Movement Disorders

Dr. Lopez had the honor of being trained at the prestigious and renown  Center for Movement Disorders and Neurorestoration at the University of Florida.  Because many movement disorders are associated with a brain disease it may also affect cognitive and/or emotional functioning.  At other times, persons with movement disorders need to be cleared for Deep Brain Stimulation (DBS) because this surgery can aggravate cognitive disorder.

What is a Movement Disorder?

The term “movement disorders” covers a wide range of deficits with a wide range of disease pathologies and treatments.  What is similar about them is that they are by and large the result of changes in the brain’s subcortical structures and are characterized by an interruption of the brain’s normal inhibition/disinhibition feedback system for the initiation of movement.  Neurological diseases cause many movement disorders, like Parkinson’s disease. Other causes include injuries, autoimmune diseases, infections and certain medicines. Many movement disorders are inherited.

Movement disorders are all neurological conditions that affect the speed, fluency, quality, and ease of movement. Changes in the functional quality of movement are known as dyskinesias.  Beneath the dyskinesia umbrella, there is hyperkinesia (referring to excessive and/or involuntary movements) and hypokinesia (referring to slowed or absent voluntary movements).  Imagine not being able to walk normally, or if parts of your body moved when you didn’t want them to.

Treatment varies by disorder. Medicine can cure some disorders. Others get better when an underlying disease is treated. Often, however, there is no cure. In that case, the goal of treatment is to improve symptoms and relieve pain.  Stem cell therapy is the process of transplanting stem cells into the damaged areas of the brain to form new neurons.   This method is in clinical trials right now as an exciting potential new treatment for movement disorders caused by cell death.

The dystonias are neurological movement disorders with a variety of causes.  They are characterized by muscle contractions that persist and result in repetitive movements and awkward posture. These can occur in many different parts of the body, including hands, feet, neck, eyes and vocal chords.

Initial symptoms are often mild and may be noticeable only after prolonged exertion, stress, or fatigue. Over a period of time, the symptoms may increase in intensity.

It is believed that the dystonias result from an abnormality in an area of the brain called the basal ganglia where some of the messages that initiate muscle contractions are processed.  The disorders result from a defect in the body’s ability to process a group of chemicals called neurotransmitters.  These neurotransmitters are needed to help cells in the brain communicate with each other.

Chorea is an abnormal involuntary movement. These movements are brief, abrupt, and irregular. In milder cases, they may appear purposeful; the patient often appears fidgety and clumsy. They can affect various body parts, and interfere with speech, swallowing, posture and gait. Chorea may worsen with anxiety, and subsides during sleep. In more severe forms, movements appear wild and violent.  Treatment is determined based on the cause of each individual’s symptoms. The most common treatments of chorea include the use of neuroleptic agents, and other dopamine depleters such as Xenazine, and benzodiazepines.

Huntington’s Disease is a hereditary disorder characterized by the death of neurons in several subcortical brain structures. HD slowly diminishes the affected individual’s ability to walk, talk and reason.  Early symptoms of HD may include a decline in cognitive ability and chorea (clumsiness, involuntary twitching and lack of coordination).  Other symptoms like depression, mood swings, and forgetfulness can also manifest. As the disease progresses, concentration and short-term memory diminish and involuntary movements of the head, trunk and limbs increase. Walking, speaking and swallowing abilities deteriorate. Eventually the person is unable to care for him or herself. Death follows from complications such as choking, infection or heart failure.

Symptoms typically manifest between the ages of 30 and 50, and evolve slowly, varying from person to person.  However, there is a more rare, early-onset version that becomes symptomatic in childhood.   Risk factors for HD revolve around heredity.  Each child of a person with the disease has a 50/50 chance of inheriting the defective gene, the presence of which can now be detected through genetic testing. Treatment is mainly based on lessening the symptoms.   Xenazine has been recently approved for treating the chorea, and more generalized drugs like Haloperidol and Valium are often prescribed to help alleviate the concomitant movement and psychological symptoms.

Parkinson’s disease is a progressive disorder of the central nervous system that mainly affects movement.  It is believed to be caused by low levels of a chemical called dopamine, which, among other things, activates cells in our brains that allow movement.  The main features of PD are slowness of movements, compromise of balance, muscle rigidity, and tremor. The primary (motor-related) symptoms include muscle rigidity, stiff posture and gait, and slowed movements.  Secondary symptoms include impairment of cognitive function and mild language difficulties.  In the later stages of the disease, some patients may develop dementia, but not all.  Risk factors include age, heredity, male gender, and exposure to toxins.  To treat PD, drugs like Selegiline focus on creating more dopamine in the brain.  Levodopa remains the most effective drug available for the relief of PD symptoms.  However, complications can arise in patients due to chronic Levodopa therapy.  Surgical treatments include Deep Brain Stimulation and are geared towards alleviating the movement symptoms.

