ConditionBrain & nerves
Movement Disorders
Movement disorders are neurological conditions that affect the speed, smoothness, quality or control of movement. Some cause too little or too slow movement, such as Parkinson's disease; others cause extra, involuntary movements, such as tremor, dystonia, chorea, tics and myoclonus. Ataxia causes clumsy, uncoordinated movement. Most involve the basal ganglia or cerebellum. Causes include genetics, aging, medicines, stroke and other illnesses. Many are well controlled with medicines, therapy or surgery.
Also called: Extrapyramidal disorders, involuntary movement disorders, dyskinesias, hypokinetic and hyperkinetic disorders
At a glance
- What they are
- Neurological conditions causing abnormal, slowed, excessive or uncoordinated movements.
- Too little movement
- Parkinson's disease and related parkinsonian syndromes.
- Too much movement
- Tremor, dystonia, chorea, tics, myoclonus, restless legs, tardive dyskinesia.
- Poor coordination
- Ataxias from cerebellar disease.
- Diagnosis
- Mostly clinical by a neurologist; brain imaging, genetic and blood tests in some cases.
- Treatment
- Medicines, botulinum toxin injections, physical therapy, deep brain stimulation.
When to get help
Call 911 or go to the ER
- Sudden weakness, clumsiness, loss of balance or abnormal movements on one side with facial drooping or speech problems: call 911 or your local emergency number
- High fever, severe muscle rigidity and confusion after starting or changing an antipsychotic or Parkinson's medicine (possible neuroleptic malignant syndrome or withdrawal)
- Sudden twisting of the neck, eyes rolling upward, or jaw locking after a new medicine, especially anti-nausea or antipsychotic drugs (acute dystonic reaction)
See a doctor within a day or two
- Rapidly worsening movements, falls or confusion over days to weeks
- Jerky movements with agitation, high temperature, sweating and diarrhea after combining certain antidepressants or other serotonin drugs
- New chorea (dance-like movements) in a child after a sore throat
Book a routine appointment
- A tremor, slowness, stiffness or shuffling walk that is gradually developing
- Repetitive involuntary movements, twisting postures or tics
- Unsteady walking or clumsy hands getting worse over months
- Involuntary movements of the mouth, tongue or face in someone taking antipsychotics or metoclopramide
How movement is controlled
Smooth, purposeful movement depends on the motor cortex, the basal ganglia (which start and scale movements and suppress unwanted ones) and the cerebellum (which coordinates timing and balance). Dopamine and other chemical messengers fine-tune these circuits. Most movement disorders come from disruption of these systems.
Types of movement disorders
Hypokinetic (too little movement)
- Parkinson's disease: slowness (bradykinesia), stiffness, resting tremor and balance problems, caused by loss of dopamine-producing cells.
- Atypical parkinsonism: progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration, which progress faster and respond less to medicines.
- Drug-induced parkinsonism from antipsychotics and some anti-nausea medicines.
Hyperkinetic (excess movement)
| Disorder | What it looks like | Examples |
|---|---|---|
| Tremor | Rhythmic shaking | Essential tremor (hands, head, voice when moving); Parkinson's tremor (at rest) |
| Dystonia | Sustained or repetitive twisting muscle contractions and postures | Cervical dystonia (neck), blepharospasm (eyelids), writer's cramp |
| Chorea | Brief, irregular, flowing dance-like movements | Huntington's disease, Sydenham's chorea |
| Tics | Sudden, repetitive movements or sounds, with an urge and brief suppressibility | Tourette syndrome |
| Myoclonus | Sudden, shock-like jerks | Sleep starts, epilepsy, metabolic causes |
| Tardive dyskinesia | Repetitive mouth, tongue and face movements | Long-term antipsychotic or metoclopramide use |
| Restless legs syndrome | Urge to move the legs at rest, worse in the evening | Iron deficiency, pregnancy, kidney disease |
Ataxia (poor coordination)
Ataxia causes unsteady walking, clumsy hands, slurred speech and abnormal eye movements, from damage to the cerebellum. Causes include alcohol, stroke, multiple sclerosis, vitamin deficiencies and inherited conditions such as spinocerebellar ataxias and Friedreich ataxia.
