{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T08:00:56Z","timestamp":1792051256007,"version":"4.4.0"},"reference-count":143,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T00:00:00Z","timestamp":1708473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Asterixis is a subtype of negative myoclonus characterized by brief, arrhythmic lapses of sustained posture due to involuntary pauses in muscle contraction. We performed a narrative review to characterize further asterixis regarding nomenclature, historical aspects, etiology, pathophysiology, classification, diagnosis, and treatment. Asterixis has been classically used as a synonym for negative myoclonus across the literature and in previous articles. However, it is important to distinguish asterixis from other subtypes of negative myoclonus, for example, epileptic negative myoclonus, because management could change. Asterixis is not specific to any pathophysiological process, but it is more commonly reported in hepatic encephalopathy, renal and respiratory failure, cerebrovascular diseases, as well as associated with drugs that could potentially lead to hyperammonemia, such as valproic acid, carbamazepine, and phenytoin. Asterixis is usually asymptomatic and not spontaneously reported by patients. This highlights the importance of actively searching for this sign in the physical exam of encephalopathic patients because it could indicate an underlying toxic or metabolic cause. Asterixis is usually reversible upon treatment of the underlying cause.<\/jats:p>","DOI":"10.3390\/medicina60030362","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T10:52:00Z","timestamp":1708512720000},"page":"362","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Flapping Tremor: Unraveling Asterixis\u2014A Narrative Review"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6179-2177","authenticated-orcid":false,"given":"Jamir Pitton","family":"Rissardo","sequence":"first","affiliation":[{"name":"Neurology Department, Cooper University Hospital, Camden, NJ 08103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Muhammad","sequence":"additional","affiliation":[{"name":"Neurology Department, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkatesh","family":"Yatakarla","sequence":"additional","affiliation":[{"name":"Medicine Department, Terna Speciality Hospital, Navi Mumbai 400706, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilofar Murtaza","family":"Vora","sequence":"additional","affiliation":[{"name":"Medicine Department, Terna Speciality Hospital, Navi Mumbai 400706, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paras","family":"Paras","sequence":"additional","affiliation":[{"name":"Medicine Department, Government Medical College, Patiala 147001, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8024-2354","authenticated-orcid":false,"given":"Ana Let\u00edcia Fornari","family":"Caprara","sequence":"additional","affiliation":[{"name":"Medicine Department, Federal University of Santa Maria, Santa Maria 97105110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,21]]},"reference":[{"key":"ref_1","first-page":"137","article-title":"Asterixis: One Type of Negative Myoclonus","volume":"43","author":"Young","year":"1986","journal-title":"Adv. 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