Movement Disorders

Understanding Movement Disorders

Movement disorders are a group of neurological conditions that cause abnormal voluntary or involuntary movements. They may involve excessive movement (hyperkinetic disorders) or reduced/slow movement (hypokinetic disorders). These conditions result from dysfunction in the basal ganglia and related brain circuits.

Dr. Chetan Padghan provides structured clinical assessment and evidence-based management for the full spectrum of movement disorders.

Types of Movement Disorders

Parkinson’s Disease & Parkinsonism

Parkinson’s disease is a progressive neurodegenerative disorder caused by loss of dopamine-producing neurons in the brain:

Cardinal Features:

• Tremor — resting tremor, often starting in one hand (“pill-rolling”)
• Rigidity — muscle stiffness throughout the range of movement
• Bradykinesia — slowness of movement, reduced facial expression, soft voice
• Postural instability — balance problems and tendency to fall (later stages)

Other Symptoms:

• Reduced sense of smell
• Sleep disturbances — vivid dreams, acting out dreams (REM sleep behavior disorder)
• Constipation and autonomic dysfunction
• Depression, anxiety, and cognitive changes
• Small handwriting (micrographia)

Parkinsonian Syndromes (Atypical Parkinsonism):

• Progressive supranuclear palsy (PSP)
• Multiple system atrophy (MSA)
• Corticobasal degeneration (CBD)
• Drug-induced parkinsonism
• Vascular parkinsonism

Tremor

Involuntary, rhythmic shaking of a body part:

• Essential tremor — the most common movement disorder; postural and action tremor, often affecting hands and voice
• Physiological tremor — normal, usually enhanced by stress, caffeine, or medications
• Dystonic tremor — tremor associated with dystonia
• Cerebellar tremor — intention tremor due to cerebellar dysfunction
• Psychogenic (functional) tremor — tremor related to functional neurological disorder

Dystonia

Sustained or intermittent muscle contractions causing abnormal postures or repetitive movements:

• Cervical dystonia (torticollis) — abnormal head and neck posturing
• Blepharospasm — involuntary eye closure
• Writer’s cramp — task-specific dystonia affecting the hand
• Generalized dystonia — affecting multiple body regions
• Hemidystonia — affecting one side of the body

Chorea & Huntington’s Disease

• Chorea — irregular, unpredictable, involuntary movements flowing from one body part to another
• Huntington’s disease — inherited neurodegenerative condition causing chorea, cognitive decline, and psychiatric symptoms
• Sydenham’s chorea — post-streptococcal autoimmune chorea in children
• Drug-induced chorea — tardive dyskinesia from neuroleptic medications

Myoclonus

Sudden, brief, shock-like involuntary movements:

• Cortical myoclonus
• Essential myoclonus
• Epileptic myoclonus
• Post-hypoxic myoclonus

Other Movement Disorders

• Tics and Tourette syndrome — repetitive, stereotyped movements or vocalizations
• Restless legs syndrome (RLS) — uncomfortable urge to move the legs, especially at rest
• Ataxia — impaired coordination and balance due to cerebellar dysfunction
• Wilson’s disease — copper metabolism disorder causing movement and liver problems
• Functional (psychogenic) movement disorders

Diagnostic Approach

Clinical Assessment

Movement disorder diagnosis is primarily clinical, based on careful observation and examination:

• Detailed history of symptom onset, progression, and pattern
• Observation of movements at rest, during posture holding, and during action
• Assessment of gait, balance, and coordination
• Evaluation of cognitive function and psychiatric symptoms
• Family history — many movement disorders have genetic components
• Medication review — to identify drug-induced movement disorders

Investigations

• Brain MRI — to identify structural causes and support specific diagnoses
• DaTscan (dopamine transporter imaging) — to differentiate Parkinson’s disease from essential tremor
• Genetic testing — for Huntington’s disease, Wilson’s disease, hereditary ataxias, and dystonia genes
• Blood tests — copper and ceruloplasmin (Wilson’s disease), thyroid function, metabolic panel
• Electrophysiology — EMG for tremor analysis, EEG for myoclonus evaluation

Treatment Approach

Parkinson’s Disease Management

• Levodopa/carbidopa — the most effective medication for Parkinson’s symptoms
• Dopamine agonists — pramipexole, ropinirole
• MAO-B inhibitors — rasagiline, selegiline
• COMT inhibitors — entacapone
• Amantadine — for dyskinesia management
• Exercise and physiotherapy — essential component of management
• Advanced therapies — deep brain stimulation (DBS) referral for selected patients

Tremor Management

• Beta-blockers (propranolol) and primidone for essential tremor
• Targeted therapy based on tremor type
• Botulinum toxin injections for focal tremors
• DBS referral for medication-resistant tremor

Dystonia Management

• Botulinum toxin injections — first-line treatment for focal dystonias
• Oral medications — anticholinergics, baclofen, benzodiazepines
• DBS for generalized or medication-resistant dystonia
• Physical therapy and rehabilitation

Other Treatments

• Tetrabenazine or deutetrabenazine for chorea
• Treatment of underlying causes (Wilson’s disease — copper chelation)
• Dopaminergic medications for restless legs syndrome
• Multidisciplinary rehabilitation

Living with Movement Disorders

• Regular follow-up for medication adjustment and monitoring
• Exercise programs — tai chi, yoga, walking, and specific physiotherapy exercises
• Occupational therapy for daily living activities
• Speech therapy for voice and swallowing difficulties
• Psychological support for depression, anxiety, and adjustment
• Caregiver support and education

---

Dr. Chetan Padghan provides expert care for all types of movement disorders in Pune. If you are experiencing tremor, slowness, stiffness, or abnormal movements, schedule a consultation for comprehensive evaluation and management.