Movement disorders

What is Parkinson’s disease?

Parkinson’s disease is a slowly progressive neurological disorder which affects over 1.5 million people in the United States. In fact, it is the second most common neurological disorder after Alzheimer’s. 

Parkinson’s disease affects movement, muscle control and balance. It can affect daily physical activities through an increase in muscle stiffness, slowness in movement, decreased size of movement, resting tremors and gait disorder. It can also impact psychological mood, facial expression, increase fatigue and decrease volume of speech. 

Parkinson’s disease usually affects people age 55-75 years old, but it can also develop in younger people. The disease is usually progressive, with symptoms becoming more severe over time.

Causes

The exact cause of Parkinson's disease is unknown. Scientists think that Parkinson's is probably due to a combination of genetic and environmental factors.

Symptoms

Parkinson’s disease is difficult to diagnose in its early stages. The disease is diagnosed mostly through symptoms, which may include:

• Tremors (shaking) in the hands, arms, legs and face
• Slowness of movement, especially when initiating motion
• Muscle rigidity
• Difficulty with walking, balance and coordination
• Difficulty eating and swallowing
• Digestive problems
• Speech problems
• Depression and difficulties with memory and thought processes

Diagnosis

Parkinson’s disease can be difficult to diagnose in its early stages. Doctors base their diagnosis on the patient’s medical history and the evaluation of symptoms during a neurological exam. No laboratory or imaging tests can diagnose Parkinson’s, although brain scans such as computed tomography (CT), magnetic resonance imaging (MRI), or positron-emission tomographic (PET) may be used to rule out other neurological disorders.

Treatment

There is no cure for Parkinson’s disease. Treatments focus on controlling symptoms and improving quality of life. Some treatments include:

• Medications - Because Parkinson’s disease symptoms are due to a deficiency of the brain chemical dopamine, the primary drug treatments help increase dopamine levels in the brain.
• Surgery - In some cases of advanced-stage Parkinson’s disease, surgery may help to control motor problems. Deep brain stimulation is currently the preferred surgical method.
• Physical therapy is an important part of Parkinson’s treatment. Rehabilitation can help patients improve their mobility, speech and functional abilities. Several of our physical and speech therapists are certified in Parkinson Therapy LSVT BIG and LOUD.

What is torticollis?

Torticollis is a twisted neck in which the head is tipped to one side, while the chin is turned to the other. It may be inherited due to changes in the genes, or acquired as a result of damage to the nervous system, upper spine, or muscles. If the condition occurs without a known cause, it is called idiopathic torticollis.

Torticollis may develop in childhood or adulthood. Congenital torticollis (present at birth) may occur if the baby's head was in the wrong position while growing in the womb, or if the muscles or blood supply to the neck are injured.

Symptoms

Some symptoms of torticollis include:

• Limited range of motion of the head
• Headache
• Head tremor
• Neck pain
• Shoulder that is higher on one side of the body
• Stiffness of the neck muscles
• Swelling of the neck muscles (possibly present at birth)

Diagnosis

Tests or procedures may be done to rule out possible causes of head and neck pain. A physical examination will show:

• Head tilts toward the affected side while the chin points to the opposite side
• Shortening of the neck muscles
• The entire head pulls and turns to one side (in more severe cases)

Diagnostic tests for torticollis include:

• CT scan of the neck
• Electromyogram (EMG) to see which muscles are most affected
• MRI of the brain

Treatment

Treating torticollis that is present at birth involves stretching the shortened neck muscle. Passive stretching and positioning are used in infants and small children. These treatments are often successful, especially if they are started within three months of birth. Surgery to correct the neck muscle may be done in the preschool years, if other treatment methods fail.

Torticollis that is caused by damage to the nervous system, spine or muscles is treated by identifying the cause of the disorder. Some treatment options include:

• Applying heat, traction to the cervical spine, and massage may help relieve head and neck pain.
• Stretching exercises and neck braces may help with muscle spasms.
• Medications may be used, including the anticholinergic drug baclofen.
• Injecting botulinum toxin can temporarily relieve torticollis, but repeat injections are usually needed every three months.
• Surgery of the spine might be needed when the torticollis is due to dislocated vertebrae. In some cases, surgery involves destroying some of the nerves in the neck muscles, or brain stimulation.

