Movement disorder | |
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Specialty | Neurology Psychiatry |
Movement disorders are clinical syndromes with either an excess of movement or a paucity of voluntary and involuntary movements, unrelated to weakness or spasticity. [1] Movement disorders present with extrapyramidal symptoms and are caused by basal ganglia disease. [2] Movement disorders are conventionally divided into two major categories- hyperkinetic and hypokinetic .
Hyperkinetic movement disorders refer to dyskinesia, or excessive, often repetitive, involuntary movements that intrude upon the normal flow of motor activity.
Hypokinetic movement disorders fall into one of four subcategories: akinesia (lack of movement), hypokinesia (reduced amplitude of movements), bradykinesia (slow movement), and rigidity. In primary movement disorders, the abnormal movement is the primary manifestation of the disorder. In secondary movement disorders, the abnormal movement is a manifestation of another systemic or neurological disorder. [3]
Movement Disorders [4] | ICD-9-CM | ICD-10-CM |
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Hypokinetic Movement disorders | ||
Poliomyelitis, [5] acute | 045 | A80 |
Amyotrophic lateral sclerosis, ALS [5] (Lou Gehrig's disease) | 335.20 | G12.21 |
Parkinson's disease (Primary or Idiopathic Parkinsonism) | 332 | G20 |
Secondary Parkinsonism | G21 | |
Parkinson plus syndromes | ||
Pantothenate kinase-associated neurodegeneration | G23.0 | |
Progressive Supranuclear Ophthalmoplegia | G23.1 | |
Striatonigral degeneration | G23.2 | |
Multiple sclerosis [5] | 340 | G35 |
Radiation-induced polyneuropathy (brachial and lumbar plexopathies) | G62.82 | |
Muscular dystrophy [5] | 359.0 | G71.0 |
Cerebral palsy [5] | 343 | G80 |
Rheumatoid arthritis [5] | 714 | M05 |
Hyperkinetic Movement disorders | ||
GLUT1 deficiency syndrome | E74.810 | |
Attention-deficit hyperactivity disorder (with hyperactivity) | 314.01 | F90 |
Tic disorders (involuntary, compulsive, repetitive, stereotyped) | F95 | |
Tourette's syndrome | F95.2 | |
Stereotypic movement disorder | F98.5 | |
Huntington's disease (Huntington's chorea) | 333.4 | G10 |
Dystonia | G24 | |
Drug induced dystonia | G24.0 | |
Idiopathic familial dystonia | 333.6 | G24.1 |
Idiopathic nonfamilial dystonia | 333.7 | G24.2 |
Spasmodic torticollis | 333.83 | G24.3 |
Idiopathic orofacial dystonia | G24.4 | |
Blepharospasm | 333.81 | G24.5 |
Other dystonias | G24.8 | |
Other extrapyramidal movement disorders | G25 | |
Essential tremor | 333.1 | G25.0 |
Drug induced tremor | G25.1 | |
Other specified form of tremor | G25.2 | |
Myoclonus | 333.2 | G25.3 |
Chorea (rapid, involuntary movement) | ||
Drug induced chorea | G25.4 | |
Drug-induced tics and tics of organic origin | 333.3 | G25.6 |
Paroxysmal nocturnal limb movement | G25.80 | |
Painful legs (or arms), moving toes (or fingers) syndrome | G25.81 | |
Sporadic restless leg syndrome | G25.82 | |
Familial restless leg syndrome | G25.83 | |
Stiff-person syndrome | 333.91 | G25.84 |
Ballismus (violent involuntary rapid and irregular movements) | G25.85 | |
Hemiballismus (affecting only one side of the body) | G25.85 | |
Myokymia, facial | G51.4 | |
Neuromyotonia (Isaacs Syndrome) | 359.29 | G71.19 |
Opsoclonus | 379.59 | H57 |
Rheumatic chorea (Sydenham's chorea) | I02 | |
Abnormal head movements | R25.0 | |
Tremor unspecified | R25.1 | |
Cramp and spasm | R25.2 | |
Fasciculation | R25.3 | |
Athetosis (contorted torsion or twisting) | 333.71 | R25.8 |
Dyskinesia (abnormal, involuntary movement) | ||
Tardive dyskinesia |
Step I : Decide the dominant type of movement disorder [6]
Step II : Make differential diagnosis of the particular disorder[ citation needed ]
Step II: Confirm the diagnosis by lab tests[ citation needed ]
Treatment depends upon the underlying disorder. [7] Movement disorders have been known to be associated with a variety of autoimmune diseases. [8]
Vesalius and Piccolomini in 16th century distinguished subcortical nuclei from cortex and white matter. However Willis' conceptualized the corpus striatum as the seat of motor power in the late 17th century. In mid-19th-century movement disorders were localized to striatum by Choreaby Broadbent and Jackson, and athetosis by Hammond. By the late 19th century, many movement disorders were described, but for most no pathologic correlate was known. [9]
Ataxia is a neurological sign consisting of lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, and abnormalities in eye movements, that indicates dysfunction of parts of the nervous system that coordinate movement, such as the cerebellum.
