Movement Disorders- Overview

DEFINITION

  • Movement disorders are a subspecialty of neurology focused on abnormal movements that can result from:
    • Brain dysfunction
    • Exposure to toxins or medications
    • Illnesses that affect the entire body
  • Movements can be graded on a scale of “too much” to “too little.”
    • Hyperkinetic – Too much or excessive movement
    • Hypokinetic – Not enough or too little movement, also described as “parkinsonian”
  • Movements are often differentiated by their speed from fast to slow.

TYPES

Myoclonus

  • It’s the fastest involuntary movement.
  • It appears as a sudden, brief muscle twitch or jerk that can cause a jump or jolt in the affected body part.
  • Examples:
    • Hiccups – Myoclonus of the diaphragm
    • Hypnic jerks – Body jerks that occur as a person falls to sleep
  • Movements are localized to one region or the whole body.
  • Causes:
    • Brain and spinal cord disease
    • Medications
    • Toxins
    • Organ failure
    • Infections
  • Treatment:
    • Depends on the cause
    • Anti-seizure drugs are often used

Ballism 

  • A sudden explosive, violent movement affects an entire limb or the whole body.
  • It appears like wild flailing or flinging, usually on one side of the body.
  • It may be associated with a stroke.

Tics

  • Movements or vocal sounds occur suddenly, repetitively, and/or nonrhythmically.
  • Examples:
    • Excessive blinking
    • Shoulder shrugs
    • Throat clearing
  • Other family members often have them too.
  • They’re often associated with obsessive-compulsive traits.
  • Semi-voluntary movements are usually preceded by an urge or inner sensation of mounting tension, and execution of the movement often provides some temporary relief.
  • They’re worsened by stress, fatigue, and excitement.
  • A diagnosis of Tourette syndrome is made if a person has both motor tics and vocalizations.
  • Treatments vary according to severity.

Tremor

  • These back-and-forth rhythmic movements can be fast or slow.
  • Fast tremors include medication-induced tremors and essential tremors (isolated tremors that occurs with movement and without any other neurologic signs).
  • Slow tremors are more often associated with Parkinson’s disease.
  • Thyroid disease can cause tremors.
  • Treatment depends on the cause.

Chorea and athetosis

  • Chorea and athetosis are irregular and unpredictable writhing, squirming, jerky, and snakelike movements that flow across body parts.
  • Chorea comes from the Greek word for “dance.”
  • Chorea is a primary sign of Huntington’s disease.
  • Movements can be focal or generalized.

Dystonia

  • A sustained pattern of movement appears as turning or twisting.
  • Examples:
    • Neck – Cervical dystonia (the most common)
    • Hand – Writer’s cramp
    • Eyelid – Blepharospasm
  • Treatment:
    • Botulinum toxin injection
      • Botox
      • Xeomin
      • Myobloc
  • Deep brain stimulation (DBS) can be performed for generalized dystonia.
  • Read the website document Advanced Therapeutics for more information.

Bradykinesia

  • Slowness or scarcity of movement seen in parkinsonism

Rigidity/spasticity

  • Muscle stiffness

Ataxia

  • Disordered, uncoordinated, or clumsy movements usually due to dysfunction of the cerebellum or brainstem
  • Sometimes a result of intoxication

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