to their brain disease and as a medication side effect.

Conclusion

Dyskinesia is a broad term for uncontrollable movements caused by various neurological or medication-related issues, while biliary dyskinesia refers specifically to impaired gallbladder motor function leading to abdominal pain and digestive symptoms.