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Age and Ageing Dec 2019Movement disorders are a diverse and challenging group of neurological conditions. Geriatricians and allied health professionals play a key role in the care of patients...
Movement disorders are a diverse and challenging group of neurological conditions. Geriatricians and allied health professionals play a key role in the care of patients living with these disorders. Age and Ageing is making freely available online a collection of 15 papers that highlight the breadth and depth of this field. Perhaps unsurprisingly papers on Parkinson's disease predominate, but rarer movement disorders, including those seen following stroke and Huntington's disease, are also represented. Difficulties in diagnosis are explored, together with innovative approaches to management of both motor and non-motor symptoms. The collection includes qualitative work, longitudinal studies and clinical trials, and both the individual patient perspective and the international perspective are considered. There are papers for generalists, papers for specialists, papers for clinical commissioners and papers for researchers. Comprehensive review articles provide clarity, guidance and pragmatism. Finally, a New Horizons article encourages us to look to the future of movement disorders, which lies not only in developing novel therapies and trials but also in recognising the enormous value of palliative care and the multidisciplinary approach.
Topics: Humans; Movement Disorders; Parkinson Disease
PubMed: 31830237
DOI: 10.1093/ageing/afz147 -
The Lancet. Child & Adolescent Health Dec 2019The diagnosis and management of movement disorders in children can be improved by understanding the pathways, neurons, ion channels, and receptors involved in motor... (Review)
Review
The diagnosis and management of movement disorders in children can be improved by understanding the pathways, neurons, ion channels, and receptors involved in motor learning and control. In this Review, we use a localisation approach to examine the anatomy, physiology, and circuitry of the basal ganglia and highlight the mechanisms that underlie some of the major movement disorders in children. We review the connections between the basal ganglia and the thalamus and cortex, address the basic clinical definitions of movement disorders, and then place diseases within an anatomical or physiological framework that highlights basal ganglia function. We discuss how new pharmacological, behavioural, and electrophysiological approaches might benefit children with movement disorders by modifying synaptic function. A better understanding of the mechanisms underlying movement disorders allows improved diagnostic and treatment decisions.
Topics: Adolescent; Basal Ganglia; Cerebral Cortex; Child; Cognitive Behavioral Therapy; Dopamine; Electrophysiological Phenomena; Humans; Motor Neurons; Movement Disorders; Synapses; Thalamus; Young Adult
PubMed: 31653548
DOI: 10.1016/S2352-4642(19)30330-X -
Handbook of Clinical Neurology 2020A number of studies reported the possible differences between men and women in movement disorders. Evidence shows that estrogens may have a neuroprotective effect and... (Review)
Review
A number of studies reported the possible differences between men and women in movement disorders. Evidence shows that estrogens may have a neuroprotective effect and may modulate the neurodevelopment of the different brain structures. Movement disorders including Parkinson's disease, dementia with Lewy body, Huntington's disease, Tourette's syndrome, and dystonia among others display significant clinical differences between sexes, with structural differences in the dopaminergic pathways between men and women. Here we summarize the most relevant clinical aspects of some of the most common movement disorders, highlighting the differences in disease onset, clinical presentation, therapy, and outcomes. Increased recognition of these differences may help physicians better understand the pathophysiology of these conditions and provide a tailored therapeutic approach.
Topics: Brain; Female; Humans; Huntington Disease; Male; Movement Disorders; Parkinson Disease; Sex Characteristics; Tourette Syndrome
PubMed: 33008531
DOI: 10.1016/B978-0-444-64123-6.00019-9 -
Continuum (Minneapolis, Minn.) Oct 2022This article is designed to help the clinician identify the most common pediatric movement disorders and recognize benign versus pathologic movements in infancy and... (Review)
Review
PURPOSE OF REVIEW
This article is designed to help the clinician identify the most common pediatric movement disorders and recognize benign versus pathologic movements in infancy and childhood, with a particular focus on treatable conditions and those that should not be missed.
RECENT FINDINGS
As telehealth has become more prevalent as a means of providing health care services, the challenges of obtaining relevant examination findings during telehealth encounters for assessment of children with movement disorders have become evident.
SUMMARY
Although many children who present with a chief complaint of "abnormal movements" are found to have a benign, self-resolving etiology, it is critical that neurologists accurately recognize benign versus pathologic movements in children to ensure appropriate diagnosis and intervention.
Topics: Child; Humans; Movement Disorders; Telemedicine
PubMed: 36222774
DOI: 10.1212/CON.0000000000001187 -
Nature Reviews. Neurology Feb 2020In a range of neurological conditions, including movement disorders, sex-related differences are emerging not only in brain anatomy and function, but also in... (Review)
Review
In a range of neurological conditions, including movement disorders, sex-related differences are emerging not only in brain anatomy and function, but also in pathogenesis, clinical features and response to treatment. In Parkinson disease (PD), for example, oestrogens can influence the severity of motor symptoms, whereas elevation of androgens can exacerbate tic disorders. Nevertheless, the real impact of sex differences in movement disorders remains under-recognized. In this article, we provide an up-to-date review of sex-related differences in PD and the most common hyperkinetic movement disorders, namely, essential tremor, dystonia, Huntington disease and other chorea syndromes, and Tourette syndrome and other chronic tic disorders. We highlight the most relevant clinical aspects of movement disorders that differ between men and women. Increased recognition of these differences and their impact on patient care could aid the development of tailored approaches to the management of movement disorders and enable the optimization of preclinical research and clinical studies.
