Anxiety, fatigue or stress increase symptoms of major movement disorders.
Movement disorders comprise a broad group of motor control disturbances in the specialty of neurology. Two major groups are distinguished: those characterized by slowness of movement and usually accompanied by increased muscle tone (akinetic rigid syndromes) and those characterized by the presence of abnormal involuntary movements (also called hyperkinesias or dyskinesias). The most important akinetic syndrome is Parkinson’s disease and its different variants, which are often called parkinsonisms or atypical parkinsonism. Hyperkinesias include tremor, dystonia, chorea, tics and myoclonias. The impact that movement disorders have on the patient’s quality of life is highly variable and will depend largely on the cause and its intensity. In some cases it is mild. In others, they cause a progressive deterioration associated with a significant alteration in the quality of life of the affected person.
Causes and most frequent symptoms
The classic symptoms of Parkinson’s disease include tremor, slowness of movement and muscle rigidity. It is not uncommon to be associated with constipation, loss of smell and mental depression and nightmares. Other less frequent parkinsonisms are associated with falls and difficulty in eye movement (progressive supranuclear palsy) or drops in blood pressure and significant difficulty in urination (multiple system atrophy). Dystonia cause muscle contractions, usually sustained and can affect any area of the body. Sometimes, especially in childhood, they are generalized.
In the adult they are more limited and cause torticolis, spasms of the scribe, involuntary closing of the eyes or difficulty to speak, depending on the area of the body that is altered. Tics are repetitive and irregular movements or sounds that can affect various muscle groups. The patients usually present an urgent sensation of need to move before the tic. They increase in situations of anxiety or fatigue but they can diminish when carrying out acts that require certain concentration.
The patient may voluntarily suppress them for a few seconds or minutes. The most important disease that is associated with tics is the Tourette’s syndrome. With the passage of time the motor and vocal tics of the disease tend to improve. Essential tremor is the most common cause of tremor. It can begin in the adolescence but in general its beginning is later. It progresses slowly in severity but does not alter gait or motor agility. The tremor is typically action tremor, i.e., it manifests when performing a motor act such as picking up a glass of water or a pencil to write; it subsides with limb rest. It sometimes improves with alcohol intake and worsens with stress and coffee intake and is often hereditary. Movement disorders are often of unknown cause and are then called primary or idiopathic. These cases include those of genetic cause, which are a minority. Other movement disorders are those of known or secondary cause. Causes of secondary cases include exposure to a toxic substance, head injuries, those produced by certain medications, infections of the nervous system or hydrocephalus. Identifying secondary cases is of enormous importance because by eliminating the cause it is possible to cure the disease.
Treatment
The management of the various movement disorders requires first and foremost a proper diagnosis. In many cases, it is the expertise of the experienced neurologist in the field of movement disorders that allows the appropriate treatment to be catalogued and proposed, since there are no specific laboratory tests in most cases. Recently, some laboratory or imaging tests have been developed that are very useful. DAT SPECT allows, for example, to visualize brain dopamine and exclude Parkinson’s if it is normal. We also have numerous laboratory tests that can establish an accurate diagnosis. Some are genetic and others allow us to diagnose infections or metabolic and other disorders. The treatment of movement disorders depends largely on the type of abnormal movement and its severity, and, of course, its cause.