Conditions We Treat in the Movement Disorders Program
The Movement Disorders Program combines exceptional clinical care with the most advanced medical technologies for accurate diagnosis and effective treatment of the full range of movement disorders.
Parkinson’s disease (PD) is a common movement disorder that affects about one million Americans currently, with 60,000 new diagnoses each year. While the incidence of PD increases with age, about four percent of people with PD are diagnosed before age 50. Men are one and a half times more likely to be diagnosed.
Parkinson’s disease is a slowly progressing, degenerative neurological condition that is chronic and worsens with age. It is caused by the loss of dopamine-producing brain cells. Dopamine is essential for smooth and coordinated muscle movement.
Symptoms of the disease include:
- Tremor or trembling of the arms, jaw, legs, and face
- Stiffness or rigidity of the limbs and torso
- Slowness of movement (bradykinesia)
- Impaired balance and coordination
The non-motor symptoms include depression, anxiety, restlessness, sleep difficulty, memory problems, fatigue, soft speech, vivid dreams, and dream enactment. Presentation, severity, and progression of these symptoms can vary person to person. Because different movement disorders can have the same symptoms, careful diagnosis is vital for proper treatment.
Essential tremor (ET) is a neurological disorder that causes rhythmic, involuntary movements of parts of the body, primarily the hands. The cause is unknown, but in most cases, it is an inherited condition (familial essential tremor). ET is the most common trembling disorder, and is often confused with Parkinson’s disease. For this reason, a careful diagnosis is extremely important.
The main symptom of ET is an involuntary movement, called tremor. It can affect several different body parts including:
- Head and neck
- Vocal cords
The tremor can occur when the body part is held still or while performing an action. For example, postural tremor — tremor while the body part is held still — can occur in your hand while holding a TV remote. Action tremor — tremor when the body part is in movement — can occur while bringing a cup to your mouth.
Less common symptoms could include a quivering sound in the voice, uncontrollable head-nodding, and tremors in the legs or feet.
ET is usually not life-threatening or severely debilitating. Stress reduction and avoidance of smoking, caffeine, and alcohol may help minimize symptoms. If tremors are pronounced enough to interfere with daily life, ET is typically treated with medication. Tremors that remain disabling despite medication trials can be treated with surgical options such as deep brain stimulation and focused ultrasound.
The cause of ET is not yet known. However, up to half of patients with ET also have a family history of the condition. Imaging studies of the brain have suggested that the cerebellum, the part of the brain responsible for complex motor functions and balance when walking or standing, has disrupted connections in people with ET.
Dystonia is a disorder that affects the way the body moves. It causes the muscles to contract, which makes them move involuntarily or become stuck in an abnormal position. Dystonia can be genetic, caused by disease or injury, or a side effect of medication. There are various types defined by how it affects the body:
- generalized dystonia can affect the entire body,
- hemidystonia affects one side,
- focal dystonia affects a specific body part, and
- multifocal dystonia affects two or more parts of the body.
When the eyes are affected, the condition is called blepharospasm, and the patient has difficulty controlling the eyelids and brow, which interferes with vision. Cervical dystonia refers to problems controlling the neck and shoulders. Other types cause problems with control of the face, jaw and mouth, hands, limbs, or extremities, etc.
Dystonia may be treated with oral medications, physical therapy or botulinum injections. In refractory cases, deep brain stimulation may be considered.
Atypical Parkinsonism is a group of rare progressive neurodegenerative conditions which share some aspects of Parkinson’s Disease but respond poorly to Levodopa. These conditions tend to progress faster than Parkinson’s Disease and have additional symptoms that help identify them. Management of these conditions includes comprehensive care provided by neurologists and speech, physical and occupational therapists to help improve quality of life. In some instances, home health services also provide valuable support.
Atypical Parkinsonism includes the following conditions:
Multiple System Atrophy
Multiple System Atrophy (MSA) affects the body’s autonomic (involuntary) functions, including blood pressure, breathing, bladder function, and muscle control. Symptoms include stiffness or rigidity, slowed movements, loss of balance and coordination, swallowing and speaking difficulties, and a significant drop in blood pressure when standing, causing dizziness, lightheadedness, fainting, or blurred vision. Medications may be prescribed to manage some symptoms.
Progressive Supranuclear Palsy
Progressive Supranuclear Palsy (PSP) affects the ability to walk normally by impairing balance. It also affects the muscles controlling the eyes, making it difficult to focus and see things clearly. “Supranuclear” refers to the region of the brain affected by the disorder.
Although PSP is not fatal, symptoms do continue to worsen. To improve balance and improve flexibility of the muscles, medicines used to treat Parkinson’s disease may be effective.
Corticobasal Degeneration (CBD) is caused by cell loss and deterioration of specific areas of the brain. The symptoms, progression, severity, and presentation of CBD can vary greatly. In many cases, affected individuals develop progressive stiffening or tightening of muscles in the limbs and are often unable to make purposeful movements with an affected limb (apraxia). Additional symptoms may include stiff or uncoordinated movement, slight tremor, exaggerated slowness (bradykinesia), lack of movement (akinesia), difficulty speaking or swallowing, and cognitive and behavioral problems, including dementia. Medicines used to treat Parkinson’s disease may be helpful for some symptoms.
