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Movement disorders

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Related Terms
  • Ablative surgery, acquired immunodeficiency syndrome, AIDS, akasthesia, ALS, amyotrophic lateral sclerosis, anticonvulsant, antidepressant, antipsychotic, arteriosclerosis, ataxia, atheitosis, atherosclerosis, ballism, basal ganglia, benzodiazepine, botulinum toxin, bradykinesia, CBC, cerebellum, cerebral palsy, cerebrospinal fluid, CHF, chorea, complete blood count, congestive heart failure, cryothalamotomy, DBS, deep brain stimulation, dyskinesia, dystonia, EEG, electroencephalogram, electromyogram, EMG, epilepsy, essential tremor, Gaucher's disease, globus pallidus, globus pallidus, heart attack, Huntington's disease, hyperkinesia, hypokenisia, involuntary, juvenile parkinsonism, labile, Lou Gehrig's disease, motor cortex, muscle biopsy, muscular dystrophy, myoclonus, neurogenetic, neurological, neurons, ocular, pallidotomy, Parkinson's disease, pneumonia, postural instability, progressive supranuclear palsy, proprioception, restless leg syndrome, Rhett syndrome, rigidity, Shy-Drager syndrome, spasticity, spinal tap, substantia nigra, subthalamic nucleus, tardive dyskinesia, thalamic nuclei, thalamotomy, thiamin, tics, Tourette's syndrome, tremor, tumor, vitamin B1, voluntary, Wernicke-Korsakoff syndrome, Wilson's disease.

Background
  • Movement disorders are a group of neurological diseases and syndromes affecting the ability to produce and control movement.
  • Movement disorders are conditions of the brain, spinal cord, and nerves throughout the body. Together, they control all the workings of the body including breathing, mood, speaking, learning, swallowing, walking, moving, and seeing.
  • There are more than 600 neurological conditions (movement disorders). Major types include diseases caused by genetics, injuries, seizure disorders, cancer (including brain tumors), and infection.
  • Movement disorders are categorized as neuro-genetic diseases (such as Huntington's disease and muscular dystrophy), developmental disorders (such as cerebral palsy), degenerative diseases of adult life (such as Parkinson's disease and Alzheimer's disease), metabolic diseases (such as Gaucher's disease), cerebrovascular diseases (such as stroke and vascular dementia), trauma (such as spinal cord and head injury), convulsive disorders (such as epilepsy), infectious diseases (such as AIDS), and brain tumors.
  • Movement disorders are conditions involving the nervous system that affect the speed, ease, and quality of movement. Movement disorders include many symptoms, including dyskinesia (difficulty performing voluntary movement), hyperkinesia (excessive voluntary movement), hypokinesia (slow voluntary movement), ataxia (lack of coordination, often producing jerky movements), and dystonia (involuntary movement and prolonged muscle contraction).
  • About six million people in the United States have movement disorders.

Signs and symptoms
  • Symptoms of movement disorders often vary and fluctuate. The severity of symptoms may be affected by factors such as anxiety, fatigue, medications, and stress.
  • Some movement disorders cause hyperkinesia (excessive spontaneous movement or abnormal involuntary movement) and others cause hypokinesia (absent or reduced ability to perform purposeful movement).
  • Abnormal movements may be rhythmical (essential tremor) or irregular and may be rapid and jerky (tics) or slowed and sustained (Parkinson's disease, dystonia). In most cases, irregular movement cannot be consciously controlled or suppressed.
  • Hyperkinetic movements:
  • Akathesia: Akathesia is restlessness and a desire to move to relieve uncomfortable sensations. Sensations may include a feeling of crawling, itching, stretching, or creeping, usually in the legs.
  • Athetosis. Atheitosis is the slow, writhing, continuous, uncontrollable movement of the arms and legs.
  • Ballism: Ballism is like chorea, but the movements are much larger, more explosive, and involve more of the arm or leg. This condition, also called ballismus, can occur on both sides of the body or on one side only (hemiballismus).
  • Chorea: Chorea is rapid, nonrhythmic, usually jerky movements, most often in the arms and legs.