Topics: Female; Humans; Male; Movement Disorders; Sex Characteristics; Sex Factors; Treatment Outcome
PubMed: 31900464
DOI: 10.1038/s41582-019-0294-x -
Tremor and Other Hyperkinetic Movements... 2020Telemedicine is the use of electronic communication technology to facilitate healthcare between distant providers and patients. In addition to synchronous video... (Review)
Review
Telemedicine is the use of electronic communication technology to facilitate healthcare between distant providers and patients. In addition to synchronous video conferencing, asynchronous video transfer has been used to support care for neurology patients. There is a growing literature on using telemedicine in movement disorders, with the most common focus on Parkinson's disease. There is accumulating evidence for videoconferencing to diagnose and treat patients with hyperkinetic movement disorders and to support providers in remote underserviced areas. Cognitive testing has been shown to be feasible remotely. Genetic counseling and other counseling-based therapeutic interventions have also successfully performed in hyperkinetic movement disorders. We use a problem-based approach to review the current evidence for the use of telemedicine in various hyperkinetic movement disorders. This Viewpoint attempts to identify possible telemedicine solutions as well as discussing unmet needs and future directions.
Topics: Dystonic Disorders; Genetic Counseling; Humans; Huntington Disease; Hyperkinesis; Medically Underserved Area; Movement Disorders; Myoclonus; Neuropsychological Tests; Parkinson Disease; Remote Consultation; Telemedicine; Tic Disorders; Tremor; Videoconferencing
PubMed: 32195039
DOI: 10.7916/tohm.v0.698 -
Neurologic Clinics May 2020Functional movement disorders (FMD) are commonly seen in neurologic practice and frequent sources of disability. Patients may present with tremor, weakness, dystonia,... (Review)
Review
Functional movement disorders (FMD) are commonly seen in neurologic practice and frequent sources of disability. Patients may present with tremor, weakness, dystonia, jerking movements, abnormal gait and speech, often combining several movement phenomenologies. Associated symptoms include chronic pain, depression, and anxiety. Treatment of FMD begins with an explanation of the diagnosis and needs to be tailored to patients' symptoms and comorbidities. There may be benefit from multidisciplinary treatment, including physical, occupational, and speech therapy, as well as psychotherapeutic interventions, especially cognitive behavior therapy. The role for neuromodulation such as transmagnetic stimulation in FMD treatment requires further research.
Topics: Conversion Disorder; Humans; Movement Disorders
PubMed: 32279721
DOI: 10.1016/j.ncl.2020.01.011 -
Handbook of Clinical Neurology 2020Deep brain stimulation (DBS) is a technique for invasive subcortical neuromodulation using a totally implantable permanent device. DBS is an effective therapy for... (Review)
Review
Deep brain stimulation (DBS) is a technique for invasive subcortical neuromodulation using a totally implantable permanent device. DBS is an effective therapy for movement disorders and is under investigation for the treatment of many other conditions including Tourette syndrome, epilepsy, and depression. Traditional DBS is limited by labor-intensive manual programming, high current requirements, and lack of responsiveness to fluctuations in the patient's signs and symptoms. The field is moving toward adaptive closed loop systems with stimulation modulated by peripheral or intracranial sensors, a technique often described as "smart neuromodulation." Advances in the understanding of brain rhythms associated with specific neurologic symptoms and the introduction of novel bidirectional neural interfaces are facilitating investigative studies of closed loop stimulation in movement disorders. These studies suggest the potential for greater efficacy with fewer adverse effects. It may be possible to generalize the hardware platforms and control strategies developed to other brain disorders.
Topics: Brain; Brain Diseases; Deep Brain Stimulation; Humans; Movement Disorders; Tourette Syndrome
PubMed: 32164850
DOI: 10.1016/B978-0-444-63934-9.00012-3 -
Continuum (Minneapolis, Minn.) Jun 2022This article reviews the recognition and management of cognitive syndromes in movement disorders, including those with parkinsonism, chorea, ataxia, dystonia, and tremor. (Review)
Review
PURPOSE OF REVIEW
This article reviews the recognition and management of cognitive syndromes in movement disorders, including those with parkinsonism, chorea, ataxia, dystonia, and tremor.
RECENT FINDINGS
Cognitive and motor syndromes are often intertwined in neurologic disorders, including neurodegenerative diseases such as Parkinson disease, atypical parkinsonian syndromes, Huntington disease, and other movement disorders. Cognitive symptoms often affect attention, working memory, and executive and visuospatial functions preferentially, rather than language and memory, but heterogeneity can be seen in the various movement disorders. A distinct cognitive syndrome has been recognized in patients with cerebellar syndromes. Appropriate recognition and screening for cognitive changes in movement disorders may play a role in achieving accurate diagnoses and guiding patients and their families regarding progression and management decisions.
SUMMARY
In the comprehensive care of patients with movement disorders, recognition of cognitive syndromes is important. Pharmacologic treatments for the cognitive syndromes, including mild cognitive impairment and dementia, in these movement disorders lag behind the therapeutics available for motor symptoms, and more research is needed. Patient evaluation and management require a comprehensive team approach, often linking neurologists as well as neuropsychologists, psychologists, psychiatrists, social workers, and other professionals.
Topics: Cognitive Dysfunction; Humans; Movement Disorders; Syndrome
PubMed: 35678400
DOI: 10.1212/CON.0000000000001134 -
Journal of the Neurological Sciences Feb 2022
Topics: Humans; Movement Disorders; Parkinsonian Disorders
PubMed: 34625287
DOI: 10.1016/j.jns.2021.120013