ANATOMY AND PHYSIOLOGY

Basal ganglia
The basal ganglia are a collection of nuclei that connects to several other areas of the brain. Due
to the diverse nuclei that they contain, the basal ganglia are involved in numerous functions,
including motor control. It is within this structure that hemiballismus primarily occurs in the
brain.

Subthalamic Nucleus
This structure within the basal ganglia innervates other structures, including a very important
connection to the inside of the globus pallidus. The subthalamic nucleus essentially provides the
excitement needed to drive the globus pallidus. Injury to this area or its efferent or afferent
connections can induce this disorder[4]. The structure itself is a regulator of motor function and is
also involved in associative and limbic functions. It was traditionally thought that the disorder
was only caused by injury to the subthalamic nucleus, but new studies are showing that damage
to other areas of the brain can also be responsible for causing this disorder. Hemiballismus
caused by lesions in the subthalamic nucleus is more severe than other forms of the disorder.

Globus Pallidus
From recent studies, it is now thought that hemiballismus can be associated with a decreased
output of the globus pallidus. This is because studies have shown that firing rates decrease from
70/s to 40/s. In addition to a decreased firing rate, degenerative neurological disorders that cause
patients to exhibit hemiballistic movements show a marked decrease in the globus pallidus mass
as well. Increases in activity in this area causes there to be an inhibition of the motor thalamus.
This causes cortical activation and thus a movement inhibition. In the case of hemiballismus, the
opposite occurs, leading to the characteristic large, irregular movements.

Putamen
The putamen is also part of the basal ganglia and can be involved in hemiballismus due to the
fact that it projects to the premotor cortex through the globus pallidus. As a result, damage to this
area can also cause hemiballistic movements to be seen as it is also part of the chain in
movement.

Caudate Nucleus
The caudate nucleus is the portion of the basal ganglia that helps control voluntary movement.
Damage to this area can also result in hemiballismus as it is directly related to voluntary
movement.

Cortical Structures
While the majority of damage that causes hemiballismus occurs within the basal ganglia, there
are still cases that have been documented on which damage to cortical structures has caused
hemiballistic movements.