Clinic for movement disorders
Movement disorders include a wide spectrum of conditions characterized by irregularities in voluntary movements or the presence of excessive involuntary movements. The traditional approach to movement disorders includes their division into two groups: hypokinetic and hyperkinetic disorders. Hypokinetic disorders (parkinsonisms) are characterized by delayed, slowed voluntary movements of low amplitudes with an increased tone of the rigors type. Hyperkinetic disorders are characterized by involuntary movements that occur spontaneously or are superimposed on voluntary movement. This group includes: chorea, dystonia, balism, tremor, tic and myoclonus.
The general clinical approach to all movement disorders is to divide them into primary and secondary or symptomatic disorders. Primary movement disorders are those in which abnormal movement is the main neurological symptom and is not caused by an identifiable neurological disease. Secondary (symptomatic) movement disorders are the result of a known neurological disease and can be hereditary or acquired. Therefore, the presence of additional symptoms and signs (such as motoric weakness, sensory loss, cognitive and psychological symptoms) should always raise the suspicion that it is a symptomatic movement disorder that requires detailed diagnostic treatment.
In the clinic for movement disorders, a doctor subspecialist for neurodegenerative diseases with many years of experience in the diagnosis and treatment of various movement disorders will examine the patient and determine whether there is a movement disorder or other neurological and systemic symptoms or outbursts. In addition to adequately taken anamnestic data, detailed clinical picture and neurological status, specific diagnostic processing will be planned which includes the necessary laboratory examination, neuroimaging tests (MR, PET, SPECT), genetic analysis, neurophysiological processing, etc., with the aim of establishing a diagnosis and planning further treatment.
Examination and treatment of patients with movement disorders consists of a series of steps through three levels:
a) Level 1. Which movement disorder is it about?
It is necessary to determine whether it is a hypokinetic or hyperkinetic movement disorder. If it is a hyperkinetic movement disorder, it is necessary to determine the speed of movement (myoclonus, chorea and tics represent fast movements, while dystonia is characterized by slow tonic contractions). The distribution of abnormal movements at rest and activity is also important (for example classic parkinsonian tremor occurs mainly at rest while dystonic movements and action myoclonus occur during voluntary movements).
b) Level 2. Which syndrome is it about?
If the patient presents with multiple different movement disorders, it is important to determine the dominant clinical picture. It is also necessary to determine whether it is a continuous or paroxysmal movement disorder.
c) Level 3. What is the etiology (cause)?
Taking the clinical characteristics and temporal development of the movement disorder into account, the next step is to consider the differential diagnosis. When investigating the etiology of a particular movement disorder, apart from knowing whether it is a primary or secondary syndrome, the patient's age and family history play an important role.
The most common movement disorders that are diagnosed and treated at the Clinic for movement disorders are:
Parkinson's disease, a typical representative of hypokinetic disorders, with the main clinical features: slowness of movements (bradykinesis), tremor at rest, increased tone of the rigor type and damage of postural reflexes
Atypical parkinsonism (parkinsonism plus syndrome) in which there are other neurological disorders in addition to the signs of parkinsonism
Tremor marked by rhythmic, involuntary, oscillatory movements of a body part
Dystonia, a movement disorder characterized by constant or intermittent muscle contractions causing torsional, repetitive movements or abnormal posture of a body part
Chorea, characterized by rapid, irregular, aimless movements that spread alternately from one part of the body to another
Myoclonus characterized by sudden, short-lived, lightning-fast, involuntary movements
Tick, stereotyped, repetitive, non-rhythmic movement
Treatment of movement disorders in the Clinic for movement disorders includes an individual approach of planning a therapeutic protocol. Depending on the results of the requested treatment and the established diagnosis, a specific drug therapy is prescribed (symptomatic for the purpose of suppressing movement disorders or causal for the purpose of removing the cause of the existing symptoms). In order to suppress involuntary movements (especially focal dystonia), treatment with botulinum toxin is prescribed and administered under ultrasound control in the treatment of cervical dystonia. This method of treatment is carried out by a trained doctor with the experience of using botulinum toxin in the treatment of focal dystonia. The use of ultrasound enables more precise localization of the botulinum toxin application site and thus better therapeutic results. The treatment of movement disorders also includes the application of physical therapy, which can be applied in St. Catherine Specialty Hospital as part of a multidisciplinary approach.
The Clinic for movement disorders enables the patient to be monitored by a doctor who is familiar with the clinical picture and during the course of the disease who is educated and trained in movement disorders. Continuity of monitoring the clinical picture and treatment of each individual patient with a movement disorder is of particular importance in achieving a satisfactory therapeutic response and ultimately improving the patient's quality of life.