MOVEMENT DISORDERS

 

Movement disorders are diseases that affect a person’s natural movements. This may include slowed or limited movement (hypokinetic) or increased or over active movement (hyperkinetic).

 

There are a wide range of movement disorders. Examples of hypokinetic movement disorders include Parkinson's disease and Parkinsonism although the tremor aspect is too much movement in the resting state. Examples of hyperkinetic movement disorders include Dystonia, Chorea and Huntington's disease, Ataxia, Essential Tremor, and Restless Legs syndrome, to name a few.

 

Spasticity is more of a motility disorder in that there may not be enough movement such as after a stroke, but at the same time, muscle tone is increased causing further restriction of normal movement. Some of these conditions are hereditary while in others, no genetic cause has been found as of yet. There may be an interplay of the environment with a genetic predisposition that causes many of these disorders to come to the surface. Genetics loads the gun but the environment pulls the trigger.

 

The diagnosis of the type of most movement disorders is made clinically which means that the diagnosis is based on the symptoms you are experiencing and what is found on the examination. Occasionally certain imaging studies (such as CT or MRI) or blood studies, including genetic testing, can support a diagnosis although in even severe movement disorders, the scans and lab studies are usually normal since the cause is more of an electrical or chemical disturbance in the brain and not something that can be seen on a scan or detected in the blood. Treatment of movement disorders depends on the diagnosis.

 

Some of the more common diagnoses treated here at Premier Neurology Institute are as follows: 

 

Parkinson’s Disease or Parkinsonism

Patients with Parkinson’s Disease or Parkinsonism have characteristic symptoms of slowed movements, rigidity and a resting tremor. A major part of the pathology of Parkinson’s is a decreased ability to produce the neurotransmitter dopamine that is critical for normal movement. Medication treatment for this disorder includes strategies to increase the availability of dopamine in the brain or stimulate the brain dopamine receptors. Examples of some of medications are Sinemet, Mirapex, Requip, Azilect and soon to be many others used alone or in combinations specific for each person.

 

Dystonia

Dystonia is a type of movement disorder caused by excessive contraction of certain muscles that may be spasmodic or induced by stimuli or certain movement. There are hereditary generalized dystonia that begin in childhood in the great majority of the cases.

 

The most common type of dystonia are focal dystonia involving just a small portion of muscles in one region of the body. The types of focal dystonia include abnormal contraction of muscles in the neck (cervical dystonia), eyelids (blepharospasm), jaw or mouth (oral-mandibular), voice (laryngeal) or hand (such as writer’s cramp). Therapy for dystonia typically involves injections in carefully selected muscles with one of the botulinum toxins (Botox, Myobloc, Dysport or Xeomin) . Dr. Vehra and Dr. Liu are both trained to utilize all four of these botulinum toxin therapies and collectively have over 15 years of experience working with these treatments. Which one is chosen for each person depends on individual circumstances. Additionally, some patients may respond favorably to oral pharmacologic therapy or surgical therapy to treat their dystonia.

 

Tremor

The most common type of tremor is Essential Tremor. It is a progressive tremor that often involves the upper extremities, but can also involve the head, voice, tongue and legs. One of the most common misdiagnoses is labeling the head tremor very commonly associated with cervical dystonia or limb dystonia as essential tremor for which the treatment is very different. The tremor of Essential tremor in the upper extremities is often present with activity (action, like drinking a cup of coffee or writing) or while extending the arms out (postural). Some patients choose not to treat their tremors with medicines, and prefer using hand weights, stress/relaxation techniques or biofeedback as therapy. For others, treatment for Essential Tremor can involve medical management, surgical therapy and sometimes Botulinum toxin administration.