Understanding movement disorders

Every movement the body makes, from raising a hand to smiling or walking, is controlled by a partnership between the central nervous system – made up of the brain and spinal cord – nerves and muscles. When one of these components isn’t working correctly, this can result in a movement disorder.

What is a movement disorder?

Movement disorders are a group of neurological conditions that cause irregular movements, such as shaking or jerking, also called tremors. They can also cause decreased or slow movement. The most common movement disorders are essential tremor, Parkinson’s disease and dystonia. Other common conditions include ataxia and restless leg syndrome.

Movement disorders fall into two categories:

• Hyperkinetic — Hyperkinetic movement disorders cause excess and uncontrollable movements, such as tremor, jerking movements and tics. These symptoms are common in conditions like essential tremor, dystonia and Tourette’s syndrome.

• Hypokinetic — By contrast, hypokinetic movement disorders are characterized by slow movement. The most common example is Parkinson’s. One of the cardinal symptoms of Parkinson’s, as well as some other movement disorders, is bradykinesia, which means slowed movement.

Damage to or a malfunction in the areas of the brain that control movement cause these conditions.

How are movement disorders diagnosed?

Dr. Alexis Clay, a Sharp-affiliated neurologist, says diagnosing a patient’s movement disorder requires closely watching the patient’s actions.

“The number one reason I see patients, often referred to me by their primary care doctor, is because they’ve developed a tremor,” says Dr. Clay. “My job is observing and looking at the type of tremor we see in the hands and the head.” Specific things she looks for include:

• Gait differences

• Shuffling

• Small steps

• Foot dragging

• Rubbing the forefinger and thumb together, also called a pill-rolling tremor, is an early sign of Parkinson’s

• Timing of tremors — for example, only when the patient performs certain movements or the tremor happens when they are distracted

• Vitamin deficiencies in the brain

Diagnostic tools can include a DaT scan, a specialized nuclear medicine imaging test that evaluates dopamine-producing neurons in the brain; an MRI of the brain; and certain medications to see whether they help symptoms.

What nonsurgical treatments are available?

In the early stages of a movement disorder, and in some cases, throughout a patient’s life, medication can be used to manage symptoms.

“Sometimes, we can get away without using medications, thanks to good occupational and physical therapy and adaptive devices,” says Dr. Clay. “There is, however, a wide choice of medications for the various movement disorders when medication is necessary, including subcutaneous injections.”

Beyond medication

When medication is no longer effective, patients may consider a procedure aimed at reducing their symptoms through surgery or a noninvasive procedure.

The Sharp Grossmont Hospital for Neuroscience offers two leading-edge treatments for essential tremor and Parkinson’s disease:

• Deep brain stimulation — Deep brain stimulation (DBS) is a neurosurgical procedure that, through an implanted device, produces electrical impulses that override abnormal impulses to control symptoms.

• MR-guided focused ultrasound — This one-time, noninvasive outpatient treatment uses ultrasound rays, guided by an MRI machine, to treat the areas of the brain causing the tremor. Sharp is the only provider in the San Diego region that offers this treatment.

Living with a movement disorder

People with movement disorders have an increasing number of advanced and evolving options with which to manage their symptoms.

According to Dr. Clay, most patients experience a significant improvement in quality of life after starting medication.

“There are also amazing physical therapy and movement programs for them, such as yoga and boxing, which my patients love,” she says. “It takes a team of people, but with the right neurologist, perhaps a psychologist, and physical and occupational therapists, patients can live a long and fulfilling life.”

Learn more about movement disorders at an upcoming free webinar, Advanced Treatments for Essential Tremor and Parkinson’s Disease, on Wednesday, September 2 at 6 pm.