Huntington’s disease

This is a genetic condition that affects movements. There is chronic progressive chorea or rapid jerky purposeless movements of various groups of muscles. There is additional emotional, behavioral, and psychiatric abnormalities.

Other movement disorders

Other movement disorders include:-

Myoclonus usually means rapid, uncontrolled, brief and irregular abnormalities of movement of a group of muscles.

Affliction of multiple system leading to atrophies. This is called Shy Dragger syndrome

Progressive supranuclear palsy (PSP) is a rare movement disorder that affects purposeful movements.

Tourette’s syndrome – This is characterized by various tics and grunts.

Wilson’s disease – This is caused by excess deposition of copper in the body leading to neurological and psychiatric symptoms along with liver disease

Drug induced movement disorders – Abnormal movements, tremor; and dystoniaand dyskinesias may be associated with intake of certain drugs. These could be due to antipsychotic medications or due to some anti-vomiting agents like metoclopramide etc.

Reviewed by April C

Causes of MD

re neurological syndromes where there may be excess of movement or a paucity of movement that is not connected to weakness, paralysis of spasticity of the muscles. Movement disorders commonly affect the speed, fluency or smoothness, quality, and ease of movement.

The pathology more often than not lies in the brain especially in an area of the brain called the basal ganglia. This region is part of the grey matter that lies deep within the brain or cerebrum.

The defects may also lie in the base of the brain or cerebellum. This leads to difficulty in walking, locomotion or maintenance of posture and normal body balance.

Although genetics is the commonly implicated cause of abnormal movements there are other causes such as stress, drugs and so forth. (1-5)

Stress, anxiety and emotional disturbancesi,

These may lead to abnormalities of movements like tremors. Tremors are rhythmic movements of hands, feet, head or voice.

They may be triggered by emotional components as well as stress. Older individuals commonly manifest essential tremors. Although the condition is not fatal, it may cause severe debility.

Drugs as cause of movement disorders

Dyskinesias signify a range of abnormal movements that may include:

hypokinesia (less movements) bradykinesia (slowing of movements) akinesia (absence of movements) chorea (rapid jerky movements) athetosis (slow writing movements) tics (rapid repeated twitches) dystonias

These may be caused due to intake of certain drugs. Antipsychotic medications taken for psychiatric conditions like Schizophrenia or anti-nausea agents like Metoclopramide may lead to these movement disorders.

Chronic diseases and movement disorders

Chronic disease like an over active thyroid gland can lead to abnormal movements like tremors.

Alcohol consumption

Alcohol consumption may lead to ataxia – an abnormal movement or gait. There are problems with coordination and balance.

There are many different types. Commonly the cerebellum is affected in this condition.

Iron deficiency

Iron deficiency is thought to be responsible for Restless leg syndrome although the exact cause of the condition is unknown.

Excess nicotine, alcohol and caffeine has also been implicated.

Restless legs syndrome affects nearly 20% of women during pregnancy and disappears after delivery. Those with renal failure may also develop symptoms.

Some evidence exists that the use of antidepressants, lithium (mood stabilizer), and blood pressure lowering drugs like calcium channel blockers may aggravate the condition.

Excess copper in the body

Copper excess in the body leads to Wilson’s disease characterized by abnormal movements, psychiatric and liver disease manifestations.

There may be tremors, lack of coordination and abnormal movements. It affects 1 in 30,000 to 1 in 40,000 individuals.

It affects all races but there is an increased incidence among European Jews, Italians, Sicilians, and Japanese.

There may be a defect in the way the body handles excess copper leading to its deposition in the liver and brain. Usually the cause is genetic with the problem lying in the 13th chromosome.

Neurodegenerative conditions

Parkinson’s disease is a neurodegenerative condition. There is a reduction of cells in the basal ganglia that produce a chemical messenger of the brain called Dopamine.

It has mainly genetics as a cause. There are other causes such as exposure to heavy metals, such as prolonged exposure to copper and manganese or exposure to pesticides and exposure to antipsychotic drugs like phenothiazines, prochlorperazine, thioridazine, chlorpromazine, haloperidol and anti-vomiting agent metoclopramide.

Genetic causes of movement disorders

Huntington’s disease is primarily caused by genetic defects that are inherited. The defect lies in the 4th chromosome and is transmitted to the offspring almost certainly (autosomal dominant trait).

Reviewed by April Cashin-Garbut

By Dr Ananya Mandal, MD

Movement disorders are abnormalities of movements and gait. Movements that appear relatively simple liking picking up a bit of paper from the floor are actually quite complex.

There are numerous to and from movement of signals from the brain to the arm as well as other parts of the body to maintain balance and guarantee a smooth, rapid and fluent movement to pick up the object. Thus any problems at any part of this complex pathway can affect normal movements.

Characteristic symptoms of movement disorders

Movement disorders are usually characterized by excess movements or by paucity or lack of movements and rigidity and contraction of muscles.

They may lead to severe disability and difficulty in leading a normal life. There is a huge effect on the society as these patients are unable to find and retain gainful employment and may need constant care and supervision for day to day activities including personal hygiene.

Most movement disorders begin slowly

A co-worker or spouse may notice the problem before the patient realizes. There may be initial weakness and stiffness of the muscles and there is usually an onset of involuntary movements.

These include twitches, tics, movements or flapping or writing of arms, head and abnormal sounds or grunts.

The symptoms may persist throughout the day or may appear only when the sufferer tries to perform a task, walk or turn their heads.

Changes in muscle tone

There may be increased or decreased muscle tone. Muscle tone refers to the resting activity of the muscles that prevents the limbs and torso from sagging and holds up the body even at rest.

With movement disorders like dystonia the muscle tone is increased as there is spasm or persistent contraction of a group of muscles.

Rigidity

Due to increased muscle tone the limbs may be difficult to maneuver by the physician.

Cogwheel rigidity is seen in patients with Parkinson’s disease. In this there is a ratchet-y feel when passively moving a limb.

Pain and spasmIncreased muscle tone may also be accompanied by pain and spasm of the muscles. This is also seen in dystonias