Movement Disorders

Movement Disorders

Ataxia. This movement disorder affects the cerebellum, brainstem, or spinal cord. Ataxia can cause clumsiness, inaccuracy, instability, imbalance, tremor or a lack of coordination while performing voluntary movements. Movements are not smooth and may appear disjointed or jerky leading to unsteady gait and falling down. Ataxia also can affect speech and eye movements.

Chorea. Chorea is characterized by repetitive, irregular, and brief involuntary movements that resemble dance-like movements. It typically involves the face, mouth, trunk, and limbs.

Dystonia. Dystonia is characterized by involuntary muscle spasms, uncontrollable twisting, repetitive movements, and abnormal posturing and positioning of the body. Dystonia results from abnormal functioning of the basal ganglia, a deep part of the brain which helps control speed and fluidity of muscle movement. It also prevents unwanted movements. These can affect any part of the body, including the arms, legs, trunk, eyelids and vocal cords. General dystonia involves the entire body. Focal dystonia involves only one body location, most commonly the neck (spasmodic torticollis or Cervical Dystonia), eyelids (blepharospasm), lower face (Meige syndrome) or hand (writer’s cramp or limb dystonia). Depending on what part of the body is affected, the condition can be very disabling

Functional movement disorder. This condition may resemble any of the movement disorders but is not due to neurological pathology and has a psychological component.

Huntington’s disease. This is an inherited progressive, neurodegenerative disorder that causes uncontrolled movements (chorea). Symptoms include jerking; uncontrollable movements of the limbs, trunk, and face; progressive cognitive decline; and the development of psychiatric problems. The condition is hereditary so a child with one affected parent has a 50 percent chance of developing Huntington’s disease.

Lyme Disease. Lyme Disease can often cause neurological symptoms such as tremors or myoclonus. The prevalence of Lyme disease has increased drastically in recent years and it is very likely that most cases go unreported. Lyme disease is most often caused by the bacterium, Borrelia Burgdorferi which is transmitted by a tick bite. A large number of Lyme cases are misdiagnosed due to the limited reliability of two standard antibody tests known as Elisa and western blot. Late disseminated Lyme diseases can develop if a patient goes untreated. The condition may also be complicated by a number of co-infections transmitted from the tick bite. Early symptoms of Lyme disease include flu-like symptoms and a Bull’s eye rash which occurs in about 50% of cases. Late-stage symptoms develop when Lyme disease goes undiagnosed for months or years following infection. The bacterium spreads throughout the body causing damage to the central nervous system, heart, and joints. The most common symptoms reported are fatigue, cardiovascular problems, Bell’s palsy, cognitive decline, and psychological changes. Lyme disease is considered very difficult to treat by the medical community and is considered a significant health problem in the United States.

Multiple system atrophy (MSA). MSA is a progressive, neurodegenerative disease affecting movement, blood pressure, and the autonomic nervous system. Symptoms, onset, and severity of MSA vary from person to person. The different ranges of symptoms were initially classified as three different diseases Shy-Drager Syndrome, Striatonigral Degeneration, and Olivopontocerebellar Atrophy. All of these now are classified under MSA. Symptoms include stiffness or rigidity; freezing or slowed movements; instability; loss of balance; loss of coordination; and a significant drop in blood pressure when standing (orthostatic hypotension), causing dizziness, lightheadedness, fainting or blurred vision. It can also cause male impotence; urinary difficulties; constipation; and speech and swallowing difficulties.

Myoclonus.  Myoclonus is a jerky movement that usually presents with a regular rhythm. Focal myoclonus occurs in one muscle or muscle group. Multifocal myoclonus occurs in several different muscle groups. Myoclonus is classified into several major types and subcategories based on the part of the body affected and its underlying causes. Myoclonus may occur without an obvious cause or can be associated with a specific disease. Diseases that are associated with myoclonus are Celiac disease, Angelman syndrome, Huntington’s disease, Rett syndrome, Creutzfeldt-Jakob disease and Alzheimer’s disease.

The most common type of myoclonus is cortical myoclonus, which arises from the sensorimotor cortex located in cortical areas of the brain. Subcortical myoclonus usually affects many muscle groups (generalized) and may be the result of abnormally low levels of oxygen in the brain know as hypoxia or a metabolic disorder seen in kidney or liver failure. Spinal myoclonus usually is caused by a focal spinal lesion, such as multiple sclerosis, syringomyelia, trauma, ischemic myelopathy. It can also be caused by infections such as herpes zosterLyme diseaseE. coli or HIV. The jerking often lasts longer and is more variable than cortical or subcortical myoclonus and continues during sleep.

The most common type of peripheral myoclonus is hemifacial spasm, which may be caused by compression of the facial nerve or it can occur for no underlying reason. Movements persist during sleep and may last for only a few days or for as long as a few months. The exact type of myoclonus is delineated further by the parts of the body affected and by the underlying causes.

Parkinson’s disease. Parkinson’s disease is a slowly progressive disorder that is caused by neurodegeneration of a brain area called the substantia nigra, which controls speed and fluidity of movement. The substantia nigra produces dopamine a very important neurochemical. Degeneration of the substantia nigra causes a depletion of dopamine leading to the presentation of symptoms seen in Parkinson’s Disease. Symptoms including tremors, muscle rigidity (stiffness of the limbs), stooped flexed posture, slowness of movements (bradykinesia), unsteady gait and balance, depression, decreased mental capacity, and dementia. Parkinson’s disease is marked by the loss of spontaneous or automatic movements such as facial expression, swallowing, and blink rate leading to masked faces, drooling, and hesitations or freezing while walking.

