MOVEMENT DISORDERS

Collected,Compiled,Edited and Presented by:-

DR.V.JAGANNATHAN

Movement Disorders is a big topic for dicussion. I would try to be as precise as possible and confine myself only to the very important aspects of the problem.

Movement disorders cause either increased and/or decreased movement. They can affect our actions or cause uncontrolled movements.                                                                          There are several movement disorders. Some of the most common ones  include Parkinson’s disease, essential tremor and restless leg syndrome.

Movement disorders are a group of neurological conditions that cause abnormal movements. They could be increased movement (like spasms, jerking) and/or decreased or slow movement. They can affect  the voluntary movements  or the involuntary movements.

Every  movement of our body, from lifting the leg to moving the jaw and tongue to talk, involves complex communication between our:

• Central nervous system 
• Motor nerves.
• Skeletal muscles.

Damage to or malfunction of the areas of the brain that control movement results in a movement disorder.

There are several different movement disorders, and they vary in severity.                        Some only affect one area of the body, while others can affect the whole of the  body. Some may interfere with certain tasks, like writing, while others can lead to issues with walking and mobility.

Abnormal movements may be the only part of a condition, such as in essential tremor. Or they can be one of several symptoms or syndromes, like in Parkinson’s disease (PD). In addition, certain movement disorders can be both a condition by themselves and a symptom of other conditions, like myoclonus.

It’s important to note that conditions that result in a lack of movement ( paralysis) or weakened muscles ( muscular dystrophy) aren’t considered movement disorders even though they affect mobility. Movement disorders cause abnormal, unwanted movements.

TYPES OF ABNORMAL MOVEMENTS

There are two main types of abnormal movements:

Hyperkinetic movement.

Hypokinetic movement.

A movement disorder can have both of these or just one.

Hyperkinetic movement

Hyperkinetic movement disorders involve increased movement.” It can affect voluntary movement or cause involuntary movement

Types of hyperkinetic movement include:

1)     Akathisia: Akathisia makes it difficult to sit or remain still due to inner restlessness and is is associated with the use of certain drugs like antipsychotic drugs

2)     Ataxia: Ataxia is a problem with coordination, causing an uncertain, awkward or even clumsy way.

3)     Chorea, athetosis and ballismus

Chorea is a movement disorder that causes involuntary, unpredictable muscle movements. The disorder can cause movement like dancing, restless or fidgety. It’s common in Huntington’s disease.                                                                                               Athetosis is a continuous stream of slow, twisting or squirming-like motions usually involving the hands and feet.                                                                                   Ballismus usually involves more intense movements, such as forceful flinging of one arm or leg.

Dystonia: Dystonia is sustained or intermittent muscle contractions causing abnormal, often repetitive movements or postures. Dystonia is a common symptom of cerebral palsy and several neurodegenerative conditions.

4)     Myoclonus: Myoclonus is brief, involuntary muscle twitching or jerking. People who experience myoclonic twitches or jerks have muscles that unexpectedly tighten (positive myoclonus) or relax (negative myoclonus).

5)     Spasticity: Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once when we try to move or even at rest. It interferes with movement and can also affect your speech and how you walk (gait).

6)     Stereotypies (stereotypic movements): Stereotypies are complex and usually bilateral (both sides of your body) movements. They’re patterned and look the same or very similar each time. Examples include rocking, hand flapping, pacing and body clenching. Stereotypies can be a feature of many conditions, including autism spectrum disorder 

7)     Tics: Tics are patterned, repetitive, nonrhythmic movements. Simple tics are brief and involve a small cluster of muscles. Examples include blinking, face scrunching, head jerking, throat clearing and grunting. Complex tics may last longer and involve more muscles. Examples include hopping and saying certain words or phrases.

8)     Tremor: Tremor involves involuntary trembling or shaking movements. The movements may be in one or more parts of your body. Tremors happen when the muscles repeatedly contract and relax.

Hypokinetic movement

Hypokinetic movement disorders involve decreased or slow movement. It generally affects voluntary movement.

Parkinsonism is the main type of hypokinetic movement. It’s a term that refers to brain conditions that cause slowed movements, rigidity (stiffness), tremor or balance issues

Neurodegenerative parkinsonism most commonly happens with Parkinson’s disease, but it can also be a feature of the following conditions:

• Multiple system atrophy.
• Corticobasal degeneration.
• Progressive supranuclear palsy.
•  Dementia.

Parkinsonism can also develop due to repeated head injuries, toxic substances, use of psychiatric medications and a lack of blood flow to certain areas ofthe brain.

Bradykinesia is another hypokinetic movement. It involves slowness of movement and speed or progressive hesitations or halts as you continue movements. It’s one of the main signs of Parkinson’s disease.

Types of movement disorders

There are several movement disorders. Some include:

1) Essential tremor: Essential tremor causes parts of the body to shake uncontrollably. It usually affects ther hands and arms but can also affect the head, voice and other body parts.

2)Huntington’s disease: Huntington’s disease is a genetic condition that affects the brain, causing unsteady and uncontrollable movements (chorea) in the hands, feet and face. Symptoms get worse over time.

3)Multiple system atrophy (MSA): MSA is a rare condition that causes certain brain areas to deteriorate. It may cause ataxia and parkinsonism.

4)Parkinson’s disease: Parkinson’s disease is a brain disorder that causes unintended or uncontrollable movements and difficulty with balance and coordination. It also causes cognitive (mental) decline.