  • Dystonia: Dystonia is sustained muscle contractions, often causing twisting or repetitive movements and abnormal postures. Dystonia may be limited to one area (focal) or may affect the whole body (general). Focal dystonias may affect the neck (cervical dystonia or torticollis), the face (one-sided or hemifacial spasm, contraction of the eyelid, or blepharospasm, contraction of the mouth and jaw or oromandibular dystonia, simultaneous spasm of the chin and eyelid, or Meige syndrome), the vocal cords (laryngeal dystonia), or the arms and legs (writer's cramp, occupational cramps). Dystonia may be painful as well as incapacitating.
  • Myoclonus: Myoclonus is a sudden, shock-like muscle contraction. Myoclonic jerks may occur singly or repetitively. Unlike tics, myoclonus cannot be controlled even briefly.
  • Tics: Tics are involuntary, rapid, nonrhythmic movements or sounds. Tics can be controlled briefly.
  • Tremor: Tremors are involuntary (uncontrollable) shaking of a body part. Tremors may occur only when muscles are relaxed or they may occur only during an action or while holding an active posture.
  • Hypokinetic movements:
  • Bradykinesia: Bradykinesia is slowness of movement.
  • Freezing: Freezing is the inability to begin a movement or involuntary stopping of a movement before it is completed.
  • Postural instability: Postural instability is the loss of ability to maintain upright posture caused by slow or absent righting reflexes.
  • Rigidity: Rigidity is an increase in muscle tension when an arm or leg is moved by an outside force.

Diagnosis
  • Diagnosis of movement disorders involves taking a family history, a history of symptoms, and performing a physical examination (including neurological examination) and various tests (including blood tests and imaging tests).
  • Blood tests: Blood tests may include a complete blood count (CBC), a creatine kinase test, and a DNA analysis (to determine if the disorder is genetic). In some cases, a cerebrospinal fluid (CSF) analysis also is performed.
  • Cerebrospinal fluid analysis involves performing a spinal tap or lumbar puncture. In this procedure, about two tablespoons of cerebrospinal fluid is drawn into a needle inserted between two lumbar vertebrae and then examined under a microscope. This procedure is usually performed in a hospital or clinic under local anesthesia, although general anesthesia can be used. Side effects include pain and tenderness in the area of puncture.
  • Imaging tests: Imaging tests, including computed tomography (CT scan), magnetic resonance imaging (MRI scan), and positron emission tomography (PET scan), may be used to detect damage (such as shrinkage) in the basal ganglia, structural abnormalities, and stroke (neurological damage due to a lack of oxygen to the brain).
  • Other imaging tests: An electromyogram (EMG) and an electroencephalogram (EEG) also may be performed. These tests are used to monitor electrical activity within the body and can help detect nerve and muscle disorders. EMG involves placing electrodes on the skin (surface EMG) or into the muscle (intramuscular EMG) to record electrical activity of the muscle. In an EEG, electrodes are attached to the scalp and connected to a machine that records electrical impulses in the brain.
  • Muscle biopsy: A muscle biopsy may also be performed to distinguish between nerve and muscle disorders. This procedure, which is performed under local anesthesia, involves making a small incision and removing a sample of muscle for microscopic evaluation. Following the procedure, patients may experience minor pain and bruising at the biopsy site for about one week.

Complications
  • Complications of movement disorders depend on the individual and the particular condition that is present.
  • Mental and emotional problems: As well as movement difficulties, there are a variety of behavioral and psychological difficulties that are experienced by many, though not all, individuals with movement disorders. The most frequently reported behavioral problems are attention deficits, obsessions, compulsions, impulsivity, irritability, aggression, immaturity, drug and alcohol abuse and addiction, self-injurious behaviors, and depression. Some individuals with movement disorders (such as Tourette's syndrome) have significant problems with labile (rapidly changing) emotions, impulsivity, and aggression directed to others. Temper fits, include screaming, punching holes in walls, threatening others, hitting, biting, and kicking, are common in such patients.
  • Along with psychiatric conditions, individuals with movement disorders, such as Huntington's disease, may be more susceptible to suicidal thoughts.
