Movement disorders are usually neurogenic disorders of the postural and musculoskeletal system. They are most often preceded by damage to cerebellar nerve tissue, the basal ganglia, or the spinal cord. Combined medicinal, movement therapy, and in some cases even invasive surgical procedures of neurology and neurosurgery are used to treat the disorder.
What are movement disorders?
In the narrow definition, movement disorders include all neurogenic disorders of the postural and musculoskeletal system that have their cause in the central nervous system. In the broader definition, movement disorders also include psychologically caused postural and locomotor disorders, such as psychologically caused lack of movement. Neurogenic movement disorders are often characterized by abnormal or extra movements that severely interfere with the patient’s daily life. In many cases, these disorders are associated with a change in muscle tone due to dysfunction of the central nervous system. In other cases, neurogenic movement disorders manifest themselves in excessive movements and are then often due to a centrally disturbed depth sensitivity, without which movements can no longer be adequately planned or controlled at will. Some of the best known neurogenic movement disorders are ataxias, tremor and spasticity. In addition, the term movement disorders is used particularly frequently in connection with degenerative diseases such as Parkinson’s disease or Huntington’s disease.
Causes
In the narrower definition, the cause of movement disorders is damage to the movement control bodies within the central nervous system. As a disease, movement disorder is often preceded by Parkinson’s disease. However, related degenerations of the central nervous system can also lead to reduced mobility. Movement disorders such as tremor in the sense of tremor can be due to genetically inherited factors or present as intention tremor, for example, in the context of cerebellar damage. Neurogenic movement disorders such as dystonia are usually hereditary and lead to an increased susceptibility to seizures due to a usually genetically increased muscle tone. Neurological gait disorders and spastic paralysis are also movement disorders and can result from inflammatory, degenerative or traumatic damage to the central nervous system or preferably the spinal cord. Ataxias present as movement disorders primarily in cerebellar disorders such as Wilson’s disease and Gilles-de-la-Tourette syndrome. Pathological processes in the basal ganglia are also frequently the cause of movement disorders. In particular, automatic movements and voluntary movement precision are disturbed. People with movement disorders suffer from different symptoms depending on the type of movement disorder and its cause. In some patients, deep motor perception is disturbed. Their central nervous system receives only reduced information about the position of joints and muscle tension due to mostly spinal cord lesions. Thus, movement planning is disturbed. Especially in the dark, disturbances of depth sensitivity lead to imprecise, sometimes overshooting movements. In movement disorders such as tremor, on the other hand, antagonistic muscle groups contract involuntarily and strictly rhythmically, causing tremors. In spastic movement disorders, there is increased muscle tone, which makes it difficult for patients to walk normally and to stretch and flex muscles involved in movement. This results, for example, in a disturbed gait pattern with unusual step frequency. In contrast, when movement disorders are caused by a reduction in muscle tone, movements often appear diffuse and patients are in danger of falling over their own legs. Movement disorders are also often characterized by reflexively defective muscle contractions that elude voluntary action and thus interfere with voluntary execution of movements.
Diseases with this symptom
- Alcoholism
- Wilson’s disease
- Dystonia
- ALS
- Restless Legs Syndrome
- Stroke
- Huntington’s chorea
- Epilepsy
- Ataxia
- Circulatory disorders
- Multifocal motor neuropathy
- Multiple sclerosis
- Spasticity
- Parkinson’s disease
- Tourette’s Syndrome
Diagnosis and course of the disease
In the diagnosis of movement disorders, gait disturbances and hand dysfunction are observed, assessed for their nature, origin and severity, and related to an overriding disease. In addition to reflex testing using equipment, the diagnostic process includes, for example, measurement of conduction in the central nervous system. This is supplemented by imaging such as MRI or examinations of attention and memory conduction. The prognosis of neurogenic movement disorders depends on the primary cause. Degenerative diseases in particular do not have an overly favorable prognosis.
Complications
Movement disorders are usually due to neurologic interventions, and cerebellar tissue is often damaged. Movement disorders are disorders of the postural and locomotor system that have their origin in the central nervous system. Patients are severely impaired in their daily lives, and movements can no longer be adequately planned and controlled. The best-known movement disorders are ataxias, spasticity and tremor. Neurological gait disorders are not uncommon; inflammatory or traumatic damage to the central nervous system or spinal cord is responsible. These people suffer from different symptoms, in some patients deep motor perception is disturbed. The central nervous system receives only reduced information and can no longer assess the position of joints and muscle tension. Thus, the movement disorder is given, these disorders lead to very imprecise and sometimes overshooting movements. The movements often seem diffuse and one always has the impression that the patient is falling over his own feet. The diagnosis of gait disorders are associated with another disease, a conduction measurement in the central nervous system is used for diagnosis. Usually an MRI is also done and attention and memory are tested. If the cerebellum is damaged, however, a physiotherapeutic treatment is advised. Through regular and targeted training, the movement disorders can be compensated by other brain regions. However, if the movement disorders do not improve, patients must learn how to deal with the movement disorder and what aids are available.
