Movement Disorders Explained

Movement disorders – a category of more than 30 neurological conditions that cause abnormal body movements – affect approximately 40 million people a year, according to the Parkinson and Movement Disorder Alliance. While Parkinson’s disease and essential tremor are the most common movement disorders, each one comes with its own set of symptoms and treatments.

“While movement disorders are not curable, we have a wide variety of treatments that allow us to control people’s motor symptoms,” says Dr. Miran Salgado, a movement disorder specialist and chief of neurology at NewYork-Presbyterian Brooklyn Methodist Hospital. “With all the different medications and surgical options, we are often able to slow the progression of these diseases and help patients maintain their quality of life.”

To learn more about the signs and symptoms of movement disorders, and the latest tools used to treat them, Health Matters spoke to three leading neuroscientists: Dr. Salgado; Dr. Michael Kaplitt, director of Functional and Stereotactic Neurosurgery at NewYork-Presbyterian/Weill Cornell Medical Center and Vice-Chair for research in the Department of Neurological Surgery at Weill Cornell Medicine; and Dr. Gordon Baltuch, co-chief of Functional Neurosurgery at NewYork-Presbyterian/Columbia University Irving Medical Center.

What are movement disorders?
Movement disorders are a group of neurological conditions that involve abnormal movements in patients. There are a number of different types of movement disorders, but the two most common ones are Parkinson’s disease and essential tremor. Other less common movement disorders include ataxia, dystonia, Huntington’s disease, and Tourette syndrome.

What do you mean by abnormal movements?
There are basically two categories of abnormal movements: hyperkinetic movements, which means there are excessive movements, and hypokinetic movements, which means a lack of movements. Essential tremor and dystonia would be an example of hyperkinetic movements, characterized by shaking, jerking, or involuntary movements. Parkinson’s falls broadly under the category of lack of movements because although it involves tremors, the disease causes slowness and stiffness in a person’s movements.

What are signs that you may have a movement disorder?
Everything that shakes is not Parkinson’s disease or a movement disorder. If you have a tremor, a twitch, a tic, cramping or stiffness that is transient – meaning it comes and goes and isn’t associated with other health issues like memory loss – and it doesn’t impact your quality of life, what you’re experiencing is probably not a movement disorder.

However, if the symptoms are recurrent or if you experience a rapid increase in stiffness or slowness when getting out of a chair or buttoning your shirt, those might be signs of a movement disorder. If you suddenly start to have trouble picking up a cup of coffee due to tremors in your hand, or your limbs become so rigid you have trouble moving, you should talk to your doctor.

What happens in your brain that causes movement disorders?
In essential tremor, the normal systems that we rely on to modulate movements stop working well. As a result, you get a tremor when you try to do something involving fine motor skills, like picking up a cup or writing with a pencil. Parkinson’s disease is a neurodegenerative disease, meaning there’s cell loss in the brain, and it usually occurs as people age. Because you have significant cell loss, that affects the circuitry and can create a whole host of motor and non-motor symptoms.

Are these disorders genetic?
Some movement disorders, like dystonia and essential tremor, can be genetic, while essential tremor can occur spontaneously or run in the family. Parkinson’s disease, on the other hand, is not genetic for the most part.

How are movement disorders treated?
There are lots of treatment options with medication management and surgical interventions that can help control the symptoms and improve your quality of life. In the case of Parkinson’s, patients can also modify their lifestyles. Diet, exercise, and controlling co-morbidities like high blood pressure or high blood sugar can help to slow down the progression of this disease.

What happens if medications aren’t enough to control the symptoms?
Most people with a movement disorder will find success in managing their symptoms through medications or lifestyle changes. But for some, they might become intolerant of the medications over time, they might have such bad side effects that the person can’t take the medicine anymore, or the disease has progressed to where it has significantly impacted a person’s daily activities. In those cases, surgical interventions, such as deep-brain stimulation or high-intensity focused ultrasound, will be considered.

What’s important for people to keep in mind if they or a loved one are diagnosed with a movement disorder?
We have a confluence of great technologies in terms of diagnosing and treating movement disorders, and there are a variety of medications that are quite effective at managing the symptoms to help people maintain their quality of life.