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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.
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.
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.
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.
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.
Increased muscle tone may also be accompanied by pain and spasm of the muscles. This is also seen in dystonias.
There are a range of different types of movement disorders. Symptoms and signs of these disorders vary for different types. (1-5)
This leads to contraction of eyelid muscles and closure of one or both eyes. This is a type of dystonia.
Dyskinesia is characterized by a series of abnormal movements. Tics and tremors are rhythmic or pendulous movements of the arms and legs.
In tics there may repeated movements like twitches of facial muscles, shrugging, grimacing, grunting or sighing.
Patients with dyskinesia may also have hypokinesia (less movements), bradykinesia (slow movements) or akinesia (complete lack of movements).
There may be choreas (rapid jerky movements of the limbs) or athetosis (slow writhing movements) or myoclonus (rapid, purposeless movements of the limbs that appear suddenly and disappear on their own).
Patients report that they feel an involuntary “pulling” or “twisting ”of the muscles before the movement appears.
Tremors are the most common symptom. They appear in the head, face, especially the chin, voice or arms and legs. Tremors may occur at rest or may occur during attempts to perform a task.
Asterixis is another symptom characterized by sudden loss of tone while attempting to maintain a limb in a certain position.
There is flapping of the hands as the patient holds out his or her arm.
Propulsion and retropulsion are symptoms affecting posture and balance. There is stooping, pull to one side while walking, short steps and easy falls while walking.
This is seen in patients with Parkinson’s disease.
Ataxia causes imbalance and difficulties in gait and walking.
Dysphonia refers to disorder of the voice caused by abnormal contraction of the muscles producing voice.
There may be times when no sound can be made at all and times when the voice is quivery, strained, hoarse or jerky.
Restless leg syndrome is characterized by creeping, tingling or feeling of bugs over the legs or sometimes arms especially at bedtime or at rest. The feeling is relieved temporarily by movement of the limbs.
Other problems include disrupted sleep, insomnia and daytime fatigue.
Wilson’s disease in addition manifests with symptoms of liver disease like jaundice etc.
There may be psychiatric and behavioral disturbances like loss of concentration, cognitive decline, depression etc. there are special KF rings that can be seen in the eyes on examination. Rarely seizures may be seen.
Parkinson’s disease is characterized by tremor at rest, rigidity and bradykinesia. There is diminished postural stability with falls and a “shuffling gait”. There is a diminished arm swing while walking.
There is a feature called festination while walking that refers to the symptom when the patient may lean forward and walk with fast, shortened steps which can result in an involuntary forward acceleration.
Sometimes the patient may just “freeze” in their movements.
There may be micrographia or progressive shortening of the letters written by the patient.
Other symptoms that are commonly seen include:
The patient may present with a fixed, immobile, and expressionless face called masked facies with excessive drooling.