Movement disorder

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Movement disorder
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 are synonymous with basal ganglia or extrapyramidal diseases. [2] Movement disorders are conventionally divided into five major categories- hyperkinetic and hypokinetic .

Contents

Hyperkinetic movement disorders refer to dyskinesia, or excessive, often repetitive, involuntary movements that intrude upon the normal flow of motor activity.

Hypokinetic movement disorders refer to 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]

Classification

Movement Disorders [4] ICD-9-CMICD-10-CM
Hypokinetic Movement disordersxxxxxxxxxx
Poliomyelitis, [5] acute045A80
Amyotrophic lateral sclerosis, ALS [5] (Lou Gehrig's disease)335.20G12.21
Parkinson's disease (Primary or Idiopathic Parkinsonism)332G20
Secondary Parkinsonism G21
Parkinson plus syndromes
Pantothenate kinase-associated neurodegeneration G23.0
Progressive Supranuclear Ophthalmoplegia G23.1
Striatonigral degeneration G23.2
Multiple sclerosis [5] 340G35
Radiation-induced polyneuropathy (brachial and lumbar plexopathies)G62.82
Muscular dystrophy [5] 359.0G71.0
Cerebral palsy [5] 343G80
Rheumatoid arthritis [5] 714M05
Hyperkinetic Movement disordersxxxxxxxxxx
Attention-deficit hyperactivity disorder (with hyperactivity)314.01F90
Tic disorders (involuntary, compulsive, repetitive, stereotyped)F95
Tourette's syndrome F95.2
Stereotypic movement disorder F98.5
Huntington's disease (Huntington's chorea)333.4G10
Dystonia G24
Drug induced dystonia G24.0
Idiopathic familial dystonia333.6G24.1
Idiopathic nonfamilial dystonia333.7G24.2
Spasmodic torticollis 333.83G24.3
Idiopathic orofacial dystonia G24.4
Blepharospasm 333.81G24.5
Other dystoniasG24.8
Other extrapyramidal movement disordersG25
Essential tremor 333.1G25.0
Drug induced tremorG25.1
Other specified form of tremorG25.2
Myoclonus 333.2G25.3
Chorea (rapid, involuntary movement)
Drug induced chorea G25.4
Drug-induced tics and tics of organic origin333.3G25.6
Paroxysmal nocturnal limb movementG25.80
Painful legs (or arms), moving toes (or fingers) syndromeG25.81
Sporadic restless leg syndrome G25.82
Familial restless leg syndromeG25.83
Stiff-person syndrome 333.91G25.84
Ballismus (violent involuntary rapid and irregular movements)G25.85
Hemiballismus (affecting only one side of the body)G25.85
Myokymia, facialG51.4
Neuromyotonia (Isaacs Syndrome)359.29G71.19
Opsoclonus 379.59H57
Rheumatic chorea (Sydenham's chorea)I02
Abnormal head movementsR25.0
Tremor unspecifiedR25.1
Cramp and spasmR25.2
Fasciculation R25.3
Athetosis (contorted torsion or twisting)333.71R25.8
Dyskinesia (abnormal, involuntary movement)
Tardive dyskinesia

Diagnosis

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

Treatment depends upon the underlying disorder. [7] Movement disorders have been known to be associated with a variety of autoimmune diseases. [8]

History

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]

Related Research Articles

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.

<span class="mw-page-title-main">Catatonia</span> Psychiatric behavioral syndrome

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.

<span class="mw-page-title-main">Tremor</span> Involuntary muscle contraction

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.

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.

<span class="mw-page-title-main">Tic</span> Sudden movement or vocalization

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 is from Neo-Latin, 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).

<span class="mw-page-title-main">Hyperkinesia</span> Excessive movements due to basal ganglia dysfunction

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.

<span class="mw-page-title-main">Hypokinesia</span> Decreased movement due to basal ganglia dysfunction

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.

<span class="mw-page-title-main">Stiff-person syndrome</span> Human medical condition

Stiff-person syndrome (SPS), also known as stiff-man syndrome, is a rare neurologic 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.