The Parkinson’s Disease Foundation estimates that that 60,000 new cases of Parkinson’s disease are diagnosed each year, adding to the seven to 10 million people who have the disease worldwide. The risk of developing Parkinson’s disease increases with age, however recently there has been an increase in the percentage of people developing PD before the age of 50.

Parkinsonism. Parkinsonism describes a group of conditions that have symptoms similar to those of Parkinson’s disease but with different pathophysiology.

Progressive Supranuclear Palsy is a rare neurological disorder that causes problems with walking, balance and eye movements. It may resemble Parkinson’s disease and often gets misdiagnosed, but it has distinct permanent neurological problems that differ from PD. People with PSP show accumulation of the protein tau in affected brain cells, while people with Parkinson’s disease show accumulation of a protein called alpha-synuclein. Initial complaints in PSP are typically vague and fall into these categories:

  • symptoms of disequilibrium, such as unsteady walking or abrupt and unexplained falls without loss of consciousness
  • visual complaints, including blurred vision, difficulties in looking up or down, double vision, light sensitivity, burning eyes, or other eye trouble
  • slurred speech
  • various mental complaints such as slowness of thought, impaired memory, personality changes, and changes in mood.

People with PSP usually stand exceptionally straight or occasionally even tilt their heads backward (and tend to fall backward). This is termed “axial rigidity.” Those with Parkinson’s disease usually bend forward. Problems with speech and swallowing are much more common and severe in PSP than in Parkinson’s disease, and tend to show up earlier in the course of the disease. Eye movement abnormalities are more severe in PSP and affect vertical eye movement before horizontal eye movement.

Both diseases share some features such as onset in late middle age, bradykinesia (slow movement), and rigidity of muscles. Tremor is very common in individuals with Parkinson’s disease but rarely seen in PSP. People with PSP do not respond to the drug levodopa whereas PD show marked improvements. This disease more commonly affects people ages 40 to 60 and usually runs its full terminal course in six to 10 years. There appears to be a genetic predisposition.

Rett Syndrome is a progressive neurological disorder that causes debilitating symptoms, including reduced muscle toneautistic-like behavior, repetitive hand movements, irregular breathing, decreased ability to express emotions, delayed brain and head growth, gait abnormalities, and seizures. Children with Rett appear to develop normally until six to 18 months of age, at which point symptoms start to appear. Loss of muscle tone usually is the first symptom. According to the International Rett Syndrome Foundation, Rett Syndrome affect female more often than male and about one in every 10,000 to 23,000 infant girls is diagnosed with Rett, but the prevalence may be much higher due to undiagnosed cases. Rett is caused by mutations in the gene MECP2, located on the X chromosome. Rett leaves its victims disabled and requiring maximum assistance with all aspects of daily living.

Restless legs syndrome. This movement disorder causes unpleasant, abnormal feelings in the legs that are relieved by movement. It is most often triggered while relaxing or lying down.

Spasticity is increased muscle contractions causing stiffness or tightness of the muscles that may interfere with normal movement, speech, and walking. Spasticity usually is caused by damage to the portion of the brain or spinal cord that controls voluntary movement. Spasticity can result from spinal cord injuries, multiple sclerosis, cerebral palsy, stroke, hypoxia, traumatic brain injury, concussions, and metabolic diseases such as Lou Gehrig’s disease (ALS).

Tardive dyskinesia. This neurological condition is caused by the use of antipsychotic and neuroleptic medications used to treat psychiatric conditions. Tardive dyskinesia characterized by repetitive involuntary movements. TD can cause rapid jerk like movements of the trunks, arms, and legs. It can also affect the face creating repetitive lip-smacking, eye blinking, and facial grimace. The condition can be quite embarrassing because it cannot be controlled.

Tic or Tourette syndrome. This is a neurological condition that starts between childhood and teenage years and is classified as involuntary and uncontrollable movements (motor tics) and vocal sounds (vocal tics).The first symptoms often are involuntary movements (tics), most commonly of the face, followed by the arms, legs or trunk. These tics are frequent, repetitive, and quick. Verbal tics (vocalizations) usually occur with the movements, but later may replace one or more movement tics. Vocalizations may include grunting, throat clearing, shouting, or barking. Verbal tics also may be expressed as coprolalia (the involuntary use of obscene words or socially unacceptable words and phrases) or copropraxia (obscene gestures).

Tremor. This movement disorder causes involuntary rhythmic movement that is oscillatory in nature. Tremors can occur in many body parts, such as the hands, legs, trunks, or head. The most common type is essential tremor.

Wilson’s disease. This is a rare genetic disorder that causes excessive copper accumulation in the liver or brain. Copper accumulation begins at birth, but symptoms begin to appear between the ages of 6 and 40, but most commonly in late adolescence. Wilson’s disease presents with neurological symptoms, psychiatric disturbances, and liver disease. Physical signs include jaundice, abdominal swelling, vomiting blood, abdominal pain, tremor, and difficulty walking, talking, or swallowing. Psychiatric signs include homicidal or suicidal behavior, depression, and aggression. If undetected and untreated, the disorder is always fatal.