Movement disorders

Overview

Movement disorders are a group of nervous system conditions that affect movement. They can cause either increased movements or reduced or slow movements. These movements may be under the person's control, known as voluntary. Or the movements may not be under the person's control, known as involuntary.

There are many types of movement disorders that cause different symptoms. For example, dystonia causes muscle contractions that lead to twisting of the body. Another movement disorder called chorea causes brief periods of quick involuntary movements that happen over and over. Parkinsonism causes slowness of movement with stiffness, tremors or loss of balance.

Treatments may be available to help manage the symptoms of movement disorders. Depending on the type of movement disorder, medicines, therapies or surgeries may be available. If a condition causes the movement disorder, treating the condition may help improve symptoms.

Symptoms

Symptoms of movement disorders vary depending on the type of the disorder. Common types of movement disorders and their symptoms include:

• Ataxia. Ataxia affects the part of the brain that controls coordinated movement. Ataxia may cause clumsy movements of the arms and legs, and a loss of balance. Ataxia also can change a person's speech and cause other symptoms. There are many causes of ataxia, including genetic and degenerative conditions. Ataxia also may be caused by an infection or another treatable condition.

• Chorea. Chorea causes brief, irregular, somewhat rapid, involuntary movements that happen over and over. The movements typically involve the face, mouth, trunk, arm and leg. Chorea can look like exaggerated fidgeting.

  The most common genetic chorea is Huntington's disease. This disease is passed down from a parent and gets worse over time. It can be confirmed with genetic testing. Huntington's disease has three types of symptoms. They include movements that can't be controlled, trouble with thinking and mental health conditions.

• Dystonia. This condition involves involuntary muscle contractions that cause twisting, irregular postures, or movements that occur again and again. Dystonia may affect the entire body or one part of the body.

  The most common type of dystonia in adults is cervical dystonia. In cervical dystonia, the neck muscles contract involuntarily. This causes the head to pull to one side or to tilt forward or backward. The head also may shake, known as a tremor.

• Functional movement disorder. This condition may look like any of the movement disorders. But it's not caused by a disease of the nervous system, also known as a neurological disease. Functional movement disorders are treatable.
• Multiple system atrophy. This rare condition affects many brain systems and gets worse over time. Multiple system atrophy causes a movement disorder, such as ataxia or parkinsonism. It also can cause low blood pressure, bladder symptoms and acting out dreams.
• Myoclonus. Myoclonus are very quick jerks of a muscle.
• Parkinson's disease. Parkinson's disease causes tremors, muscle stiffness, slow or decreased movement, or loss of balance. It also can cause symptoms not related to movement. These symptoms include a reduced sense of smell, constipation, acting out dreams and a decline in thinking skills. Parkinson's disease slowly gets worse over time.
• Parkinsonism. Parkinsonism is a general term for slowness of movement along with stiffness, tremors or loss of balance. There are many different causes. Parkinson's disease and certain dopamine blocking medicines are the most common causes. Other causes include degenerative disorders such as multiple system atrophy and progressive supranuclear palsy. Stroke or repeated head trauma also can cause parkinsonism.
• Progressive supranuclear palsy. This is a rare nervous system condition that causes problems with walking, balance and eye movements. It may resemble Parkinson's disease but is a distinct condition.
• Restless legs syndrome. This movement disorder causes aching, itching, or creeping feelings in the legs while relaxing or lying down. The feeling often goes away with movement.
• Tardive dyskinesia. This neurological condition is caused by long-term use of certain medicines used to treat mental health conditions, called neuroleptic medicines. It also can be caused by a common gastrointestinal medicine called metoclopramide (Reglan, Gimoti). Tardive dyskinesia causes involuntary movements that occur over and over. Symptoms include grimacing, eye blinking and other movements.
• Tourette syndrome. This is a neurological condition associated with repetitive movements and vocal sounds called tics. Tics are voluntary movements, but they're caused by an involuntary urge to make the movements. Tourette syndrome starts between childhood and teenage years.
• Tremor. This movement disorder causes rhythmic shaking of parts of the body, such as the hands, head or other body parts. The most common type is essential tremor.

Causes

A wide variety of factors can cause movement disorders, including:

• Genetics. Some types of movement disorders can be caused by an altered gene. The altered gene is passed down from a parent to a child. This is called an inherited condition. Huntington's disease and Wilson's disease are two movement disorders that can be inherited.
• Medicines. Medicines such as anti-seizure and anti-psychotic medicines can lead to movement disorders.
• Illegal drugs or large amounts of alcohol. Illegal drugs such as cocaine can cause movement disorders such as chorea. Drinking large amounts of alcohol can cause chorea or ataxia.
• Not getting enough of certain vitamins. Having low levels of certain vitamins in the body, known as a vitamin deficiency, can cause movement disorders. A deficiency in vitamin B-1, vitamin B-12 or vitamin E can lead to ataxia.
• Medical conditions. Thyroid conditions, multiple sclerosis, stroke, viral encephalitis and several others can cause movement disorders. Brain tumors also can lead to movement disorders.
• Head injury. Head trauma from an injury can lead to movement disorders.

For most people with a movement disorders, there is no known cause. When healthcare professionals haven't found the exact cause, it's called idiopathic.

Risk factors

Your risk of some movement disorders is higher if you have a parent with the condition. Movement disorders that can be passed down through families include essential tremor, Huntington's disease, Wilson's disease and Tourette syndrome.

Other factors that may increase the risk of having a movement disorder include having certain medical conditions or taking certain medicines. Drinking large amount of alcohol, doing illegal drugs such as cocaine or not having enough of certain vitamins in the body also can increase risk.

Diagnosis

To diagnose a movement disorder, your healthcare professional begins with a physical exam and a review of your symptoms. Your healthcare professional also takes your medical history.

You may need tests that can help diagnose a movement disorder or find another cause of your symptoms. Tests may include:

• Blood tests. Your blood may be tested for vitamin deficiencies, thyroid function and other conditions.
• Genetic tests. Your healthcare professional may recommend that you're tested for certain genetic conditions that may lead to movement disorders.
• Imaging tests. These may include magnetic resonance imaging (MRI), computerized tomography (CT) and positron emission tomography (PET) scans. Some people may need a test that measures the electrical activity within muscles, known as electromyography (EMG). Your healthcare professional also might order a dopamine transporter (DAT) scan, which can help diagnose parkinsonism.

Treatment

Treatment for movement disorders may include medicines to manage symptoms. Sometimes a combination of medicines may be needed. Botox injections also can treat some movement disorders, such as dystonia and essential tremor.

If there's a medical condition that's causing the movement disorder, treating the condition can help relieve symptoms.

Physical, occupational and speech therapy also can help people with movement disorders.

People who have serious symptoms may need surgery. Sometimes deep brain stimulation may be an option to treat movement disorders such as essential tremor or Parkinson's disease.