Functional movement disorders
Genuine, involuntary movement symptoms caused by a problem in how the brain controls movement rather than structural damage. They are common and treatable with specialized physical therapy and psychological support.
Causes
- Neurodegeneration: Parkinson's disease, atypical parkinsonism, Huntington's disease
- Genetics: many dystonias, ataxias, Huntington's disease, Wilson disease
- Medicines: antipsychotics, anti-nausea drugs, lithium, valproate, stimulants
- Stroke and head injury
- Infections and autoimmune disease: Sydenham's chorea after strep infection, autoimmune encephalitis
- Metabolic and toxic causes: liver or kidney failure, thyroid disease, low or high blood sugar, alcohol, copper overload
- Functional (non-structural) causes
Diagnosis
A neurologist, ideally a movement disorder specialist, diagnoses most conditions by observing the movements, often with video, and examining tone, speed, coordination and gait. Tests depend on the suspected cause:
- Brain MRI to look for stroke, tumors or patterns of degeneration
- DaTscan (dopamine transporter imaging) to support a diagnosis of parkinsonism in uncertain cases
- Blood tests: thyroid, liver, kidney, copper and ceruloplasmin, vitamin E, B12, iron
- Genetic tests for inherited conditions
- EEG for myoclonus or seizures
Treatment
- Parkinson's disease: levodopa, dopamine agonists, MAO-B inhibitors; deep brain stimulation for advanced disease.
- Essential tremor: propranolol, primidone; deep brain stimulation or focused ultrasound for severe tremor.
- Dystonia: botulinum toxin injections for focal dystonias; oral medicines; deep brain stimulation for generalized dystonia.
- Chorea and tardive dyskinesia: VMAT2 inhibitors such as tetrabenazine, deutetrabenazine and valbenazine.
- Tics: behavioral therapy (comprehensive behavioral intervention for tics) and medicines.
- Restless legs: correct iron deficiency, alpha-2-delta ligands such as gabapentin.
- Ataxia: treat reversible causes; physical, occupational and speech therapy.
- Drug-induced disorders: stop or change the medicine where possible.
Physical, occupational and speech therapy, exercise and fall prevention are important for nearly all movement disorders.
Frequently asked questions
What are the most common movement disorders?
The most common are essential tremor, Parkinson's disease, restless legs syndrome and dystonia. Tics and Tourette syndrome are common in children. Drug-induced movement disorders, such as tardive dyskinesia, are also frequent in people taking certain medicines.
What causes involuntary movements?
Involuntary movements usually result from disruption of the basal ganglia or cerebellum. Causes include genetic conditions, Parkinson's and Huntington's diseases, medicines such as antipsychotics, stroke, infections, metabolic problems and functional disorders.
Can movement disorders be cured?
Most cannot be cured, but many can be well controlled. Drug-induced and some metabolic or autoimmune movement disorders improve when the cause is treated. Medicines, botulinum toxin and deep brain stimulation greatly reduce symptoms in many conditions.
What does a movement disorder specialist do?
A movement disorder specialist is a neurologist with extra training in conditions like Parkinson's disease, tremor and dystonia. They make precise diagnoses, fine-tune complex medicines, give botulinum toxin injections and assess people for deep brain stimulation.
Sources
This guide was written from current patient and clinical guidance, including:
- National Institute of Neurological Disorders and Stroke: Movement disorders; Parkinson's disease; Dystonia
- International Parkinson and Movement Disorder Society: Patient education
- American Academy of Neurology: Movement disorders guidelines
- MedlinePlus: Movement disorders
- Parkinson's Foundation: What is Parkinson's?