The condition may be easier to treat in infants and children. If torticollis becomes chronic, numbness and tingling may develop due to pressure on the nerve roots in the neck. The muscle itself may become large (hypertrophic) due to constant stimulation and exercise.

What is spasticity?

Spasticity is stiff or rigid muscles. It may also be called unusual "tightness" or increased muscle tone. Reflexes (for example, a knee-jerk reflex) are stronger or exaggerated. The condition can interfere with walking, movement or speech.

Spasticity is usually caused by damage to the part of the brain that is involved in movements under your control. It may also occur from damage to the nerves that go from the brain to the spinal cord.

Symptoms

Some symptoms of spasticity include:

• Abnormal posture
• Carrying the shoulder, arm, wrist and finger at an abnormal angle because of muscle tightness
• Exaggerated deep tendon reflexes (the knee-jerk or other reflexes)
• Repetitive jerky motions (clonus), especially when you are touched or moved
• Scissoring (crossing of the legs as the tips of scissors would close)
• Spasticity may also affect speech. Severe, long-term spasticity may lead to contracture of muscles, which can reduce range of motion or leave the joints bent.

Causes

Some causes of spasticity include:

• Adrenoleukodystrophy
• Brain damage caused by lack of oxygen, as can occur in near drowning or near suffocation
• Cerebral palsy
• Head injury
• Multiple sclerosis
• Neurodegenerative illness (illnesses that damage the brain and nervous system over time)
• Phenylketonuria
• Spinal cord injury
• Stroke

Diagnosis

To diagnose spasticity, your doctor will perform a physical exam and ask questions about your symptoms, including:

• When was it first noticed?
• How long has it lasted?
• Is it always present?
• How severe is it?
• What muscles are affected?
• What makes it better?
• What makes it worse?
• What other symptoms are present?

Treatment

Exercise, including muscle stretching, can help make your symptoms less severe. Home-based physical therapy is also helpful. Your doctor may refer you to a physical therapist. Physical therapy involves different exercises, including muscle stretching and strengthening exercises. Physical therapy exercises can be taught to parents to help their child at home.

Medicines for spasticity include baclofen, benzodiazepines (such as diazepam), clonidine, dantrolene, gabapentin, and tizanidine. Botulinum toxin can be injected into the spastic muscles. In rare cases, a pump may be inserted into the spinal fluid to directly deliver medicine to the nervous system.

Sometimes, a person may need surgery to release the tendon or to cut the nerve-muscle pathway.

What is essential tremor?

Essential tremor is a type of involuntary shaking movement in which no cause can be identified. Involuntary means you shake without trying to do so.

Causes

Essential tremor is the most common type of tremor. Everyone has some tremor present, but the movements are often so small that they can't be seen. Essential tremors are most common in people older than 65.

The exact cause for essential tremor is unknown. Tremors occur when there is a problem with the nerves that supply certain muscles. Some research suggests that the part of the brain that controls muscles movements does not work correctly in patients with essential tremor.

Symptoms

The tremor is more likely to be noticed in the hands, but may affect the arms, head, eyelids or other muscles. The tremor rarely affects the legs or feet. People with essential tremor may have trouble holding or using small objects such as silverware or a pen.

The shaking most often involves small, rapid movements—more than five times a second.

Specific symptoms of an essential tremor may include:

• Head nodding
• Shaking or quivering sound to the voice (if the tremor affects the voice box)
• Problems with writing, drawing, drinking from a cup, or using tools (if the tremor affects the hands)

The tremors may:

• Occur when you move (action-related tremor), and may be less noticeable with rest
• Come and go, but often get worse as you age
• Get worse with stress, caffeine and certain medications
• Not affect both sides of the body the same way

Diagnosis

Your doctor can diagnose essential tremor by performing a physical exam and asking questions about your medical and personal history.

