Movement disorders are neurological syndromes characterized by either excess or paucity of voluntary movements unrelated to weakness or spasticity. They are divided into hyperkinetic disorders like restless leg syndrome, tremor, dystonia, myoclonus, chorea, and tics, and hypokinetic disorders like Parkinson's disease and Parkinson plus syndromes. Restless leg syndrome causes uncomfortable sensations in the legs relieved by movement, especially at night. Essential tremor is a common postural tremor of the hands that may be accentuated by activity and improved by alcohol. Dystonia causes sustained muscle contractions leading to twisting and repetitive movements or abnormal postures.

1. MOVEMENT DISORDERS
DR. SUSHIL KUMAR NAYAK
JR-3 PM&R
NILD, KOLKATA

2. • MOVEMENT DISORDERS ARE NEUROLOGIC
SYNDROMES CHARACTERIZED BY EITHER AN
EXCESS OF MOVEMENT OR A PAUCITY OF
VOLUNTARY AND AUTOMATIC MOVEMENTS,
UNRELATED TO WEAKNESS OR SPASTICITY

3. • HYPERKINETIC
• HYPOKINETIC

4. HYPERKINETIC
• RESTLESS LEG SYNDROME
• TREMOR,
• DYSTONIA,
• MYOCLONUS
• CHOREA,
• TICS

5. HYPOKINETIC
• PARKINSON DISEASE
• PARKINSON PLUS SYNDROMES-
• PROGRESSIVE SUPRANUCLEAR PALSY
• MULTIPLE SYSTEM ATROPHY
• CORTICOBASAL GANGLIONIC DEGENERATION

6. RESTLESS LEG SYNDROME
• CHARACTERIZED BY A DEEP, ILL-DEFINED DISCOMFORT
OR DYSESTHESIA IN THE LEGS THAT ARISES DURING
PROLONGED REST OR WHEN THE PATIENT IS DROWSY
AND TRYING TO FALL ASLEEP, ESPECIALLY AT NIGHT.
• PATIENTS EXPERIENCE SENSORY DISTURBANCES IN THE
LEGS THAT ARE CHARACTERISTICALLY RELIEVED BY
MOVEMENT

7. IRLS STUDY GROUP DIAGNOSTIC
CRITERIA
• The urge to move the legs usually but not always accompanied by
or felt to be caused by uncomfortable and unpleasant sensations
in the legs.
• The urge to move the legs and any accompanying unpleasant
sensations begin or worsen during periods of rest or inactivity,
such as lying down or sitting.
• The urge to move the legs and any accompanying unpleasant
sensations are partially or totally relieved by movement, such as
walking or stretching, at least as long as the activity continues.
• The urge to move the legs and any accompanying unpleasant
sensations during rest or inactivity only occur or are worse in the
evening or night than during the day.
• The occurrence of the features listed in points 1 to 4 is not solely
accounted for as symptoms primary to another medical or a
behavioral condition (e.g., myalgia, venous stasis, leg edema,
arthritis, leg cramps, positional discomfort, habitual foot tapping).

8. MANAGEMENT
• FIRST-LINE TREATMENT- LONG-ACTING DOPAMINERGIC
COMPOUNDS AND IRON SUPPLEMENTS, PARTICULARLY IN
PATIENTS WITH LOW SERUM FERRITIN (LESS THAN 50 TO 80
MG/L).
• SECOND-LINE TREATMENT INCLUDES ANTICONVULSANTS,
SUCH AS GABAPENTIN, PREGABALIN, OR CARBAMAZEPINE.
BENZODIAZEPINES AND OPIOIDS, SUCH AS METHADONE OR
OXYCODONE, ARE ALSO USED.

9. TREMOR
• a rhythmic, oscillatory movement produced by
alternating or synchronous contracting of antagonist
muscle pairs.
• Tremors may be described as fast or slow, coarse or
fine, uniplanar or biplanar.
• Resting tremor is usually observed when the body part
is at complete rest, as is seen in Parkinson tremor.
• Postural tremor appears while maintaining a body
posture;
• when the tremor is produced during a movement, it is
termed an action tremor. Tremors may involve the
limbs, neck,

10. • PHYSIOLOGIC TREMOR-
• TREMOR OCCURS (MOTOR UNITS AT SUBTETANIC RATES).
• PHYSIOLOGIC TREMOR CAN BE EXACERBATED BY
• ANXIETY,
• FATIGUE,
• HYPOGLYCEMIA,
• THYROTOXICOSIS,
• ALCOHOL WITHDRAWAL,
• LITHIUM USE,
• SYMPATHOMIMETIC DRUGS,
• METHYLXANTHINES SUCH AS CAFFEINE, AND SODIUM VALPROATE.

