Movement disorder

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12 hours ago
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Albert Flores

Movement disorder refers to any clinical syndrome with either an excess of movement or a paucity of voluntary and involuntary movements, unrelated to weakness or spasticity. Movement disorders are synonymous with basal ganglia or extrapyramidal diseases. Movement disorders are conventionally divided into two major categories- hyperkinetic and hypokinetic.

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. +more In secondary movement disorders, the abnormal movement is a manifestation of another systemic or neurological disorder.

Classification

Movement DisordersICD-9-CMICD-10-CM
Hypokinetic Movement disorders
Parkinson's disease (Primary or Idiopathic Parkinsonism)332G20
Secondary ParkinsonismG21
Parkinson plus syndromes
Pantothenate kinase-associated neurodegenerationG23. 0
Progressive Supranuclear OphthalmoplegiaG23. +more1
Striatonigral degenerationG23. 2
Hyperkinetic Movement disorders
DystoniaG24
Drug induced dystoniaG24. 0
Idiopathic familial dystonia333. 6G24. 1
Idiopathic nonfamilial dystonia333. 7G24. 2
Spasmodic torticollis333. 83G24. 3
Ideopathic orofacial dystoniaG24. 4
Blepharospasm333. 81G24. 5
Other dystoniasG24. 8
Other extrapyramidal movement disordersG25
Essential tremor333. 1G25. 0
Drug induced tremorG25. 1
Other specified form of tremorG25. 2
Tremor unspecifiedR25. 1
Myoclonus333. 2G25. 3
Opsoclonus379. 59H57
Chorea (rapid, involuntary movement)
Drug induced choreaG25. 4
Rheumatic chorea (Sydenham's chorea)I02
Huntington's Chorea333. 4G10
Ballismus (violent involuntary rapid and irregular movements)G25. 85
Hemiballismus (affecting only one side of the body)G25. 85
Athetosis (contorted torsion or twisting)333. 71R25. 8
Dyskinesia (abnormal, involuntary movement)
Tardive dyskinesia
Attention-deficit hyperactivity disorder (with hyperactivity)314. 01F90
Tic disorders (involuntary, compulsive, repetitive, stereotyped)F95
Tourette's syndromeF95. 2
Drug-induced tics and tics of organic origin333. 3G25. 6
Stereotypic movement disorderF98. 5
Paroxysmal nocturnal limb movementG25. 80
Painful legs (or arms), moving toes (or fingers) syndromeG25. 81
Sporadic restless leg syndromeG25. 82
Familial restless leg syndromeG25. 83
Stiff-person syndrome333. 91G25. 84
Abnormal head movementsR25. 0
Cramp and spasmR25. 2
FasciculationR25. 3
.

Diagnosis

Step I : Decide the dominant type of movement disorder

Step II : Make differential diagnosis of the particular disorder

Step II: Confirm the diagnosis by lab tests * Metabolic screening * Microbiology * Immunology * CSF examination * Genetics * Imaging * Neurophysiological tests * Pharmacological tests

Treatment

Treatment depends upon the underlying disorder. Movement disorders have been known to be associated with a variety of autoimmune diseases.

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. +more 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.

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