Understanding Movement Disorders

Author: Steven Mitchell, Neurologist at the Bronson Neuroscience Center in Kalamazoo

Within the field of neurology, there are diseases that can affect movement. Parkinson’s disease is probably the most well-known one, but movement disorders include a range of diseases.

Movement disorders refer to conditions that cause you to have abnormal voluntary or involuntary movements, or slow, reduced movements. They can be categorized into two groups:

• Hyperkinetic—excessive movement
• Hypokinetic—less movement

The diagnosis of most movement disorders is based on a patient’s history and a physical examination. This article covers a number of movement disorders seen in a neurology clinic, starting with the most common.

Types of movement disorders

Essential tremor (benign essential tremor or familial tremor) causes shaking in the hands and sometimes the head and voice. The cause of essential tremor is not fully known but may have a genetic connection.

Weighted pens and utensils can help provide a counterbalance to the shaking which reduces the impact of tremors on everyday activities.
Some patients with essential tremor receive help from medications to reduce the severity of their symptoms and improve their quality of life. In some cases, botulinum toxin injections (Botox) may help block the nerve signals to muscles, to reduce tremors for a period of time.

In more severe cases, deep brain stimulation (DBS) or magnetic resonance-guided focused ultrasound (MRgFUS) are potential surgical options.

DBS acts like a pacemaker for the brain delivering electrical impulses to specific areas, and MRgFUS creates a permanent brain lesion to help reduce tremors.

Parkinson’s disease is the second most common neurodegenerative condition after Alzheimer’s disease, affecting millions of people worldwide.

Although Parkinson’s disease is most common in those over 60 years old, it can occur in younger people. For example, Michael J. Fox developed symptoms of this movement disorder at age 29. Young people diagnosed with Parkinson’s disease often have an underlying genetic cause. Regardless of the age of onset, the disease symptoms progress over time.

Four major movement symptoms:

• tremor at rest
• muscle rigidity (i.e., stiffness)
• slowed movement
• balance issues

It’s important to note that “non-motor” symptoms may also be experienced.
Non-motor symptoms may include:

• constipation
• urinary issues
• depression
• anxiety
• apathy
• cognitive changes
• sleep changes

Parkinson's treatment is personalized to each patient based on age and symptom severity. Medications may help or DBS when symptoms are not responding well to medication.

Patients are encouraged to exercise regularly. Evidence suggests that aerobic exercise may even slow Parkinson’s disease progression. Physical, occupational, or speech therapy might also be recommended.

Dystonia is characterized by uncontrolled muscle movement that results in abnormal posture. It may involve one or more areas of the body. It can be caused by both genetic and acquired factors, but in some cases, the cause is not known.

Dystonia can be divided into several different categories and subtypes, each with its own unique set of symptoms and causes.

The most common type is focal dystonia, which affects a single part of the body, such as a hand or an eye.

• Cervical dystonia is the most common form of focal dystonia, resulting in abnormal twisting of the head and neck.
• Blepharospasm results in uncontrollable closure of the eyes.
• Musician’s dystonia affects those who play musical instruments. Similar task-specific focal dystonia can occur in those who play sports, such as the “yips” in golfers and baseball players or can occur when a person is writing by hand (also known as “writer’s cramp”).

Treatment of dystonia varies based on the subtype and areas of the body involved. Botox is the treatment of choice for focal dystonia and works by selectively weakening the muscles.

Medications can also be helpful depending on the situation. DBS may be considered when medication is not effective.

Tic disorders involve sudden, rapid, recurrent, nonrhythmic movements or sounds. They tend to ebb and flow in severity and may change over time. Although some tics may be mild, others can cause major distress and difficulty with daily activities.

Tics are usually preceded by a building sensation or urge which is alleviated once the movement or sound occurs.
Tourette syndrome is a specific tic disorder that starts before age 18 and includes a combination of both motor and vocal tics.

Patients with tic disorders may have co-existing attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety or mood disorders.

Tic disorders are diagnosed by talking to and examining the patient, as there is no definitive lab or imaging test for them yet.
Treatment includes a specific type of therapy called “Comprehensive Behavioral Intervention for Tics” (CBIT) and in some cases medication.

Chorea is a constant random flow of nonrhythmic muscle movement. It originates from the Greek word for ‘dance’.
Once chorea is diagnosed, lab and imaging studies are typically needed to find the underlying cause. In certain cases, genetic testing might also be done.

There are many potential causes of chorea, both acquired and genetic. One genetic cause is Huntington’s disease which causes abnormal movements, cognitive and psychiatric changes. If one parent is affected by the disease, there is a 50 percent chance that their child will also be affected.
Treatment of chorea mostly depends on the primary cause. Medications may be used to reduce abnormal movements.

Tardive syndromes are a group of delayed-onset movement disorders caused by exposure to medications that block the effect of dopamine in the brain. This includes tardive dyskinesia, which causes involuntary movements of the face and tongue. Medications that treat psychiatric or gastrointestinal issues can lead to tardive syndromes.

The most common way to treat tardive syndromes is to wean down or get completely off the medication that is causing it. Support in this process is typically offered by the patient’s psychiatrist or another prescribing physician. In cases where medication cannot be stopped or the movements continue, other medications may be used as treatment.

Functional movement disorder (psychogenic movement disorder) is a diagnosis applied to a broad range of abnormal movements. It is often sudden in onset and may be associated with a psychological or physical stressor.

Although it’s quite common, diagnosis is sometimes delayed or missed due to symptoms being very similar to other movement disorders. Unfortunately, some patients may incorrectly be perceived as “faking” their symptoms.

The exact cause is unclear but is likely a mix of many factors such as a person’s biology, psychology and social situation.
Treatment of functional movement disorder involves a combination of physical, occupational, or speech therapy and cognitive behavioral therapy.

Looking Ahead

Although approved treatments for most movement disorders are for symptom relief, there is hope for disease-modifying treatments in the future. If you are experiencing any of the symptoms mentioned above, the first step is to see a movement disorder specialist. They will provide you with a correct diagnosis and a care plan to improve your quality of life. Talk to your primary care provider about a referral to the Bronson Neuroscience Center.

Bronson Neuroscience Center has offices at Bronson Battle Creek and at Bronson Methodist Hospital. To learn more about the services and treatments offered at the Bronson Neuroscience Center visit bronsonhealth.com/neuro

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