Movement disorders: Symptoms
We distinguish between two major classes of movement disorders: hypokinetic (too little movement) and hyperkinetic (too much movement). These movement disorders are further subdivided according to the type of movement disorder, the cause and the accompanying symptoms. Some movement disorders occur in the context of neurodegenerative diseases, i.e. a premature loss of nerve cells that cannot be attributed to inflammation, tumors, circulatory disorders or other known causes.
Unique expertise at the USZ
The USZ offers unique expertise and choice in the field of movement disorders, both in terms of diagnosis and treatment.
To ensure that our patients are diagnosed to the best possible standards, the department offers all standard procedures (e.g. structural and functional imaging, neurogenetics, video-assisted examinations) in collaboration with other clinics at the hospital. In collaboration with experts from ETH Zurich, we also offer precise measurement methods for individual movement disorders such as tremor (trembling), which support the diagnosis.
The experienced team of specialists at the USZ is complemented by consulting professors such as Prof. Deuschl from Kiel (specifically: tremor, deep brain stimulation, focused ultrasound), Prof. Wolters from Amsterdam (specifically: pump therapies), Prof. Kaelin from Lugano (specifically: dystonia, botulinus toxin treatments) and PD Dr. Waldvogel from Lucerne (specifically: phenotyping of movement disorders), all of whom are internationally leading experts in their fields.
From a therapeutic point of view, we offer other forms of treatment in addition to traditional drug therapy. These include deep brain stimulation, MR-guided focused ultrasound, duodopa and apomorphine pumps. In addition, we offer individual patients the opportunity to participate in clinical trials, which also aim to alleviate symptoms or have a beneficial effect on the disease.
This unique variety of diagnostic and therapeutic tools allows us to design a highly personalized treatment strategy for each individual affected person, in the context of a personal and attentive treatment.
Types of movement disorders
A small overview, which is by no means complete, shows how differently movement disorders can manifest themselves:
Hypokinetic movement disorders
- Parkinson’s syndrome: This refers to a slowing and impoverishment of movements, which can be accompanied by muscle stiffness (rigor) or tremors. Parkinson’s syndrome can be a sign of Parkinson’s disease, but can also occur in the context of other diseases. These include other neurodegenerative, so-called atypical Parkinson’s syndromes, but also circulatory disorders in the brain or drug side effects.
Hyperkinetic movement disorders
- Tremor: Tremor is a very common movement disorder. This results in a regular up and down or back and forth movement of the arms, legs, head or chin, for example. Essential tremor is the most common form of this disorder.
- Dystonia: Dystonia is characterized by persistent tension or distortion of individual muscles, which can lead to incorrect posture. Examples include torticollis (torticollis), writer’s cramp, blepharospasm (eyelid spasm) and musician’s dystonia.
- Tics: By this we mean short, sometimes similarly manifesting movements such as squinting the eyes, raising the shoulders, tapping the thighs, but also more complex movements accompanied by vocalizations. Patients can usually suppress such movements for a short time, but feel relieved when they are able to perform the movement. Tourette’s disease is an important disorder.
- Chorea: Chorea is a movement disorder with complex, random, moderately fast movements. Chorea can occur as part of Huntington’s disease, often with changes in general behavior, but also after certain infections, for example.
Movement disorders: Causes
Movement disorders are usually a symptom of a neurological disease. The cause therefore usually lies in the brain, more precisely in the basal ganglia. This region is part of the gray matter, which is located deep in the brain or cerebrum. The causes can be both congenital and acquired, and are often completely unknown.
- Unknown cause: In most neurodegenerative diseases such as Parkinson’s disease, the cause is unknown. These diseases are sometimes referred to as “idiopathic”.
- Genetic causes: In more and more diseases, e.g. dystonia or Huntington’s disease, there are underlying genetic changes that can be detected.
- Psychological and emotional causes: Psychological problems and illnesses can lead to all kinds of movement disorders or exacerbate movement disorders.
- Medication: Various medications, for example for epileptic seizures or psychiatric illnesses, can lead to various forms of movement disorders.
- Alcohol consumption as a cause: Excessive and prolonged alcohol consumption can lead to so-called ataxia, a gait disorder. Patients suffer from coordination problems and balance disorders. There are many different types of ataxia. The cerebellum is often affected by this disease.
- Metabolic disorders as a cause: iron deficiency can trigger or exacerbate restless legs syndrome and a disturbance in copper metabolism can lead to tremor. There are also many other metabolic disorders that can affect movement.
Movement disorders: Diagnosis by us
Movement disorders must primarily be assessed clinically. In other words, this means that a doctor – ideally a specialist in movement disorders – carefully observes, describes, documents and finally interprets the symptoms. Depending on the situation, this can be immediately expedient or challenging.
Based on these conclusions and the corresponding diagnostic assessment, a decision must be made as to whether further diagnostic steps are necessary. These include attempts to improve symptoms with certain medications, imaging such as an MRI, CT or nuclear medicine examinations, genetic tests, blood tests or precise measurements of movement disorders using appropriate equipment.
Movement disorders: Treatment
In many cases, the diseases responsible for the movement disorders cannot be cured. Treatment is therefore often aimed at alleviating the symptoms.
Which therapy is ultimately the right one depends on the actual cause and requires a precise diagnosis by medical personnel.