MOVEMENT DISORDERS

Signs and Symptoms/Diagnosis

Symptoms of movement disorders often vary and fluctuate. The severity of symptoms may be affected by factors such as anxiety, fatigue, medication, and stress.

Some movement disorders cause hyperkinesia (i.e., excessive spontaneous movement or abnormal involuntary movement) and others cause hypokinesia (i.e., absent or reduced ability to perform purposeful movement).

Abnormal movements may be rhythmical (e.g., essential tremor) or irregular and may be rapid and jerky (e.g., tics) or slowed and sustained (e.g., Parkinson's disease, dystonia). In most cases, irregular movement cannot be consciously controlled or suppressed.

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Diagnosis

Diagnosis of movement disorders involves taking a family history and a history of symptoms, and performing a physical examination (includingneurological examination) and various tests (e.g., blood tests, imaging tests).

Blood tests may include a complete blood count (CBC), a creatine kinase test, and a DNA analysis. In some cases, a cerebrospinal fluid 

Cerebrospinal fluid analysis involves performing a spinal tap, or lumbar puncture. In this procedure, about 2 tablespoons of cerebrospinal fluid is drawn into a needle inserted between two lumbar vertebrae and then examined under a microscope.

Imaging tests, including computed tomography (CT scan),magnetic resonance imaging (MRI scan), and positron emission tomography (PET scan), may be used to detect damage (e.g., shrinkage) in the basal ganglia, structural abnormalities, and stroke.

An electromyogram (EMG) and an electroencephalogram(EEG) also may be performed. These tests are used to monitor electrical activity within the body and can help detect nerve and muscle disorders. EMG involves placing electrodes on the skin (surface EMG) or into the muscle (intramuscular EMG) to record electrical activity of the muscle. In an EEG, electrodes are attached to the scalp and connected to a machine that records electrical impulses in the brain.

A muscle biopsy may also be performed to distinguish between nerve and muscle disorders.

Medications that may be used include the following:

  • Antiepileptics (e.g., carbamazepine [Tegretol®], valproate [Depakote®])
  • Antiseizure medications (e.g., primidone [Mysoline®], gabapentin [Neurontin®])
  • Beta-blockers (e.g., propranolol [Inderal®])
  • Dopamine agonists (e.g., bromocriptine [Parlodel®], pergolide [Permax®])
  • Tranquilizers (benzodiazepines such as diazepam [Valium®] and clonazepam [Klonopin®])

Side effects of antiepileptics include dizziness, drowsiness, nausea, and vomiting. Antiseizure medications may cause a lack of coordination and balance (ataxia), dizziness, nausea, and fatigue. Benzodiazepines may cause blood clots (thrombosis), drowsiness, and fatigue. Side effects caused by beta-blockers include slowed heart rate (bradycardia), depression, light-headedness, and nausea. Dopamine agonists may cause nausea, headache, dizziness, and fatigue.

Parkinson's disease may be treated using a number of different medications.

Botulinum toxin injection therapy (BOTOX® therapy) is used to treat some types of movement disorders (e.g., spasmodic torticollis, blepharospasm, myoclonus, tremor). In this treatment, a potent neurotoxin (produced by the bacterium Clostridium botulinum) is injected into a muscle to inhibit the release of neurotransmitters that cause muscle contraction.

In some cases, treatment is repeated every 3 to 4 months. Patients may develop antibodies to the toxin over time, causing treatment to become ineffective. Side effects include temporary weakness in the group of muscles being treated and rarely, flu-like symptoms.

When medication is ineffective, severe movement disorders may require surgery. In deep brain stimulation (DBS), a surgically implanted, battery-operated medical device (neurostimulator) is used to deliver electrical stimulation to areas of the brain that control movement. The electrical charge blocks nerve signals that trigger abnormal movement.

In DBS, an electrode (lead) is inserted through a small incision in the skull and is implanted in the targeted area of the brain. An insulated wire (extension) is then passed under the skin in the head, neck, and shoulder, connecting the lead to the neurostimulator, which is surgically implanted in the chest or upper abdomen.

Side effects of deep brain stimulation include:

  • Bleeding at the implantation site
  • Depression
  • Impaired muscle tone
  • Infection
  • Loss of balance
  • Slight paralysis (paresis)
  • Slurred speech (dysarthia)
  • Tingling (parethesia) in the head or the hands

Ablative surgery locates, targets, and then destroys (ablates) the clearly defined area of the brain that produces chemical or electrical impulses that cause abnormal movements.

 

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