Movement Disorders - Types and Treatment

Introduction:

Movement disorders cause abnormal movements and affect various body parts, such as hands, limbs, fingers, posture, trunk, facial muscles, toes, feet, head, and neck. These disorders mainly occur due to damage to the brain or spinal cord. They are, thus, treated by physiotherapists who are experts in managing musculoskeletal pain issues and must know about the control mechanisms needed to maintain stability in functional motions. Movement dysfunction frequently results when a person lacks control over the stabilizing muscles within their muscle system.

The breakdown of the movement system's stabilizers is the primary cause of chronic pain. Therefore, the healthcare provider must examine the functioning of the overall movement system to diagnose and treat the movement disorder issues in a patient by looking beyond the isolated area. Therefore, the article discusses movement disorders, their types, causes, symptoms, and treatments to manage the condition.

What Are the Causes of Movement Disorders?

The causes of movement disorders include

• Damage to the spinal cord and brain.

• Peripheral nerve damage.

• Genetic mutations and conditions.

• Metabolic disorders.

• Infections.

• Stroke (brain damage due to interruption in the blood supply).

• Vascular diseases.

• Toxins.

• Side effects from medications.

What Are the Types of Movement Disorders?

The most common types of movement disorders are:

• Ataxia: The region of the brain that regulates coordinated movement is impacted by this movement condition. Other symptoms of ataxia include uncoordinated or sloppy balance, speech, or limb motions. Various factors, including hereditary and degenerative conditions, can bring on ataxia. Another ailment that can be treated, such as an infection, can also produce ataxia.

• Cervical Dystonia: The neck muscles contract uncontrollably in cervical dystonia, causing the head to pull to one side or tilt forward or backward. These might shake.

• Chorea: Involuntary motions that are short, erratic, repeated, and fairly quick are known as chorea. The face, lips, trunk, and limbs are frequently used in the movements. Chorea might resemble excessive fidgeting.

• Dystonia: This syndrome causes twisted, repeated movements and long-lasting involuntary muscle contractions. One body part or the entire body may be impacted by dystonia.

• Functional Movement Disorder: Any movement abnormality may be similar to this illness. Functional movement disorder is curable and not caused by a neurological condition.

• Huntington's Disease: Genetic tests can prove that this is an inherited, progressive condition. There are three aspects to Huntington's disease: erratic mobility, cognitive (related to thinking and remembering) issues, and psychological symptoms.

• Multiple System Atrophy: This unusual neurological condition worsens with time and affects numerous brain systems. An ataxic or Parkinsonian movement disorder is brought on by multiple system atrophy. In addition, it may result in playing out dreams, low blood pressure, and poor bladder function.

• Myoclonus: This syndrome causes muscles to jerk violently in an instant.

• Parkinson's Disease: Tremor, muscle stiffness, sluggish or reduced mobility, or imbalance are symptoms of this slowly progressing condition. Additionally, it may result in symptoms unrelated to movement, such as a loss of smell, constipation, acting out dreams, and cognitive deterioration.

• Parkinsonism: It refers to a generalized slowness of movement and stiffness, tremor, or loss of balance. There are a wide variety of causes. The most frequent causes include Parkinson's disease and specific dopamine-blocking drugs. Degenerative conditions like multiple system atrophy and progressive supranuclear palsy are other causes. A stroke or persistent head trauma can also bring on Parkinsonism.

• Progressive Supranuclear Palsy: This is an uncommon neurological condition that affects walking, balance, and eye movements. Even though it occasionally may mimic Parkinson's disease, it is a separate disorder.

• Restless Legs Syndrome: When relaxing or lying down, this movement problem creates uncomfortable leg sensations that are frequently eased by movement.

• Tardive Dyskinesia: Long-term usage of specific medications known as neuroleptic medicines, which treat psychiatric problems, results in this neurological illness. Repetitive and unconscious motions like grimacing, eye blinking, and others are brought on by tardive dyskinesia.

• Tourette Syndrome: This neurological disorder manifests as repeated movements and vocal noises between childhood and adolescence.

• Wilson's Disease: This rare genetic illness causes the body to accumulate excessive levels of copper, which can lead to neurological issues like dystonia, tremor, Parkinsonism, or ataxia.