Dementia with Lewy Bodies
Dementia with Lewy Bodies causes symptoms similar to Parkinson’s Disease but along with significant memory problems, such as dementia, hallucinations and changes in levels of alertness.
Huntington’s disease is a genetic brain disorder in which brain cells, or neurons, in certain areas of the brain start to break down. As the neurons degenerate, the disease can lead to emotional disturbances, loss of intellectual abilities, and uncontrolled movements. The most common form is adult-onset, in which symptoms develop at ages mid-30s and 40s. In rare instances, children or adolescents develop the disease. Initial symptoms may include emotional changes such as mood swings, irritability, or depression, and intellectual problems such as difficulty learning new things, recalling facts, or making decisions.
In later stages, effects of the disease may include uncontrollable movement, memory loss, personality changes, difficulty swallowing or feeding oneself, difficulty speaking, or disorientation, hallucinations, paranoia, and psychosis. There is no cure for Huntington’s disease, but treatment with medication for symptoms can help.
Ataxia and other Gait Disorders
Ataxia and other gait disorders refer to the loss of muscle control in the arms and legs that can cause loss of balance and coordination, and may also involve fingers, hands, other parts of the body, speech, and eye movements. Ataxia can be caused by many conditions and depending on the acuity of symptom onset, it could be related to vascular causes (such as a stroke), infections, autoimmune, nutritional or hereditary causes to name a few. A thorough evaluation is needed to reach an accurate diagnosis and guide further management.
Restless Legs Syndrome
This syndrome is characterized by unusual itching, crawly, or tingling sensations in the legs, usually while lying down or sleeping. “Restless legs” refers to the urge to move the legs to relieve the symptoms. This condition is very common and is not life-threatening or seriously debilitating. However, it usually interferes with quality sleep, so it may lead to a sleep disorder.
Treatment usually begins with lifestyle changes, such as practicing good sleep routines, exercising, and avoiding smoking, caffeine, and alcohol. In more troublesome cases, medication may be prescribed.
Tics and Tourette Syndrome
A tic disorder refers to a semi-voluntary neurological condition characterized by movements that are often preceded by an urge and followed by a sense of relief. Tourette syndrome is a chronic neurological disorder characterized by repetitive and involuntary movements and vocalizations. Onset for both these conditions is in childhood and symptoms often improve through adulthood. Behavioral interventions such as the Comprehensive Behavioral Intervention for Tics (CBIT) can be very helpful. Medications may also be prescribed if symptoms become and remain disabling.
Myoclonus is a sudden, involuntary twitching or jerking of a muscle or group of muscles, caused by sudden muscle contractions (positive myoclonus) or muscle relaxation (negative myoclonus). Some forms of myoclonus are very common, such as hiccups or sudden jerks as one is falling asleep. Severe myoclonus could indicate a disorder of the brain or central nervous system.
Tardive Syndrome is an umbrella term to describe conditions causing persistently abnormal movements because of prolonged exposure to certain antipsychotic medications and other medications that block the dopaminergic receptors in the brain. The most common tardive syndrome is tardive dyskinesias which includes flowing or dance like movements that most commonly involves the mouth, tongue, and limbs. Management of these conditions is often individualized and coordinated with the patient's psychiatrist if the condition is due to long-term antipsychotic medication use.
Functional Movement Disorder
Functional movement disorder is a condition where the person experiences an abnormal movement(s) or positioning of the body due to the nervous system not working properly (but not due an underlying neurological disease). This diagnosis is usually made by a neurologist. This condition can be very disabling and management largely relies on patient education, physical therapy and psychological treatment.
Secondary parkinsonism is similar to Parkinson’s disease, but the symptoms are caused by certain medications or by another illness. The term refers to any condition that causes the same type of symptoms as Parkinson’s disease. Medications used to treat Parkinson’s disease may help alleviate symptoms.
Wilson’s disease is a rare genetic disorder characterized by the body’s inability to rid itself of excess copper. A small amount of copper is necessary for health, but too much copper is toxic. Normally, the liver rids the body of excess copper. Wilson’s disease prevents the liver from working normally.
The symptoms of Wilson’s disease vary depending on the organs that are affected. Neurological symptoms caused by excess copper in the central nervous system can cause symptoms such as: stiff muscles, weak muscles, tremors, shakes or uncontrollable movements, repetitive movements, poor coordination and fine motor movements, and difficulty speaking or swallowing. Psychological symptoms may include anxiety, depression, and psychosis. Treatment is with medications used to treat heavy metal toxicity.
Parkinson’s disease is a neurological condition that progresses slowly and worsens with age.
Speech language pathologists treat a number of Parkinson's disease's conditions.
Essential tremor is a movement disorder that affects about 10 million Americans.