Movements Disorders

Dystonia is a movement disorder characterized by involuntary muscle contractions, which force the body into repetitive or twisting movements. The condition, which is associated with fixed postures, can take several forms, affecting only one muscle, a group of muscles, one side of the body or the whole body.

Symptoms

Symptoms differ depending on the type of dystonia you have and the region of the body it is affecting. Early signs might be a “dragging” leg, foot cramping, involuntary neck pulling, uncontrollable blinking, or difficulties speaking or swallowing.

Causes

The cause of dystonia is not yet known; it may be idiopathic, genetic or acquired. Dystonia may result from damage or abnormality in the part of the brain that controls movement. It may also be a result of a medication or a symptom of another condition.

Living better

The first step to living better is the right diagnosis. Your doctor may prescribe certain medications, non-medical treatments or suggest alternative therapies.

Exams and tests

Depending on what your doctors have seen or observed, they may decide to take a blood or urine testing for more information. Imaging tests such as MRI or CT scan of the brain may be useful in establishing your diagnosis.

Another test, called electromyography (EMG), may be performed. This test measures electrical activity within your muscles and nerves and can provide information about the cause of your symptoms.

Treatments

While there is no cure for dystonia, there are several treatments available to help manage your symptoms.

• Botox® is often very effective for dystonia when one muscle or one region of the body is affected. These injections may reduce or eliminate muscle contractions at the site.
• Medicines that target neurotransmitters — the signaling chemicals in the brain — can also relieve symptoms of dystonia.
• Physical therapy, occupational therapy and speech therapy are often helpful in easing symptoms of dystonia.
• Stress management, massage, and biofeedback may also be helpful.

In some cases, when patients don’t find relief with other treatments, surgery may be indicated. Surgical options include deep brain stimulation (DBS) and other procedures focused on reducing muscle spasms.

Essential tremor is a neurological condition which can cause shaking or tremor of the hands, head, and voice. Essential tremor is the most common movement disorder, affecting over 10 million people in the United States.

Symptoms

Shaking, quivering, trembling, back and forth — almost fluttering — motions of the hands can start gradually, on one side of the body. These movements can also affect the chin, lips, and head — where it shakes up and down, or side to side — and voice. The tremors worsen with movement, such as when you are performing a task, and with stress and fatigue.

Essential tremors are not associated with any other symptoms, though in later stages your walk may become unsteady.

Causes

The condition is thought to be affected by the misfiring of electrical activity in the brain. About half of the patients who experience essential tremors may have inherited it — it does seem to run in families — but the exact gene is not known. The other half of those who have the condition have no family history; there is still research being done in this area.

Living better

While essential tremor is generally benign, it can interfere with your daily activities like writing, eating, and drinking. Fortunately, there are many resources available at St. Luke’s to help minimize the impact of this disease on your daily life.

• Occupational therapy can provide you with tools and instruments to make things easier, such as weighted cutlery and heavier drinking glasses
• Physical therapy can help you to improve your strength and coordination.
  
  

Exams and tests

Essential tremor is diagnosed through a careful physical exam and a detailed medical history by your neurologist. Your medical provider may additionally check blood work or consider brain imaging to assess for any structural changes that may be related to your symptoms.

Treatments

The treatments for essential tremor vary according to the severity of your condition. There are many medications which are helpful for reducing tremor symptoms. Botox® injections may be helpful for certain tremors. In certain cases, deep brain stimulation (DBS) has been very successful for controlling symptoms.

Huntington’s disease is an inherited degenerative neurological condition that affects a patient’s movements, thinking and emotions. Huntington’s disease is rare, affecting 1 in 10,000 people in the United States. Most commonly, symptoms begin between the ages of 35 and 50. When the disease appears before the age of 20, it’s called Juvenile Huntington’s disease.

Symptoms

Generally, Huntington’s disease affects you in stages. You may experience only certain symptoms or you might experience symptoms at different stages.

Early Stage

• Changes in your ability to move in a coordinated fashion
• Changes in your balance, and episodes of feeling clumsier than usual
• Fidgeting
• Changes in mood and personality
• Cognitive deficits, difficulty thinking clearly

Mid Stage

• Difficulty in the way you move may be exaggerated
• Diminished speech and eating difficulties
• Trouble reasoning
• Behavioral changes may worsen
• Feelings of anger and depression may occur 

Late Stage

• Total dependence on those around you
• Complications of the disease may include weight loss, malnutrition, speech and swallowing difficulties, inability to communicate

Juvenile Huntington’s is recognized by similar yet distinct symptoms. Children and teenagers affected with the disease show a loss of things they already knew: math skills just learned may disappear or they may not remember how to play or work with others well. Their work in school declines rapidly, and they start to have behavior problems. Changes in fine motor skills, accompanied by contracted and rigid muscles and tremors, are also noted.

