Problems With Movement

Types of movement problems

Neurologists sort movement problems into two broad groups, plus coordination problems:

If the problem is mainly reduced range or ability to move because of pain, weakness or joint stiffness, see limited mobility.

Common causes

Essential tremor

The most common movement disorder in adults. It causes shaking of both hands when they are being used (holding a cup, writing), sometimes with head or voice tremor. It often runs in families and improves briefly with a small amount of alcohol.

Parkinson's disease

Parkinson's disease is caused by loss of dopamine-producing cells in the brain. Its core features are slowness of movement plus a resting tremor or rigidity. It usually starts on one side. Early signs include smaller handwriting, a softer voice, reduced arm swing, loss of smell, constipation and acting out dreams in sleep.

Medicines and drugs

Drug-induced movement disorders are common and often reversible. Culprits include:

• antipsychotics and anti-nausea drugs such as metoclopramide and prochlorperazine (parkinsonism, acute dystonia, tardive dyskinesia)
• lithium and valproate (tremor)
• some antidepressants, stimulants and asthma inhalers (tremor)
• alcohol, and withdrawal from alcohol or benzodiazepines
• stimulants such as amphetamines and cocaine (chorea, tics)

Stroke and other brain injuries

A stroke can suddenly cause weakness, clumsiness or abnormal movements on one side. Traumatic brain injury, brain tumors and infections can also cause movement disorders.

Cerebellar problems

The cerebellum fine-tunes movement. Damage from alcohol, stroke, MS, vitamin deficiency or inherited disease causes ataxia: a drunken-looking walk, poor hand coordination, slurred speech and jerky eye movements.

Other causes

• Multiple sclerosis
• Huntington's disease, an inherited condition causing chorea, mood changes and memory decline
• Wilson disease, a copper buildup that can cause tremor and dystonia in young people
• Thyroid overactivity, low blood sugar, kidney or liver failure, which cause tremor or jerks
• Peripheral neuropathy, which causes unsteadiness from loss of position sense
• Functional movement disorder, genuine movement symptoms caused by a problem with how the brain sends and receives signals rather than structural damage

Clues from other symptoms

• Slowness plus constipation, loss of smell and soft voice: Parkinson's disease
• Shaking only with action and a family history: essential tremor
• Unsteadiness with numb feet: neuropathy
• Unsteadiness with slurred speech and double vision: cerebellar or brainstem problem
• Movements with mood or memory changes: Huntington's disease or other brain diseases
• Movements that started after a new medicine: drug-induced

How doctors assess movement problems

A neurologist, often a movement disorders specialist, relies mainly on watching how you move. Expect:

• questions about when it started, whether it is getting worse, family history, medicines, alcohol, and sleep, mood and memory
• observing your movements at rest, while holding a posture, and during tasks such as writing, tapping fingers and walking
• checking muscle tone, reflexes, strength, sensation and coordination (finger to nose, heel to shin)

Videos of intermittent movements on your phone are very helpful. Tests may include blood tests (thyroid, glucose, kidney and liver function, copper, B12), an MRI of the brain, a DaTscan to look at dopamine function, genetic testing for inherited conditions, and an EEG for jerks that might be seizures.

Treatment

• Medicine review: stopping or changing a causative drug often improves or cures the problem, though tardive dyskinesia can persist.
• Specific medicines: dopamine-replacing drugs for Parkinson's, beta blockers or primidone for essential tremor, medicines to reduce chorea or tics.
• Botulinum toxin injections: first-line for focal dystonia, such as cervical dystonia and blepharospasm.
• Deep brain stimulation: implanted electrodes for selected people with Parkinson's, essential tremor or dystonia that does not respond to medicine.
• Therapy: physical therapy for balance and walking, occupational therapy for daily tasks, speech therapy, and specialist therapy for functional movement disorder.
• Safety at home: removing trip hazards, grab rails, weighted utensils and walking aids.

Frequently asked questions

What are the main types of movement disorders?

The main types are hypokinetic disorders with slowness and stiffness, such as Parkinson's disease, and hyperkinetic disorders with extra movements: tremor, dystonia, chorea, myoclonus, tics and tardive dyskinesia. Ataxia, a loss of coordination, is often grouped with them.

What is the most common movement disorder?

Essential tremor is the most common movement disorder in adults. It causes shaking of the hands during activities such as writing or drinking. Restless legs syndrome and Parkinson's disease are also common.

Can anxiety cause problems with movement?

Anxiety can cause a fine tremor and muscle tension, and stress worsens most movement disorders, including tics and tremor. Anxiety does not cause the slowness of Parkinson's disease or sudden one-sided weakness. New movement problems should be checked by a doctor.

Are movement disorders curable?

Some are. Drug-induced movement problems often go away when the medicine is stopped, and those from thyroid or metabolic problems improve with treatment. Others, like Parkinson's disease and essential tremor, are long-term but can be well controlled.

When should I worry about a movement problem?

Get emergency help for sudden weakness, clumsiness or slurred speech, or stiffness with fever after a new medicine. See a doctor promptly for movement problems that are new, worsening over days, or interfering with daily life.