  • Other health complications: Some movement disorders, such as Huntington's disease, can make the individuals susceptible to life-threatening complications related to this disease, such as pneumonia (a bacterial infection in the lungs and respiratory system) and heart disease (including heart attack, congestive heart failure or CHF, and atherosclerosis or hardening of the arteries) are the two leading causes of death for individuals with Huntington's disease. Additionally, Huntington's disease patients have higher incidence of choking and respiratory complications, gastrointestinal diseases (such as cancer of the pancreas), and suicide than the population without the condition. Ocular (eye) complications (including nystagmus or involuntary eye movements) may be present in some individuals with movement disorders, including Wernicke-Korsakoff syndrome (results from thiamin or vitamin B1 deficiency).

Treatment
  • Treatment of a movement disorder begins with determining its cause. Physical and occupational therapy may help make up for lost control and strength. Drug therapy can help compensate for some imbalances of the brain, helping to alleviate tics and other hyperkinetic disorders. Oral medications can also help reduce overall muscle tone. Local injections of botulinum toxin can selectively weaken overactive muscles in dystonia and spasticity. Surgical destruction or inactivation of basal ganglionic circuits has proven effective for Parkinson's disease and is being tested for other movement disorders. Transplantation of fetal cells into the basal ganglia has produced mixed results in Parkinson's disease.
  • Medications: Medications that may be used for movement disorders include anticonvulsants (such as carbamazepine or Tegretol® and divalproex sodium or Depakote®), beta-blockers (such as propranolol or Inderal®), dopamine agonists (such as bromocriptine or Parlodel® and pergolide or Permax®), and tranquilizers (benzodiazepines such as diazepam or Valium® and clonazepam or Klonopin®).
  • Side effects of anticonvulsants include dizziness, drowsiness, nausea, lack of coordination, and vomiting. Benzodiazepines may cause drowsiness, fatigue, and physical addiction. Side effects caused by beta-blockers include bradycardia (slowed heart rate), depression, light-headedness, and nausea. Dopamine agonists may cause nausea, headache, dizziness, and fatigue.
  • Antipsychotic agents, such as risperidone (Risperdal®), olanzapine (Zyprexa®), quetiapine (Seroquel®), chlorpromazine (Thorazine®), or haloperidol (Haldol®), may partially suppress involuntary movements and help to control psychiatric (mental) abnormalities, including severe agitation, hallucinations, or psychotic delusions (symptoms commonly seen in Huntington's disease). Because antipsychotic therapy may have potentially severe adverse effects, including the development of tardive dyskinesia (neurological condition that involves involuntary movements of the tongue, lips, face, trunk, and extremities), such medications should only be used to treat chorea (involuntary movements) if the condition is functionally disabling. In addition, these agents should be prescribed at the lowest possible dosages and periodically discontinued if possible (drug holidays).
  • Levodopa (Dopar®), selegiline (Eldepryl®), and amantadine (Symmetrel®) are commonly used in Parkinson's disease to improve dopamine (a brain chemical) balance and reduce symptoms.
  • Monoamine-depleting agents (monoamines are brain chemicals), such as reserpine (Serpalan®), may alleviate chorea (involuntary movements) associated with Huntington's disease with a decreased risk of causing tardive dyskinesia. Anticholinergic drugs may also be used, including trihexyphenidyl (Artane®) or benztropine mesylate (Cogentin®), However, these agents may aggravate or cause drowsiness, depression, and fine motor tremors or have other serious, life-threatening adverse effects, including neuroleptic malignant syndrome (a neurological disorder that includes high fever, sweating, unstable blood pressure, stupor, muscular rigidity, and autonomic dysfunction that includes blood pressure and breathing) and agranulocytosis (failure of the bone marrow to make white blood cells for the immune system).
  • Medical management may also include administration of certain agents to help alleviate depression or obsessive-compulsive behaviors potentially associated with movement disorders (particularly Huntington's disease). These drugs may include antidepressants such as paroxetine (Paxil®), fluoxetine (Prozac®, Sarafem®), and sertraline (Zoloft®).
