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Movement Disorders

The area of movement disorders includes problems such as Tremor, Parkinson's Disease, Parkinsonian Syndromes, Dystonia (including Torticollis, Spasmodic Dysphonia and Blepharospasm), Restless Leg Syndrome, Tic and Tourette Syndrome, Chorea, Spasticity, Tardive Dyskinesia and Myoclonus.

Tremor

Although quite common, and more prevalent with aging, tremor is not a normal consequence of growing older. There are numerous causes of tremor, and this symptom alone may not represent a neurological disease or a serious problem. Treatment, if necessary, is dependent upon the cause of the tremor.

Parkinson's Disease

Described first 180 years ago in 1817 by Dr. James Parkinson, a London physician, it has the attention of researchers around the world, but the cause of this neurological disease remains elusive. Parkinson's disease may produce a great variety of symptoms, but the four basic, so called 'cardinal signs' include tremor, slowness of movement, stiffness of movement, and impairment of balance. There is no test for Parkinson's disease; the diagnosis is established by listening to the symptoms and physical examination by an experienced clinician. As of yet there is no cure, but there are numerous therapies that help the symptoms.

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Dystonia

This term is used to describe involuntary muscle contractions that produce abnormal postures or movements. In adults, dystonia most commonly affects the head and neck area, causing head turning or shaking (sometimes referred to as torticollis), or involuntary closing of the eyes (blepharospasm). Torticollis is the most common adult form of the disease. The National Spasmodic Torticollis Association, a non-profit organization, serves as clearing house for informations about scientific breakthrough and support group for patients with torticollis www.torticollis.org. Dystonia may affect almost any body part, and often is initially apparent during a specific movement. They result from an abnormality in an area of the brain called the basal ganglia where some of the messages that initiate muscle contractions are processed. Scientists suspect a defect in the body's ability to process a group of chemicals called neurotransmitters that help cells in the brain communicate with each other.

Although some of the dystonias are caused by another disease and therefore called secondary dystonia, the majority of dystonia cases are called primary or idiopathic dystonia because they have no connection to another disease or injury. Of the primary dystonias, many cases appear to be inherited in a dominant manner; i.e., only one carrier parent need contribute the dystonia gene for the disease to occur. Each child has a 50/50 chance of being a carrier.

In dystonia, however, a carrier may or may not develop a dystonia. Sometimes the symptoms are so mild that they are missed. The symptoms may vary widely even among members of the same family. This is due to the so-called low penetrance. That means low appearance of the symptoms despite the presence of the gene. The product of one defective gene appears to be sufficient to cause the chemical imbalances that may lead to dystonia. The possibility exists that another gene or genes and environmental factors may play a role as well. Dystonia is a symptom and thus could be caused by different diseases and specifically, idiopathic dystonia could be caused by different genes. Recently, different genes have emerged as the cause of different types of dystonia.

Physicians use a variety of therapies aimed at reducing or eliminating muscle spasms and pain. In recent years these symptoms have been successfully treated in many cases by injecting botulinum toxin (known as Botox) in a controlled manner into the contracting muscles in order to partially relax them.

Spasmodic Dysphonia

The muscles that generate a person's voice go into periods of spasms resulting in breaks or interruptions in the voice.

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Spasmodic Dysphonia

Causes an urge to move the legs.

Tic and Tourette Syndrome

Motor tics are repetitive, usually quick movements that can usually be suppressed by the person who has them, at least for a few seconds. They are not a nervous habit, but are believed to be neurological in their origin. Tourette syndrome is the name applied when motor tics associated with vocal tics (such as throat clearing, or uttering words or fragments of words) begin in childhood, last longer than a year, and change over time. Most people who have Tourette syndrome do not have the famous symptom of uttering obscenities.

Tic is common, particularly in childhood, and may improve or cease altogether as one grows older. Occasionally it is sufficiently troubling that medication is warranted. Teasing from other children, or misunderstanding and criticism from parents and teachers are sometimes more problematic than the tic itself.

Chorea

Causes involuntary and unpredictable body movements.

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Huntington's Disease

Huntington's disease is a degenerative disease of the brain which is inherited as an autosomal dominant trait. This means that only 1 parent needs to have the abnormal gene to pass the disease on and that about 50% of the children will be affected. Symptoms usually start in the 3rd or 4th decade of life but can begin in childhood or as late as retirement age.

The main symptoms are involuntary movements, dementia and psychiatric disturbance. All symptoms worsen over time. Although there is no cure, there are useful treatments for many of the symptoms.

The recent discovery of the abnormal Huntington's disease gene has led to the development of a blood test for making a definitive diagnosis in individuals suspected of having this disease. At risk individuals should receive genetic counseling, and neurological and psychiatric evaluation as part of the process.

Tardive Dyskinesia

"Tardive" means late, and "dyskinesia" simply means abnormal movement. Tardive dyskinesia is a general term referring to involuntary movements that are induced by medications, usually major tranquilizers, such as haloperidol (Haldol). These movements typically involve the face and mouth, although they may occur in any body part.

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Myoclonus

Refers to quick and involuntary muscle jerk.

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