5)Periodic limb movement disorder (PLMD): PLMD involves repetitive limb movements that occur during sleep and may cause sleep disruption. The limb movements usually involvethe lower extremities, consisting of extension of ther big toe and flexion of your ankle, knee and hip.

6)Progressive supranuclear palsy (PSP): PSP is a rare neurodegenerative disorder that damages certain areas of ther brain. It affects how we walk, think, swallow and move our eyes.

7)Restless leg syndrome (RLS): RLS is a sleep disorder that causes an intense, often irresistible urge to move your legs (and even your arms or body). It occurs along with other sensations in your limbs like pulling, creeping, tugging, throbbing, itching, aching, burning or crawling.

8)Wilson disease: Wilson disease is a rare genetic condition that happens when your body accumulates too much copper, especially in your liver and brain. It can cause stiff muscles, tremors and uncontrolled movements.

Apart from these there are a few more syndromes also describing movement problems

Common movement disorder

The three most common movement disorders are 1) Parkinson’s disease 2)Essential tremors and 3)Restless leg Syndrome.

Symptoms and Causes

The symptoms of movement disorders vary widely. All movement disorders cause abnormal movements. Some movement disorders have other symptoms, such as thinking and mood changes. The symptoms can range in severity from barely noticeable to disruptive.

In general, signs and symptoms of movement disorders include:

1.Episodes of uncontrolled movement, like twitches, spasms, tremors, jerks, twisting and shaking.

2.Problems with coordination and balance.

3.Trouble with certain movement tasks, such as writing, swallowing or speaking.

4.Difficulty in walking or changes in gait.

5.Stiffness or rigidity of  limbs and trunk.

Abnormal movements can affect one or more of several parts of the body, including :-

·         Limbs.

·         Hands and fingers.

·         Feet and toes.

·         Facial muscles.

·         Head and neck.

·         Trunk and posture.

·         Voice.

Cause of movement disorders

In general, movement disorders develop from damage to or malfunction of certain parts of the brain that control movement, including our:

• Primary motor cortex: The primary motor cortex is in the frontal lobe. It’s responsible for initiating voluntary movements. Damage to the primary motor cortex can result in spasticity, myoclonus and issues with fine motor movements.
• Basal ganglia: The basal ganglia help start and smooth out voluntary muscle movements, suppress involuntary movements and coordinate changes in  posture. Damage to the basal ganglia can result in chorea, athetosis, dystonia and parkinsonism.
• Cerebellum: The cerebellum coordinates  movements, helps the limbs move smoothly and accurately, and helps maintain balance. Damage to this part of your brain results in loss of coordination.
• Thalamus: Your thalamus is a relay station of all incoming motor and sensory information. Damage to the thalamus can cause tremor and motor impairments.

Several situations can result in damage to these areas, including:

• Genetic conditions and mutations.
• Traumatic brain injury.
• Infections.
• Toxins.
• Acquired or inherited metabolic disorders.
• Stroke and vascular diseases.
• Medication side effects.

Some movement disorders have a single cause. But in many cases, the condition results from multiple factors. Some movement disorders have unknown causes.

Diagnosis

We have to perform multiple tests to make a diagnosis starting  with a detailed history, physical exam and a neurological exam.

Based on the symptoms, they may order any of these tests:

• Blood tests to help diagnose certain kinds of movement disorders or rule out other causes.
• Electromyography (EMG) to assess the health of the muscles and the nerves that control them.
• Electroencephalogram (EEG) to check the electrical activity of  brain.
• Lumbar puncture to analyze  cerebrospinal fluid.
• Muscle biopsy to distinguish between nerve and muscle conditions.
• Nerve conduction study to measure the flow of electrical current through a nerve before it reaches a muscle.

• Computed tomography (CT).
• Magnetic resonance imaging (MRI).

Management and Treatment

The treatment for movement disorders varies based on the type.                                                  Most movement disorders don’t have a cure, so the goal of treatment is to manage symptoms. But some movement disorders, such as medication-induced parkinsonism, are often treatable.

Examples of treatments for movement disorders include:

• Medication: Several drugs can help the symptoms of movement disorders. For example, muscle relaxants can help with spasticity.                                                  Dopaminergic medications may help with Parkinson’s disease and restless leg syndrome.                                                                                                                  Antianxiety medications may help with dystonia. There are also specific medications for specific conditions.
• Physical therapy Physical therapists help you manage symptoms like pain, stiffness and discomfort that make it hard to move.
• Occupational therapy: Occupational therapy helps improve our ability to perform daily tasks.
• Mobility aids: Mobility aids, like canes, walkers and wheelchairs, can help you move more safely and increase your independence.
• Speech therapy: Speech therapy helps improve  speech, language skills and swallowing ability.
• Psychotherapy:. Movement disorders often lead to mental health conditions, like depression and anxiety. Psychotherapy can help.
• Deep brain stimulation: This is a brain surgery for people with advanced Parkinson’s disease, dystonia and other tremors. It may reduce involuntary movements.

As I mentioned earlier this is a vast subject and I have tried to ba as precise as possible and at the same I have tried my best not to omit any important information

I request your valuable respnse by way of enrichment ,suggestion,comments any note on my commissions and omissions

Thank you,

Jagannathan

Wednesday ,16th October ,2024