Parkinsonism refers to any condition that causes the motor symptoms seen in Parkinson’s disease (tremors, slow movement, impaired speech or muscle stiffness).  All types of Parkinsonism are caused by the death of dopamine-containing neurons in the brain.  Other, non-PD related, causes of parkinsonism include Lewy body dementia, stroke, encephalitis, corticobasal degeneration, and certain antipsychotics. Treatment is directed at the underlying cause, and may include medication to manage the symptoms.

Ataxia describes a lack of muscle coordination during voluntary movements, such as walking or picking up objects. A sign of an underlying condition, ataxia can affect your movements, your speech, your eye movements and your ability to swallow. Ataxia can develop over time or come on suddenly, depending on the cause. Ataxia causes poor coordination, but other signs and symptoms vary. Persistent ataxia usually results from damage to your cerebellum, the part of your brain that controls muscle coordination. Many conditions may cause ataxia, including alcohol abuse, stroke, tumor, cerebral palsy and multiple sclerosis. It’s also possible to inherit a defective gene that may cause one of many ataxia variants.   Treatment for ataxia depends on the underlying cause. Adaptive devices, such as walkers or canes, might help you maintain your independence despite your ataxia. You may also benefit from physical therapy, occupational therapy and speech therapy.

Tremors are unintentional trembling or shaking movements in one or more parts of your body. Most tremors occur in the hands, but can also appear in other parts of the body.  They can develop at any age, but are most common in older people.   Often, there is no obvious trigger, but sometimes neurological disorders like Parkinson’s disease, an overactive thyroid, chronic drinking or certain medicines can cause them.  Some forms are inherited, while others have no known cause.  There is no cure for most tremors. Treatment depends on each individual patient’s chain of causation. In many cases, medicines and surgical procedures can reduce tremors and improve muscle control.

Essential tremor is a disorder of the nervous system that causes rhythmic shaking. Essential tremor can affect almost any part of the body, but the trembling occurs most often in the hands.  Although usually not a dangerous condition, essential tremor worsens over time and can be severe in some people. It’s sometimes confused with Parkinson’s disease, and is most common in older adults.

Startle is a stereotypical response to an unexpected stimulus (usually auditory, but can also be visual, tactile or vestibular). Hyperexplexia, or Exaggerated Startle disease, is a genetic disorder in which babies have an exaggerated startle reflex.  It develops most often as a result of various neurologic and psychiatric conditions. This can be acquired or genetic. Hereditary hyperexplexia manifests shortly after birth with violent jerking to noise and touch, massive and sustained stiffening of the trunk and limbs, clenching fists, and attacks of high-frequency trembling.  Symptomatic hyperexplexia is a clinical sign of brain or brainstem disorders.  Treatment is with medications. The neurologic features can usually be controlled with Klonopin.

Tourette syndrome (TS) is a neurological disorder characterized by repetitive, involuntary movements and vocalizations called tics.  Tics are classified as either simple or complex. Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include eye blinking and other vision irregularities, facial grimacing, shoulder shrugging, and head or shoulder jerking.  Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting. Although the cause of TS is unknown, research points to abnormalities in certain brain regions (including the basal ganglia, frontal lobes, and cortex), involving the neurotransmitters responsible for communication among neurons.  Most people with TS don’t need treatment, but effective medications are available for those whose symptoms interfere with functioning. Drugs like Haloperidol are the most consistent medications for tic suppression.

Restless legs syndrome (RLS) is a condition in which your legs feel extremely uncomfortable while you’re sitting or lying down. It makes you feel like getting up and moving around. When you do so, the unpleasant feeling of restless legs syndrome temporarily goes away.  Restless legs syndrome can begin at any age and generally worsens as you get older. Women are more likely than men to develop this condition. Restless legs syndrome can disrupt sleep, leading to daytime drowsiness, and make traveling difficult.  Sometimes, treating the underlying condition, such as iron deficiency or peripheral neuropathy, greatly relieves symptoms of restless legs syndrome.  There are also medications that are used to treat other related diseases (like Parkinson’s) that can help.