Movement Disorders
Movement disorders are a group of neurological disorders that result in abnormal, slow, or rapid movements, which can be either voluntary or involuntary. Slow movements are known as bradykinesia, whereas abnormally fast involuntary movements are called hyperkinesia. These disorders can affect the entire body or specific regions, and unwanted movements are a hallmark feature. This significantly impacts the smooth, consistent, and controlled motion of the body. The disorders are typically related to problems in brain regions that regulate coordination, posture, and muscle tone.
Movement disorders can be progressive or remain stable over time, and may be hereditary or acquired. They can affect motor and behavioral functions, with severity ranging from mild, unnoticeable tremors to a disabling disease.
Common movement disorders include Parkinson’s Disease, Essential Tremor, Dystonia, Huntington’s Disease, Ataxia, and Tourette Syndrome. Parkinson’s disease and essential tremor are the two most common movement disorders.
What Causes Movement Disorders?
The pathophysiology of movement disorders varies among specific conditions. It is, however, largely the result of an interruption in areas of the brain that govern movement, such as the motor cortex, cerebellum, and basal ganglia. Some movement disorders are related to an underlying disease, which may influence both their cause and treatment. Hereditary conditions are transmitted through an inheritance pattern in a family pedigree, whereas others result from exposure to environmental factors, trauma, or other neurological diseases. For example, Huntington’s Disease results from a mutation in one gene, while Parkinson’s is the degeneration of the dopamine-secreting neurons for as yet unknown reasons.
Stroke, encephalitis infections, autoimmune reactions, or long-term drug use also lead to abnormal motor patterns. The severity and management of spasticity often depend on the underlying disorder causing the muscle tightness. Injuries or disorders affecting the spinal cord, which is a crucial part of the central nervous system, can also result in movement disorders such as spasticity and ataxia. Secondary Parkinsonism is a disorder with symptoms similar to Parkinson’s disease, but it can be caused by medication side effects, other neurological disorders, illness, or brain damage. Parkinsonism can also develop due to repeated head injuries, toxic substances, use of psychiatric medications, and a lack of blood flow to certain areas of the brain.
However, in the majority of cases, no cause is found, and a diagnosis of an idiopathic movement disorder is rendered. Researchers continue to investigate the roles of inflammation, protein misfolding, and oxidative stress in the etiology of these neurological disorders.
Overview of Common Involuntary Movements and Movement Disorders
These movement disorders are categorized based on the type and pattern of abnormal movements they cause. The etiology and severity differ, but in any case, there is always a breakdown of the connection between the muscle and the central nervous system. Two movement disorders that are often highlighted for their involuntary or abnormal muscle movements are dystonia and chorea. Some of the most well-characterized ones are:
Parkinson’s Disease
Parkinson’s Disease is an ancient disease and a chronic condition of nerve cells that make the chemical dopamine. It is a common type of hypokinetic movement disorder. Tremor, stiff muscles, slow movement, difficulty walking, and loss of balance are all typical signs.
Essential Tremor
Essential Tremor is a common type of hyperkinetic movement disorder characterized by increased movement and uncontrolled shaking or trembling, especially of the arms and hands. About 50 percent of patients have a family history, suggesting a genetic component.
Dystonia
Dystonia causes spastic muscle contractions that result in twisting, repetitive movements, or posturing of one or more muscles. It results from abnormal functioning of the basal ganglia, a deep part of the brain that helps control coordination of movement, and can affect the entire body in generalized cases.
Huntington’s Disease
Huntington’s Disease is a hereditary, progressive, degenerative, and fatal disorder that causes progressive degeneration of nerve cells in the brain, leading to uncontrollable movements, cognitive decline, and psychiatric disability. Symptoms include chorea (abnormal, jerky movements) and abnormal eye movements, which can be early signs.
Mixed Dementia
Tourette Syndrome is characterized by motor and vocal tics—repetitive, rhythmic noises or movements that are difficult to suppress. Throat clearing is a common vocal tic.
Ataxia
Ataxia interferes with coordination and balance as a result of damage to the cerebellum, a hereditary condition, but one that might also occur secondary to infection, trauma, or stroke. Oral L-DOPA is a cornerstone treatment for ataxia associated with Parkinsonism.
All these conditions are unique from one another, yet share some similarities: disruption of voluntary motor control, which, left untreated, may result in loss of independence.