<span class="mw-page-title-main">Neurological examination</span> Assessment to determine if the nervous system is impaired

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.

<span class="mw-page-title-main">Waxy flexibility</span> Catatonia psychomotor symptom

Waxy flexibility is one of the twelve symptoms that can lead to the diagnosis of catatonia. It is a psychomotor symptom that results in a decreased response to stimuli and a tendency to remain in an immobile posture. If one were to move the arm of someone with waxy flexibility, the patient would keep that arm where it had been positioned until moved again as if positioning malleable wax. Attempts to reposition the patient are met by "slight, even resistance".

<span class="mw-page-title-main">Paroxysmal kinesigenic choreoathetosis</span> Medical condition

Paroxysmal kinesigenic choreoathetosis (PKC) also called paroxysmal kinesigenic dyskinesia (PKD) is a 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. This rare disorder only affects about 1 in 150,000 people, with PKD accounting for 86.8% of all the types of paroxysmal dyskinesias, and occurs more often in males than females. There are two types of PKD, primary and secondary. Primary PKD can be further broken down into familial and sporadic. Familial PKD, which means the individual has a family history of the disorder, is more common, but sporadic cases are also seen. Secondary PKD can be caused by many other medical conditions such as multiple sclerosis (MS), stroke, pseudohypoparathyroidism, hypocalcemia, hypoglycemia, hyperglycemia, central nervous system trauma, or peripheral nervous system trauma. PKD has also been linked with infantile convulsions and choreoathetosis (ICCA) syndrome, in which patients have afebrile seizures during infancy and then develop paroxysmal choreoathetosis later in life. This phenomenon is actually quite common, with about 42% of individuals with PKD reporting a history of afebrile seizures as a child.

<span class="mw-page-title-main">Neurological disorder</span> Any disorder of the nervous system

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 relatively common, but many rare. They may be assessed by neurological examination, and studied and treated within the specialties of neurology and clinical neuropsychology.

<span class="mw-page-title-main">Basal ganglia disease</span> Group of physical problems resulting from basal ganglia dysfunction

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.

<span class="mw-page-title-main">Blocq's disease</span> Loss of memory of specialized movements causing the inability to maintain an upright posture

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.

<span class="mw-page-title-main">Joseph Jankovic</span> American neurologist

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.

<span class="mw-page-title-main">Upper limb neurological examination</span>

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.

References

  1. Fahn, Stanley; Jankovic, Joseph; Hallett, Mark (2011-08-09). Principles and Practice of Movement Disorders. Elsevier Health Sciences. ISBN   978-1437737707.
  2. Bradley, Walter George (2004-01-01). Neurology in Clinical Practice: Principles of diagnosis and management. Taylor & Francis. ISBN   9789997625885.
  3. Flemming, Kelly; Jones, Lyell (2015-06-15). Mayo Clinic Neurology Board Review: Clinical Neurology for Initial Certification and MOC. Oxford University Press. ISBN   9780190244934.
  4. Singer, Harvey S.; Mink, Jonathan; Gilbert, Donald L.; Jankovic, Joseph (2015-10-27). Movement Disorders in Childhood. Academic Press. ISBN   9780124115804.
  5. 1 2 3 4 5 6 "Debilitating Diseases – 12 Diseases that change millions of lives". dodgepark.com. Dodge Park. Retrieved 14 March 2024.
  6. Poewe, Werner; Jankovic, Joseph (2014-02-20). Movement Disorders in Neurologic and Systemic Disease. Cambridge University Press. ISBN   9781107024618.
  7. "MedlinePlus: Movement Disorders".
  8. Baizabal-Carvallo, JF; Jankovic J. (2012-07-18). "Movement disorders in autoimmune diseases". Movement Disorders. 27 (8): 935–46. doi:10.1002/mds.25011. PMID   22555904. S2CID   25191890.
  9. Lanska, Douglas J. (2010-01-01). Chapter 33: the history of movement disorders. Handbook of Clinical Neurology. Vol. 95. pp. 501–546. doi:10.1016/S0072-9752(08)02133-7. ISBN   9780444520098. ISSN   0072-9752. PMID   19892136.