Catatonia is a complex neuropsychiatric behavioral syndrome that is characterized by abnormal movements, immobility, abnormal behaviors, and withdrawal. The onset of catatonia can be acute or subtle and symptoms can wax, wane, or change during episodes. It has historically been related to schizophrenia, but catatonia is most often seen in mood disorders. It is now known that catatonic symptoms are nonspecific and may be observed in other mental, neurological, and medical conditions. Catatonia is now a stand-alone diagnosis, and the term is used to describe a feature of the underlying disorder.
A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving oscillations or twitching movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the hands. In some people, a tremor is a symptom of another neurological disorder.
Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia, rigidity, and postural instability. Both hypokinetic as well as hyperkinetic features are displayed by Parkinsonism. These are the four motor symptoms found in Parkinson's disease (PD) – after which it is named – dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and many other conditions. This set of symptoms occurs in a wide range of conditions and may have many causes, including neurodegenerative conditions, drugs, toxins, metabolic diseases, and neurological conditions other than PD.
Encephalopathy means any disorder or disease of the brain, especially chronic degenerative conditions. In modern usage, encephalopathy does not refer to a single disease, but rather to a syndrome of overall brain dysfunction; this syndrome has many possible organic and inorganic causes.
A tic is a sudden and repetitive motor movement or vocalization that is not rhythmic and involves discrete muscle groups. It is typically brief and may resemble a normal behavioral characteristic or gesture.
Chorea is an abnormal involuntary movement disorder, one of a group of neurological disorders called dyskinesias. The term chorea is derived from the Ancient Greek: χορεία, as the quick movements of the feet or hands are comparable to dancing.
Dysarthria is a speech sound disorder resulting from neurological injury of the motor component of the motor–speech system and is characterized by poor articulation of phonemes. In other words, it is a condition in which problems effectively occur with the muscles that help produce speech, often making it very difficult to pronounce words. It is unrelated to problems with understanding language, although a person can have both. Any of the speech subsystems can be affected, leading to impairments in intelligibility, audibility, naturalness, and efficiency of vocal communication. Dysarthria that has progressed to a total loss of speech is referred to as anarthria. The term dysarthria was formed from the Greek components dys- "dysfunctional, impaired" and arthr- "joint, vocal articulation".
Sydenham's chorea, also known as rheumatic chorea, is a disorder characterized by rapid, uncoordinated jerking movements primarily affecting the face, hands and feet. Sydenham's chorea is an autoimmune disease that results from childhood infection with Group A beta-haemolytic Streptococcus. It is reported to occur in 20–30% of people with acute rheumatic fever and is one of the major criteria for it, although it sometimes occurs in isolation. The disease occurs typically a few weeks, but up to 6 months, after the acute infection, which may have been a simple sore throat (pharyngitis).
Hyperkinesia refers to an increase in muscular activity that can result in excessive abnormal movements, excessive normal movements, or a combination of both. Hyperkinesia is a state of excessive restlessness which is featured in a large variety of disorders that affect the ability to control motor movement, such as Huntington's disease. It is the opposite of hypokinesia, which refers to decreased bodily movement, as commonly manifested in Parkinson's disease.