A physical exam will show shaking with movement, usually small movements that are faster than five times per second. There are usually no problems with coordination or mental function.

Treatment

Treatment may not be needed unless the tremors interfere with your daily activities or cause embarrassment. For tremors made worse by stress, try techniques that help you relax. For tremors of any cause, avoid caffeine and get enough sleep. For tremors caused or made worse by a medication, talk to your doctor about stopping the drug, reducing the dosage, or switching. Do NOT change or stop medications on your own.

An essential tremor is not a dangerous problem, but some patients find the tremors annoying and embarrassing. In some cases, it may be dramatic enough to interfere with work, writing, eating or drinking.

What is dystonia?

Dystonia—uncontrolled or slow movement—is a problem with muscle tone, usually in large muscle groups. The problem leads to slow, uncontrollable, jerky movements of the head, limbs, trunk or neck.

Causes

The slow twisting movements of muscles (athetosis) or jerky muscle contractions (dystonia) may be caused by a number of conditions, including:

• Cerebral palsy
• Drug side effects
• Encephalitis
• Genetic diseases
• Hepatic encephalopathy
• Huntington's disease
• Stroke

Sometimes two conditions (such as a brain injury and medication) interact to cause the abnormal movements when neither one alone would cause a problem.

Diagnosis

To diagnose dystonia, your doctor will perform a physical exam, which may include a detailed examination of the nervous and muscle systems.

Your doctor will ask questions about your medical history and symptoms, including:

• When did you develop this problem?
• How long have you had it?
• Is it always the same?
• Is it always present or only sometimes?
• Is it getting worse?
• Is it worse after exercise?
• Is it worse during times of emotional stress?
• Have you been injured or in an accident recently?
• Have you been sick recently?
• Is it better after you sleep?
• Does anyone else in your family have a similar problem?
• What other symptoms do you have?
• What medications are you taking?

Diagnostic tests may include:

• Blood studies (such as CBC or blood differential)
• CT scan of the head or affected area
• EEG
• EMG and nerve conduction velocity studies (sometimes done)
• Genetic studies
• Lumbar puncture
• MRI of the head or affected area
• Urinalysis

What is hemifacial spasm/blepharospasm

An eyelid twitch is a general term for involuntary spasms of the eyelid muscles. In some instances, the eyelid may repeatedly close (or nearly close) and re-open.

Causes

The most common things that make the muscle in your eyelid twitch are fatigue, stress and caffeine. Once spasms begin, they may continue off and on for a few days. Then, they disappear. Most people experience this type of eyelid twitch on occasion and find it very annoying. In most cases, you won't even notice when the twitch has stopped.

More severe contractions, where the eyelid completely closes, are possible. These can be caused by irritation of the surface of the eye (cornea) or the membranes lining the eyelids (conjunctiva).

Sometimes, the reason your eyelid is twitching cannot be identified. This form of eyelid twitching lasts much longer, is often very uncomfortable, and can also cause your eyelids to close completely.

Symptoms

In addition to having repetitive, uncontrollable twitching or spasms of your eyelid (usually the upper lid), you may be very sensitive to light or have blurry vision.

Treatment

Eyelid twitching usually disappears without treatment. In the meantime, the following steps may help:

• Get more sleep.
• Drink less caffeine.
• Lubricate your eyes with eye drops.

If twitching is severe, small injections of Botox can temporarily cure the spasms.

The outlook depends on the specific type or cause of eyelid twitch. In some cases, the twitches usually stop within a week. Permanent eye injury from unrecognized cornea injury is possible, but rare.

Call your primary care doctor or eye doctor (ophthalmologist, optometrist) if:

• Eyelid twitching does not go away within one week.
• Twitching completely closes your eyelid.
• Twitching involves other parts of your face.
• You have redness, swelling, or a discharge from your eye.
• Your upper eyelid is drooping.