11. • THE MOST COMMON MOVEMENT DISORDER IS ESSENTIAL TREMOR (ET) A
TYPE OF POSTURAL TREMOR BUT MAY BE ACCENTUATED BY GOAL-
DIRECTED ACTIVITIES.
• ET IS TYPICALLY UNIPLANAR WITH FLEXION-EXTENSION MOVEMENT OF
THE HAND.
• CONSUMPTION OF SMALL QUANTITIES OF ALCOHOL IMPROVES ET IN
MOST CASES, AND ALCOHOL INGESTION IS AN OFTEN-USED CLINICAL
CHALLENGE TO AID DIAGNOSIS.
• HOWEVER, CARE SHOULD BE TAKEN BY THE CLINICIAN TO NOT IMPLY TO
THE PATIENT THAT ALCOHOL USE IS A RECOMMENDED TREATMENT.

12. DYSTONIA
• IS DEFINED AS AN ABNORMAL MOVEMENT
CHARACTERIZED BY SUSTAINED MUSCLE
CONTRACTIONS, FREQUENTLY CAUSING TWISTING AND
REPETITIVE MOVEMENTS, WHICH MAY PROGRESS TO
PROLONGED ABNORMAL POSTURES.
• DYSTONIA IS AUTOSOMAL DOMINANT IN INHERITANCE.

13. • FOCAL DYSTONIA: ONE PART OF THE BODY IS
INVOLVED, SUCH AS BLEPHAROSPASM,
OROMANDIBULAR DYSTONIA, AND CERVICAL
DYSTONIA.
• SEGMENTAL DYSTONIA: TWO OR MORE CONTIGUOUS
PARTS INVOLVED, SUCH AS MEIGE SYNDROME.
• MULTIFOCAL DYSTONIA: TWO OR MORE
NONCONTIGUOUS PARTS ARE INVOLVED.
• HEMIDYSTONIA: ONE SIDE OF THE BODY IS AFFECTED.
• GENERALIZED DYSTONIA.

14. • DYSTONIA MAY BE TASK-SPECIFIC, SUCH AS
WRITER’S CRAMP OR MUSICIAN’S CRAMP.
• IT IS RELIEVED BY REST OR SLEEP.
• ONE OF THE PECULIAR AND UNIQUE FEATURES IS
THAT SOME PATIENTS HAVE THE ABILITY TO RELIEVE
THE DYSTONIC MOVEMENT BY SENSORY TRICKS,
USUALLY TACTILE STIMULI.

15. MYOCLONUS
• IS DEFINED AS SUDDEN, SHOCKLIKE MOVEMENTS
THAT ARE USUALLY RANDOM AND RANGE IN
SEVERITY FROM MILD TO SEVERE ENOUGH TO MOVE
THE WHOLE BODY.
• IT CAN BE PHYSIOLOGIC AND CAN BE SEEN AFTER
EXERCISE, EXCESSIVE FATIGUE, OR SOMETIMES WHEN
THE INDIVIDUAL IS FALLING ASLEEP, SUCH AS
HYPNAGOGIC JERKS.

16. • SPINAL MYOCLONUS
• PALATAL MYOCLONUS.
• ASTERIXIS (NEGATIVE MYOCLONUS)

17. • The word chorea is derived from the Greek
word khoreia, which means dance.
• CHOREA IS DEFINED BY THE IRREGULAR,
UNPREDICTABLE, BRIEF JERKY MOVEMENTS
THAT ARE USUALLY OF LOW AMPLITUDE
• movements are usually distal and range in
severity.

18. • CHOREA RESULTS FROM PATHOLOGIC CHANGES
IN THE BASAL GANGLIA.
• MILD CHOREA MAY RESEMBLE FIDGETINESS IN
CHILDREN,
• SEVERE CHOREA MAY INTERFERE WITH SPEECH,
SWALLOWING, ABILITY TO MAINTAIN POSTURE,
OR ABILITY TO AMBULATE.
• HUNTINGTON DISEASE, BENIGN HEREDITARY
CHOREA, AND WILSON DISEASE

19. TICS
• ARE DEFINED AS ABNORMAL MOVEMENTS (MOTOR
TICS) OR ABNORMAL SOUNDS (PHONIC TICS) THAT ARE
BRIEF, INVOLUNTARY, RAPID, AND NONRHYTHMIC.
• THERE IS OFTEN AN IRRESISTIBLE URGE TO MOVE
BEFORE THE TIC, RESULTING IN A TENSION THAT
BUILDS AND IS SUBSEQUENTLY RELIEVED BY
EXECUTION OF THE TIC.

20. • SIMPLE MOTOR TICS- brief, isolated
movement as an eye blink, facial grimace,
shoulder shrug, or head jerk. slower and
sustained.
• COMPLEX MOTOR TIC- stereotyped facial
expressions or patterned coordinated
movements