Hemiballismus or hemiballism is a basal ganglia syndrome resulting from damage to the subthalamic nucleus in the basal ganglia. Hemiballismus is a rare hyperkinetic movement disorder, that is characterized by violent involuntary limb movements, on one side of the body, and can cause significant disability. Ballismus affects both sides of the body and is much rarer. Symptoms can decrease during sleep.
Hypokinesia is one of the classifications of movement disorders, and refers to decreased bodily movement. Hypokinesia is characterized by a partial or complete loss of muscle movement due to a disruption in the basal ganglia. Hypokinesia is a symptom of Parkinson's disease shown as muscle rigidity and an inability to produce movement. It is also associated with mental health disorders and prolonged inactivity due to illness, amongst other diseases.
Stiff-person syndrome (SPS), also known as stiff-man syndrome, is a rare neurological disorder of unclear cause characterized by progressive muscular rigidity and stiffness. The stiffness primarily affects the truncal muscles and is characterised by spasms, resulting in postural deformities. Chronic pain, impaired mobility, and lumbar hyperlordosis are common symptoms.
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history, but not deeper investigation such as neuroimaging. It can be used both as a screening tool and as an investigative tool, the former of which when examining the patient when there is no expected neurological deficit and the latter of which when examining a patient where you do expect to find abnormalities. If a problem is found either in an investigative or screening process, then further tests can be carried out to focus on a particular aspect of the nervous system.
Paroxysmal kinesigenic choreoathetosis (PKC) also called paroxysmal kinesigenic dyskinesia (PKD) is a rare hyperkinetic movement disorder characterized by attacks of involuntary movements, which are triggered by sudden voluntary movements. The number of attacks can increase during puberty and decrease in a person's 20s to 30s. Involuntary movements can take many forms such as ballism, chorea or dystonia and usually only affect one side of the body or one limb in particular.
A neurological disorder is any disorder of the nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord or other nerves can result in a range of symptoms. Examples of symptoms include paralysis, muscle weakness, poor coordination, loss of sensation, seizures, confusion, pain, tauopathies, and altered levels of consciousness. There are many recognized neurological disorders, some are relatively common, but many are rare.
Basal ganglia disease is a group of physical problems that occur when the group of nuclei in the brain known as the basal ganglia fail to properly suppress unwanted movements or to properly prime upper motor neuron circuits to initiate motor function. Research indicates that increased output of the basal ganglia inhibits thalamocortical projection neurons. Proper activation or deactivation of these neurons is an integral component for proper movement. If something causes too much basal ganglia output, then the ventral anterior (VA) and ventral lateral (VL) thalamocortical projection neurons become too inhibited, and one cannot initiate voluntary movement. These disorders are known as hypokinetic disorders. However, a disorder leading to abnormally low output of the basal ganglia leads to reduced inhibition, and thus excitation, of the thalamocortical projection neurons which synapse onto the cortex. This situation leads to an inability to suppress unwanted movements. These disorders are known as hyperkinetic disorders.
Blocq's disease was first considered by Paul Blocq (1860–1896), who described this phenomenon as the loss of memory of specialized movements causing the inability to maintain an upright posture, despite normal function of the legs in the bed. The patient is able to stand up, but as soon as the feet are on the ground, the patient cannot hold himself upright nor walk; however when lying down, the subject conserved the integrity of muscular force and the precision of movements of the lower limbs. The motivation of this study came when a fellow student Georges Marinesco (1864) and Paul published a case of parkinsonian tremor (1893) due to a tumor located in the substantia nigra.
Joseph Jankovic is an American neurologist and professor at Baylor College of Medicine in Houston, Texas. He is the Distinguished Chair in Movement Disorders and founder and director of the Parkinson's Disease Center and Movement Disorders Clinic.
An upper limb neurological examination is part of the neurological examination, and is used to assess the motor and sensory neurons which supply the upper limbs. This assessment helps to detect any impairment of the nervous system, being used both as a screening and an investigative tool. The examination findings when combined with a detailed history of a patient, can help a doctor reach a specific or differential diagnosis. This would enable the doctor to commence treatment if a specific diagnosis has been made, or order further investigations if there are differential diagnoses.