Movement disorders are clinical syndromes with either an excess of movement or a paucity of voluntary and involuntary movements, unrelated to weakness or spasticity.[1] Movement disorders are synonymous with basal ganglia or extrapyramidal diseases.[2] Movement disorders are conventionally divided into five major categories- hyperkinetic and hypokinetic.
| Movement disorder | |
|---|---|
| Specialty | Neurology Psychiatry |
Hyperkinetic movement disorders refer to dyskinesia, or excessive, often repetitive, involuntary movements that intrude upon the normal flow of motor activity.
Hypokinetic movement disorders refer to akinesia (lack of movement), hypokinesia (reduced amplitude of movements), bradykinesia (slow movement), and rigidity. In primary movement disorders, the abnormal movement is the primary manifestation of the disorder. In secondary movement disorders, the abnormal movement is a manifestation of another systemic or neurological disorder.[3]
Classification
| Movement Disorders[4] | ICD-9-CM | ICD-10-CM |
|---|---|---|
| Hypokinetic Movement disorders | ||
| Poliomyelitis,[5] acute | 045 | A80 |
| Amyotrophic lateral sclerosis, ALS[5] (Lou Gehrig's disease) | 335.20 | G12.21 |
| Parkinson's disease (Primary or Idiopathic Parkinsonism) | 332 | G20 |
| Secondary Parkinsonism | G21 | |
| Parkinson plus syndromes | ||
| Pantothenate kinase-associated neurodegeneration | G23.0 | |
| Progressive Supranuclear Ophthalmoplegia | G23.1 | |
| Striatonigral degeneration | G23.2 | |
| Multiple sclerosis[5] | 340 | G35 |
| Radiation-induced polyneuropathy (brachial and lumbar plexopathies) | G62.82 | |
| Muscular dystrophy[5] | 359.0 | G71.0 |
| Cerebral palsy[5] | 343 | G80 |
| Rheumatoid arthritis[5] | 714 | M05 |
| Hyperkinetic Movement disorders | ||
| Attention-deficit hyperactivity disorder (with hyperactivity) | 314.01 | F90 |
| Tic disorders (involuntary, compulsive, repetitive, stereotyped) | F95 | |
| Tourette's syndrome | F95.2 | |
| Stereotypic movement disorder | F98.5 | |
| Huntington's disease (Huntington's chorea) | 333.4 | G10 |
| Dystonia | G24 | |
| Drug induced dystonia | G24.0 | |
| Idiopathic familial dystonia | 333.6 | G24.1 |
| Idiopathic nonfamilial dystonia | 333.7 | G24.2 |
| Spasmodic torticollis | 333.83 | G24.3 |
| Idiopathic orofacial dystonia | G24.4 | |
| Blepharospasm | 333.81 | G24.5 |
| Other dystonias | G24.8 | |
| Other extrapyramidal movement disorders | G25 | |
| Essential tremor | 333.1 | G25.0 |
| Drug induced tremor | G25.1 | |
| Other specified form of tremor | G25.2 | |
| Myoclonus | 333.2 | G25.3 |
| Chorea (rapid, involuntary movement) | ||
| Drug induced chorea | G25.4 | |
| Drug-induced tics and tics of organic origin | 333.3 | G25.6 |
| Paroxysmal nocturnal limb movement | G25.80 | |
| Painful legs (or arms), moving toes (or fingers) syndrome | G25.81 | |
| Sporadic restless leg syndrome | G25.82 | |
| Familial restless leg syndrome | G25.83 | |
| Stiff-person syndrome | 333.91 | G25.84 |
| Ballismus (violent involuntary rapid and irregular movements) | G25.85 | |
| Hemiballismus (affecting only one side of the body) | G25.85 | |
| Myokymia, facial | G51.4 | |
| Neuromyotonia (Isaacs Syndrome) | 359.29 | G71.19 |
| Opsoclonus | 379.59 | H57 |
| Rheumatic chorea (Sydenham's chorea) | I02 | |
| Abnormal head movements | R25.0 | |
| Tremor unspecified | R25.1 | |
| Cramp and spasm | R25.2 | |
| Fasciculation | R25.3 | |
| Athetosis (contorted torsion or twisting) | 333.71 | R25.8 |
| Dyskinesia (abnormal, involuntary movement) | ||
| Tardive dyskinesia | ||
Diagnosis
Step I : Decide the dominant type of movement disorder[6]
Step II : Make differential diagnosis of the particular disorder[citation needed]
Step II: Confirm the diagnosis by lab tests[citation needed]
- Metabolic screening
- Microbiology
- Immunology
- CSF examination
- Genetics
- Imaging
- Neurophysiological tests
- Pharmacological tests
Treatment
Treatment depends upon the underlying disorder.[7] Movement disorders have been known to be associated with a variety of autoimmune diseases.[8]
History
Vesalius and Piccolomini in 16th century distinguished subcortical nuclei from cortex and white matter. However Willis' conceptualized the corpus striatum as the seat of motor power in the late 17th century. In mid-19th-century movement disorders were localized to striatum by Choreaby Broadbent and Jackson, and athetosis by Hammond. By the late 19th century, many movement disorders were described, but for most no pathologic correlate was known.[9]