Finding Out the Symptoms
Symptoms are relatively heterogeneous among disorders, but they mostly start gradually and continue to progress over time. Movement disorders can affect muscle movements, speech, or emotional expression, depending on the specific condition. The majority of them take too long before going to see a doctor, believing that early symptoms are just symptoms of fatigue, stress, or aging. Mild movement dysfunction, however, can be a sign of underlying neurological dysfunction.
Warning signs may include a slow gait, tremors in the hands while writing or eating, loss of balance, muscle spasms, excessive blinking, or difficulty walking. In some movement disorders, there may be a gradual loss of automatic movement, such as blinking, swallowing, or facial expression. These all, in most cases, progress to other areas of the body, ultimately affecting coordination, speech, and even breathing. Other symptoms, including non-motor features, may also be present. Early diagnosis allows for early treatment, and progression can be slowed, or function can improve.
Diagnosis and Evaluation
A neurologist initially diagnoses movement disorders through a comprehensive evaluation that includes a detailed medical history, a neurological physical exam, and may involve advanced imaging and additional testing. Because most disorders have similar appearing symptoms, physicians will closely observe how the symptoms change over time. Structural abnormalities can be identified through specific tests, such as MRI or CT scans, while blood tests can help determine metabolic or autoimmune etiologies. In genetic disorders, genetic testing can confirm a suspected diagnosis. In certain patients, drug testing can provide clues for diagnosis based on the body’s response. Electromyography (EMG) and nerve conduction studies are equally valuable for evaluating nerve and muscle function. Diagnosis is ultimately a combination of clinical experience and supporting data.
Treatment Approaches
Treatment varies depending on the category of movement disorder and its specific pattern. Some are medically treated, and some will require more than one type of treatment. The goal of treatment for movement disorders is to improve symptoms and relieve pain when no cure is available, as well as to alleviate symptoms, preserve function, and improve quality of life. The primary treatment modalities are:
Injections
Botulinum Toxin Injections are used to treat both dystonia and essential tremor by inhibiting inappropriate muscle spasms.
Deep Brain Stimulation
Deep Brain Stimulation (DBS) Surgery with electrodes placed in areas of the brain that are being targeted for managing abnormal activity. DBS is used to treat Parkinson’s disease and dystonia.
Speech Therapy
Speech Therapy for voice, swallowing, or communication disorders.
Medication
Medications such as dopamine agonists (in Parkinson’s disease), anticholinergics, or muscle relaxants. Levodopa and dopamine agonists may also be effective in treating symptoms of Multiple System Atrophy (MSA). Oral L-DOPA is a cornerstone treatment for ataxia associated with Parkinsonism.
Physical Therapy
Physical and Occupational Therapy to strengthen, enhance flexibility, and enhance muscle function daily. Physical therapists play a key role in the multidisciplinary approach to managing movement disorders.
Treatment may be most effective through a multidisciplinary approach involving collaboration by caregivers, physical therapists, occupational therapists, and neurologists.
Living with a Movement Disorder
Everyday life with dementia, for the patient or caregiver, is replete with everyday challenges. Dementia affects people differently, impacting mood, behavior, and cognition in various ways depending on the individual and the type of dementia. Everyday routines, such as dressing, showering, preparing meals, eating, drinking, and performing household tasks, can be overwhelming.
A few demented patients become socially withdrawn due to shame at being confused or because the social situation is too complex to handle. They slowly become unable to identify familiar people or even themselves when they look in the mirror.
Psychological anguish to families may be tremendous because they grieve losing the person, but struggle to continue caring for them.
When to Seek Help
If you or the person you care about starts shaking, stiffening, jerking, or being clumsy on walks, see a doctor. Most movement disorders are easier to deal with if caught early. Although the symptoms can be frustrating or intermittent, it is worth investigating, especially if they become troublesome or interfere with function or safety.
Take the Next Step Toward Understanding and Support
Unexplained changes in movement must never be ignored. Tremor, stiffness, or jerky movement happening at irregular intervals that afflict you or your acquaintance need a checkup with a neurological specialist, and solutions and relief of mind often follow. With professional diagnosis, an individually tailored treatment regimen, and suitable assistance, many can live independently notwithstanding their diagnosis.
Our staff will provide empathetic care, tailored to your individual needs. From the initial appointment to ongoing care, and everything in between, we will guide you through it.
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