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