When should you see a doctor?
Movement disorders have a variety of causes. Most are neurological, but there are also psychological causes of movement disorders, such as Munchausen syndrome. Tremor is the most common symptom in neurology and can occur at rest and during movement. A well-known movement restriction is essential tremor, also known as “restless legs.” It occurs as a result of Parkinson’s disease, which requires specialist treatment. Many movement disorders are the result of accidents. They also require treatment. Neurological movement disorders are caused by a whole range of diseases, so accurate clarification is imperative. In addition to Parkinson’s disease and tremor, dementia, diseases of the autonomic nervous system, stroke, epilepsy and spastic paralysis can also cause movement disorders. A wide variety of brain area disorders, as well as spinal cord injuries, produce movement disorders in diverse forms. Neurological gait disorders severely limit the patient and can significantly increase the risk of falls. Therefore, seeing a doctor is extremely important. Only the specialized clinic can find out the cause of a movement disorder. It has the diagnostic possibilities and can, for example, carry out performance measurements on the central nervous system. Here, examinations of attention and memory performance are also possible. In addition, specialized neurological clinics often have tremor laboratories that can measure informative movement and muscle currents. Only the composition of individual facets provides a meaningful overall picture and leads to a clear diagnosis.
Treatment and therapy
Patients with movement disorders are usually managed by an interdisciplinary team of nurses, neurologists, physical therapists, and speech therapists who specialize in the treatment of movement disorders. The disorder is treated depending on its primary cause. For example, drug therapies are available for some disorders.Tremor in Parkinson’s patients can thus be suppressed at least temporarily in the early stages by drugs such as L-dopa. Botulinum toxin therapy has also become established as a drug therapy for various movement disorders. A rather new treatment method is deep brain stimulation, which is mainly used for Parkinson’s disease, spastic movement disorders, dystonia and tremor disorders. Stimulation electrodes are placed in the patient’s nervous system as part of a neurosurgical procedure, where they use high-frequency signals to inhibit hyperexcited activity. For some time, intrathecal baclofen has also been used to treat severe dystonia and spasticity. Especially in the case of movement disorders after cerebellar damage due to strokes, physiotherapeutic treatment is sometimes the most important way of treatment. Patients can shift the functions of defective brain areas to healthy brain areas through regular and targeted training under expert supervision, thus bringing about an improvement in the movement disorder. If movement disorders do not improve, patients learn to cope with the disorder in occupational therapy and use assistive devices to better cope with everyday life.
Outlook and prognosis
Movement disorders can develop not only in old age. Movement disorders also occur repeatedly in young age. The causes may vary. Studies repeatedly show that the younger generation moves less. Too little movement or the wrong movement can be causes of movement disorders. For example, strength athletes very often have to struggle with movement disorders. The causes are usually overtraining and undertraining. The prospects for recovery are very good in the case of movement disorders. If the injured patient has overtrained, he or she should take a gentler approach to training. Only in this way can the overloaded muscles recover. The muscles will then regenerate on their own. Undertraining, i.e. too little exercise, can also have consequences. Sitting in front of the computer, television, etc. for too long can result in movement disorders. An exact prognosis can be established with a doctor. It is important to determine how severe this disorder is so that the right treatment can be selected.
Prevention
Neurogenic movement disorders can be prevented only to the extent that diseases of the central nervous system can be prevented. No promising preventive measures currently exist for autoimmune diseases such as multiple sclerosis and degenerative diseases such as Parkinson’s disease.
Here’s what you can do yourself
In the home and in the home environment, all routine activities of everyday life should be simplified. This applies to dressing, taking meals, personal hygiene to going to the toilet. Barrier-free living is not always possible. However, carpet edges and door thresholds are sources of danger that should not be underestimated. Remedies are small ramps and the removal of carpets. A chair in the bathroom and hallway, additional handles to hold on to, comfortable coat racks that are easy to put on and take off, or shoes with Velcro fasteners are real helpers. The bedroom and the bed must take into account the requirements of the movement restriction. Adapted entry heights to enable comfortable entry and exit, holders for walking aids and easily accessible light switches also make it easier to get up at night. Utensils such as glasses, water glass, medication and dentures are conveniently within easy reach on a small side table. A house emergency call system, which different institutions offer such as the Johanniter, DRK or or the Malteser assistance service, proves useful. In an emergency, be it a fall or not being able to get out of the bathtub, fast and reliable help is at hand. A telephone with simple operation, large buttons and a bright display makes it easier to make calls. When staying outside the home, a cell phone is useful.