  • Lithium (Lithobid® or Eskalith®) or valproic acid (Depakene®) may be prescribed to treat excitement and severe mood swings, similar to bipolar disorder.
  • Some medications used help decrease the symptoms of specific disorders. For instance, levodopa or L-dopa (Sinemet®) is used in Parkinson's disease.
  • Botulinum toxin: Botulinum toxin injection therapy (BOTOX®) is used to treat some types of movement disorders (including spasmodic torticollis, blepharospasm, myoclonus, and tremor). In this treatment, a potent neurotoxin (produced by the bacterium Clostridium botulinum) is injected into a muscle to inhibit the release of neurotransmitters that cause muscle contraction. In some cases, treatment is repeated every three to four months. Patients may develop antibodies to the toxin over time, causing treatment to become ineffective. Side effects include temporary weakness in the group of muscles being treated and rarely, flu-like symptoms.
  • Deep brain stimulation: Deep brain stimulation (DBS) involves a surgically implanted, battery-operated medical device (neurostimulator) used to deliver electrical stimulation to areas of the brain that control movement. The electrical charge blocks nerve signals that trigger abnormal movement. In DBS, an electrode (lead) is inserted through a small incision in the skull and is implanted in the targeted area of the brain. An insulated wire (extension) is then passed under the skin in the head, neck, and shoulder, connecting the lead to the neurostimulator, which is surgically implanted in the chest or upper abdomen. Side effects of deep brain stimulation include bleeding at the implantation site, depression, impaired muscle tone, infection, loss of balance, paresis (slight paralysis), dysarthia (slurred speech), and parethesia (tingling) in the head or the hands.
  • Ablative surgery: Ablative surgery locates, targets, and then ablates (destroys) the clearly defined area of the brain that produces chemical or electrical impulses that cause abnormal movements. In this surgery, a heated probe or electrode is inserted into the targeted area. The individual remains awake during the procedure to determine if the problem has been eliminated. A local anesthetic is used to dull the outer part of the brain and skull. The brain is insensitive to pain, so the individual does not feel the actual procedure. In some cases, it may be difficult to estimate how much tissue to destroy and the amount of heat to use.
  • This type of surgery involves either ablation in the part of the brain called the globus pallidus (called pallidotomy) or ablation of brain tissue in the thalamus (called thalamotomy). A related procedure, cryothalamotomy, uses a super cooled probe that is inserted into the thalamus to freeze and destroy areas that produce tremors.
  • Pallidotomy may be used to eliminate uncontrolled dyskinesia (such as jerky, involuntary movements) and thalamotomy may be performed to eliminate tremor. These procedures are successful in approximately 75% of cases.
  • Nutrition and lifestyle changes: Proper diet and exercise is very important for individuals with movement disorders. In some conditions, such as in Huntington's disease, individuals may even choke. Caregivers who help individuals eat should allow plenty of time for meals. Food can be cut into small pieces, softened, or pureed to ease swallowing and prevent choking. While some foods may require the addition of thickeners, other foods may need to be thinned. Dairy products, in particular, tend to increase the secretion of mucus, which in turn increases the risk of choking.
  • Some individuals may benefit from swallowing therapy, which is especially helpful if started before serious problems arise. Suction cups for plates, special tableware designed for people with disabilities, and plastic cups with tops can help prevent spilling. The individual's doctor can offer additional advice about diet and about how to handle swallowing difficulties or gastrointestinal problems that might arise, such as incontinence or constipation.
  • Maximizing physical activity is a goal in all movement disorders. Patients should perform daily activities to the extent possible. If they cannot, a regular exercise program or physical therapy may help condition them physically and teach them adaptive strategies. Because the disease, medications, and inactivity can lead to constipation, patients should consume a high-fiber diet, such as bran cereals, whole wheat bread, fresh vegetables, and brown rice. Dietary supplements, including psyllium and stimulant laxatives (such as bisacodyl or Dulcolax®), may be needed for constipation.
