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Movement Disorders including Parkinson's Disease
What are movement disorders?
Movement disorders are a group of neurological illnesses characterised by the loss of voluntary movement.
Although quite different in presentation, one thing all movement disorders have in common is a dysfunction of the region of the brain known as the basal ganglia.
Whilst the exact cause of these disorders is not known, excellent treatments do exist.
A brief description of some of the more common movement disorders is shown below.
Main types of movement disorder
Parkinson's Disease is a progressive neurodegenerative disease in which motor symptoms (tremor, stiffness, slowness and balance) result from the loss of dopamine-producing neurons in the substantia nigra region of the brain.
It is now well recognised that other neurotransmitter systems may also be affected, resulting in changes of mood, thinking and other body functions. Symptoms can vary considerably from patient to patient and therefore treatment must be individualised. They range from oral medications to deep brain stimulation (DBS)
Dystonia is a neurologic condition in which there are sustained muscle contractions that can cause involuntary twisting and repetitive movements, resulting in abnormal postures that sometimes can be painful.
The dystonia can be focal (involve only one area of the body) or may include many body parts. Treatments include oral medications, botulinum toxin injections and DBS.
Essential tremor (ET)
ET is considered as one of the most common movement disorders, appearing as a tremor of both hands. It is most prominent when performing activities such as writing, eating or drinking.
Although most often encounteresd in later adulthood, this condition can occur at any age. Many of those affected by ET hve other family members with the same condition. Treatments include oral medication and DBS.
Tourette's Syndrome (TS)
TS is an inherited neurological disorder that often begins in childhood and results in sudden, rapid and repetitive movements (motor tics) and vocalisations (vocal tics). Tics, although under partial voluntary control are very difficult to suppress.
In addition to the tics, some patients may experience psychiatric and behavioural problems. Treatment consists of oral medications and psychiatric and behavioural counseling.
Huntingdon's Disease (HD)
HD is a hereditary neurological disorder that results in involuntary abnormal movements, gait and balance problems, behavioural and psychiatric difficulties, along with progressive cognitive decline.
Genetic testing is available to confirm the diagnosis. Treatment can be challenging and consists of oral medications and behavioural counseling along with psychiatric treatment.
Chorea is an abnormal inoluntary movement consisting of continual, irregular movements that flow from one body part to another.
Chorea can be seen as a manifestation of other primary neurologic illnesses, or can be a result of toxic exposures as well as metabolic disturbances. Treatment consists of oral medications, correcting any underying medical problems and sometimes DBS.
Diagnosis of movement disorders
In most cases, diagnosing a specific type of movement disorder depends upon the clinical skill and experience of the neurologist. Other specialists such as psychologists, psychiatrists and behavioural neurologists are called upon when needed.
In some movement disorders, specific and specialised blood tests can help with the diagnosis. Imaging techniques can also be helpful.
Magnetic resonance imaging uses a magnetic field to produce pictures of structures inside the brain.
MRI is a painless technique that usually takes 20 minutes and it can provide valuable information about the structure and function of the brain. MRI scanning is widely available.
DaTscan is a diagnostic tool for patients with difficult-to-diagnose movement disorders. This nuclear medicine scan is painless and can be used to determine if there is a dopamine deficiency.
The test can potentially lead to a more accurate and early diagnosis of Parkinsonism, at which time treatment can begin. DaTscan is only available at a limited number of centres worldwide.