Causes

Huntington’s disease is hereditary. Only one gene needs to be passed down for the disease to be present, so if one of your parents has Huntington’s disease, you have a 50 percent chance of being affected.

Living better

Huntington’s disease is about managing symptoms and living as well as you can. Some studies have shown that exercise can be beneficial for patients with Huntington’s disease. Maintaining optimal nutrition is also very important for patients with Huntington’s disease. It is important to eat healthy, nutritious and calorie dense food to prevent weight loss. Occupational, speech and physical therapists can work with you throughout the disease process to help manage your symptoms.

Exams and tests

If Huntington’s disease is suspected because of your symptoms or because of a family history of the disease, a blood or saliva test may be ordered to look for the Huntington’s gene.

Other tests may include:

• Checking motor function, balance, coordination, and reflexes
• Cognitive tests
• A psychological evaluation
• An MRI, CT scan or other brain imaging may be ordered to see if there are any structural changes in your brain, and to assess for other causes of your symptoms.

Treatments

While there is no cure, there are several medications that can treat the symptoms of Huntington’s disease. These medications can be helpful to treat involuntary movements, called chorea, as well as mood and behavioral changes associated with the disease. Physical therapy, occupational therapy, and speech therapy are often helpful in managing symptoms of Huntington’s.

Parkinson’s disease is a chronic, progressive neurological disease the results in symptoms like slowed movements, muscle stiffness, and tremor. It affects about seven to 10 million people worldwide, including over a million Americans. Of the 60,000 new cases diagnosed each year in the United States, only four percent are diagnosed before the age of 50. Parkinson’s disease affects men more often than women.

Symptoms

Most of the symptoms of Parkinson’s are seen as movement difficulties. The three most common occurrences are tremor, slowness of movement, and stiffness or rigidity. There may be a loss of natural movements and experience balance issues. Over time, you may develop an unsteady or shuffling walk. Speech and swallowing problems can also occur. The disease seems to progress in stages.

Early Stage

In its early stage, Parkinson’s may be barely noticeable. At first you may also notice a change in your ability to smell, experience constipation and develop a sleep disorder. Also, an early sign is usually hand tremors on one side of your body. You may realize that your posture is getting worse, have problems keeping your balance, and your movements may become slower.

Mid Stage

Your symptoms may start to affect both sides of your body, and spread to more areas. Balance issues and lack of facial control are more clearly seen in this stage, and you may be finding it harder to complete tasks.

Late Stage

In later stages, Parkinson’s becomes more pronounced in the areas already affected, and spreads to other areas. Your movements will become slower, and your muscles will become rigid and uncooperative. Also, in late stage, some may experience cognitive problems.

Causes

The specific source of Parkinson’s disease is known: there is a degeneration of nerve cells in the section of the brain that controls movement. Certain cells wither or die, and can’t produce dopamine, a neurotransmitter that helps regulate movement. According to the National Parkinson’s Foundation, the symptoms of the disease appear when about 80 percent of these cells are damaged.

Living better

Although there is no cure for Parkinson’s disease, there are effective treatments that can allow patients to continue living their daily lives comfortably for many years. The medical professionals at St. Luke’s Movement Disorder Center work together with you to create a treatment plan that optimizes your health and well-being.

• Physical therapy and exercise programs, like Tai Chi, can help you with balance issues. Exercise has been proven to be very helpful in building strength, promoting flexibility and even delaying disability.
• Occupational therapy can provide you with the tools and equipment you need to accomplish your daily activities.
• Speech therapy can help to assess and treat slurred speech and swallowing issues.
• Sleep medicine specialists are available to help assess and optimize your sleeping habits.
• St. Luke’s offers a Parkinson’s support group called Support to Empower Parkinson’s Strategies (PD STEPS). It is a free, monthly, community education program for those living with Parkinson’s disease. Register by calling 1-866-STLUKES (785-8537) (option 4).

Exams and tests

Parkinson’s disease is generally diagnosed through physical exam and a detailed medical history. Blood and brain imaging tests may be ordered by your medical provider to see if there are any structural changes in your brain, and to assess for other causes of your symptoms.

Treatments

There is no cure for Parkinson’s disease, but there are many effective medications and therapies to treat the primary symptoms of Parkinson’s and help you live your life comfortably for many years.

St. Luke’s has neurorehabilitation specialists certified in LSVT Big and Loud therapy, which is a program to specifically treats certain symptoms of Parkinson’s disease.

In some cases, when patients don’t find relief with other treatments, surgery may be indicated. St. Luke’s was first in the region to offer deep brain stimulation (DBS) as a treatment for Parkinson’s disease and continues to perform the most DBS procedures in the region.