• Essential Tremor: An uncontrollable shaking or trembling, typically affecting one or both hands or arms, is an essential tremor. It gets worse when simple movements are tried. It is not connected to an underlying illness (such as Parkinson's disease) and is brought on by anomalies in the parts of the brain that regulate movement. Most patients, about 50 percent, have a family history of the illness. Although this ailment typically does not lead to major issues, it can undoubtedly disrupt everyday life and be upsetting. Physical treatment or lifestyle modifications may sometimes help symptoms.

What Are the Symptoms of Movement Disorder?

Some of the common symptoms of movement disorder are:

• Problem with balance and coordination.

• Limbs become rigid or stiff.

• Uncontrolled movements, such as jerks, twitches, spasms, shaking, twisting, and tremors.

• Walking difficulties.

• Change in the gait.

• Trouble in swallowing, writing, and speaking.

What Are the Risk Factors for Movement Disorders?

The extent of tissue alterations can be influenced by prolonged posture and repeated movement, as well as intrinsic (such as personal traits) and extrinsic (such as work and fitness) factors. Also, a combination of micro-instability, relative stiffness, neuromuscular activation pattern, and motor learning contributes to the development and duration of the movement disability or disorders.

How Is Movement Disorder Diagnosed?

Movement disorders are a very complex condition and may even arise due to some other underlying medical condition or may mimic other conditions as well. Therefore, the healthcare provider advises various diagnostic tests apart from physical and neurological examinations. These include:

• Blood Tests: Blood tests help rule out various types of movement disorders and other underlying causes.

• ECG (Electroencephalogram): This helps to analyze the brain’s electrical activity.

• Biopsy: A muscle biopsy is done to distinguish between muscle and nerve conditions.

• EMG (Electromyography): This test is used to assess muscle health and the nerves controlling them.

• Lumbar Puncture: Lumbar puncture is done for cerebrospinal fluid analysis.

• Nerve Conduction Study: This is done to calculate the electrical current flow passing through nerves before reaching the muscles.

• CT (Computed Tomography) Scan and MRI (Magnetic Resonance Imaging): These tests are also advised by the doctor to view the spinal cord, brain, and nerves.

What Is the Treatment Given for Movement Disorder?

• Medication therapy is prescribed to the patients to relieve the symptoms of movement disorders. Patients who are taking medicine have a reduction in tremors in between 50 and 75 percent of cases. Medications include beta-blockers, anti-seizure drugs, Benzodiazepines, and carbonic anhydrase inhibitors. Beta-blockers may cause memory loss and confusion in older people; they are typically prescribed for younger patients.

• Botox injections are also given, which can decrease tremors by obstructing nerve and muscle communication.

• Physical therapy is advised to the patient to improve the body’s physical movements. These therapies are given by professional physical therapists to manage symptoms such as stiffness, pain, and discomfort.

• Psychotherapy or talk therapy is also advised to the patient to change their emotions, behaviors, and thoughts, as movement disorders can also lead to anxiety and depression.

• Mobility aids, such as canes, wheelchairs, and walkers, are also given to the patient to help them with movement and ensure independence.

• Speech therapy is advised as a part of treatment to improve language skills, speech, and swallowing ability.

• Deep brain stimulation or brain surgery is also done in cases of Parkinson’s disease, tremors, or dystonia to manage involuntary movements. Thalamotomy is the deliberate destruction of a section of the thalamus, a region deep inside the brain that receives sensory signals. About 75 percent of individuals who have this surgery relieve one side of the body. Due to the significant risk of speech loss, surgery on both sides of the thalamus is uncommon.

• Surgery may be an alternative when medicine has failed to control severe cases of essential tremors. A neurostimulator is implanted under the collarbone to block tremor-inducing signals by sending electrical impulses to the thalamus (part of the brain).

• Patient education, analysis and adjustment of daily activities, and the prescription of particular exercises are also a part of the treatment. Patient education involves explaining to the patient how musculoskeletal conditions may be related to the repetition of impaired movements and sustained alignments in a particular direction and how to correct the impairments during all daily activities, especially those that produce symptoms. The most crucial aspect of the program is educating the patient on how to carry out daily tasks appropriately and symptom-free. The continuous alignments and repeated movements are rectified to enable the patient to understand the cause of the symptoms and how to lessen or control them.

Conclusion:

Movement disorders cannot be completely cured, but their symptoms can be managed through various treatment modalities. These disorders are of various types and may present different symptoms in each individual, so a unique treatment plan may be required. Therefore, one must consult the doctor timely in case they experience any symptoms of movement disorder and avail timely treatment.