  • Although their coordination may be poor, individuals should continue walking using assistance if necessary. Those who want to walk independently should be allowed to do so as long as possible. Careful attention should be given to keeping their environment free of hard, sharp objects to help ensure maximal independence while minimizing the risk of injury from a fall. Individuals can also wear special padding during walks to help protect against injury from falls. Some individuals have found that small weights around the ankles can help stability. Wearing sturdy shoes that fit well can help too, especially shoes without laces that can be slipped on or off easily.
  • Speech therapy: Some movement disorders, such as Huntington's disease, can impair speech, affecting the ability of the individual to express complex thoughts. Speech therapy may improve the individual's ability to communicate and swallow. It is important for caregivers to understand that individuals with these movement disorders may not be communicating due to the disease and not due to lack of sociability.
  • Social activity: Unless and until the disease's progression prohibits it, people with movement disorders should participate in outside activities, socialize, and pursue hobbies and interests. These activities also give family members and caregivers valuable time for themselves.
  • Caregiver support: Movement disorders confront individuals and their caregivers with many complex problems that must be dealt with for the life of the patient. While it may be emotionally difficult, it is important for patients and caregivers to make informed, carefully considered decisions regarding the future while the patient is capable of making his or her contribution to a planned course of action.
  • Physical therapy: According to the American Physical Therapy Association, the goal of physical therapy or physiotherapy is to improve mobility, restore function, reduce pain, and prevent further injury by using a variety of methods, including exercises, stretches, traction, electrical stimulation, and massage. Physical therapy has been reported useful in neurological disorders.

Integrative therapies
  • Good scientific evidence:
  • 5-HTP: 5-HTP is the precursor for serotonin. Serotonin is the brain chemical associated with sleep, mood, movement, feeding, and nervousness. Cerebellar ataxia results from the failure of part of the brain to regulate body posture and limb movements. 5-HTP has been observed to have benefits in some people who have difficulty standing or walking due to cerebellar ataxia. However, current evidence is mixed. Further research is needed before a strong conclusion can be drawn.
  • Avoid 5-HTP if allergic or hypersensitive to it. Signs of allergy to 5-HTP may include rash, itching, or shortness of breath. Avoid with eosinophilia syndromes, Down syndrome, or mitochondrial encephalomyopathy. Use cautiously if taking antidepressant medications, 5-HTP receptor agonists, carbidopa, phenobarbital, pindolol, reserpine, tramadol, or zolpidem. Use cautiously with kidney insufficiency, HIV/AIDS (particularly HIV-1 infection), epilepsy, or with a history of mental disorders. Avoid if pregnant or breastfeeding.
  • Music therapy: Music therapy has been reported to improve symptoms in people with Parkinson's disease. Modest improvements were seen in symptoms including: motor coordination, speech intelligibility and vocal intensity, bradykinesia (slow movement), emotional functions, activities of daily living, and quality of life. Music therapy is generally known to be safe.
  • Zinc: Wilson's disease is an inherited disorder of copper metabolism characterized by a failure of the liver to excrete copper, which leads to its accumulation in the liver, brain, cornea, and kidney, with resulting chronic degenerative changes. Early research suggests that zinc treatment may be effective in the management of Wilson's disease. More well-designed trials are needed to confirm these early results.
  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.
  • Unclear or conflicting scientific evidence:
  • Acupressure, Shiatsu: The practice of applying finger pressure to specific acupoints (energy points) throughout the body has been used in China since 2000 B.C. Shiatsu technique involves finger pressure at acupoints and along body meridians (energy lines). It can incorporate palm pressure, stretching, massaging, and other manual techniques. Shiatsu practitioners commonly treat musculoskeletal and psychological conditions, including neck/shoulder and lower back problems, arthritis, depression, and anxiety. Acupressure may benefit several measures of severity of Parkinson's disease. Preliminary clinical evidence from one small study with individuals with facial spasms reported improvement when using Shiatsu acupressure. Further study is needed before conclusion can be made.
  • Acupressure appears to be safe if self-administered or administered by an experienced therapist. Serious, long-term complications have not been reported, according to available scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
  • Acupuncture: Aucupuncture has been reported to help relieve symptoms of some neurological disorders, including cerebral palsy, nerve damage, Parkinson's disease (characterized by fine muscle coordination and tremors), Tourette's syndrome (characterized by "tics"), and trigeminal neuralgia. More trials need to be performed.
  • Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, neurological disorders or if taking anticoagulants. Avoid on areas that have received radiation therapy and during pregnancy. Avoid electroacupuncture with irregular heartbeat or in patients with pacemakers. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with a history of seizures.
  • Alexander technique: The Alexander technique is an educational program that teaches movement patterns and postures with an aim to improve coordination and balance, reduce tension, relieve pain, alleviate fatigue, improve various medical conditions, and promote well-being. Preliminary research suggests that Alexander technique instruction may improve fine and gross movements and reduce depression in patients with Parkinson's disease. Well-designed human trials are necessary.
  • Serious side effects have not been reported in the available literature. It has been suggested that the technique may be less effective with learning disabilities or mental illnesses. The Alexander technique has been used safely in pregnant women.
  • Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. Injections of arginine have been proposed to help manage adrenoleukodystrophy (ALD), although most study results are inconclusive. Further research is needed to evaluate the use of arginine in ALD and other neurological conditions.
  • Avoid if allergic to arginine. Avoid with a history of stroke or liver or kidney disease. Avoid if pregnant or breastfeeding. Use cautiously if taking blood-thinners, blood pressure drugs, antidiabetic drugs, or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease.
  • Ashwagandha:Ashwagandha (Withania somnifera) is widely cultivated in India and the Middle East for its medicinal properties, and it is also found in parts of Africa. There is insufficient scientific evidence to determine if ashwagandha is a safe and effective treatment for Parkinson's disease.
  • Avoid if allergic or hypersensitive to ashwagandha products or any of their ingredients. Dermatitis (allergic skin rash) was reported in three of 42 patients in one ashwagandha trial.There are few reports of adverse effects associated with ashwagandha, but there are few human trials using ashwagandha and most do not report the doses or standardization/preparation used.Avoid with peptic ulcer disease. Ashwagandha may cause abortions based on anecdotal reports. Avoid if pregnant or breastfeeding.
  • Ayurveda: Ayurveda is a form of natural medicine that originated in ancient India more than 5,000 years ago. Ayurveda is an integrated system of techniques that uses diet, herbs, exercise, meditation, yoga, and massage or bodywork to achieve optimal health. There is evidence that the traditional herbal remedy Mucuna pruriens may improve symptoms in Parkinson's disease and that it may offer advantages over conventional L-dopa preparations in the long-term management of the disorder. More studies are needed in this area.
  • Ayurvedic herbs should be used cautiously because they are potent, and some constituents may be potentially toxic if taken in large amounts or for a long time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs may interact with other herbs, foods, and drugs. A qualified healthcare professional should be consulted before taking.
  • Belladonna: Belladonna has been used for centuries to treat many medical conditions. To date, human studies have shown a lack of benefit from belladonna in treating autonomic nervous system disorders.
  • Avoid if allergic to belladonna or plants of the Solanaceae(nightshade) family (bell peppers, potatoes, eggplants). Avoid with a history of heart disease, high blood pressure, heart attack, abnormal heartbeat, congestive heart failure, stomach ulcers, constipation, stomach acid reflux (serious heartburn), hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy, urinary retention, narrow angle glaucoma, psychotic illness, Sjögren's syndrome, dry mouth, neuromuscular disorders, (such as myasthenia gravis), or Down syndrome. Avoid if pregnant or breastfeeding.
  • Chiropractic: Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system) and how this relationship affects the preservation and restoration of health. Although there is not enough reliable scientific evidence to conclude the effects of chiropractic techniques in the management of Parkinson's disease, anecdotal reports suggest a positive impact on fine muscle coordination in some individuals. More clinical research is necessary.
  • Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data. Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders, or migraines. Use cautiously with a risk of tumors or cancers.
  • Choline: Data regarding the effectivenses of choline in the treatment of Parkinson's disease is conflicting and inconclusive at this time.
  • Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
  • Chromium: Chromium is an essential trace element that exists naturally in trivalent and hexavalent states. Chromium has been studied for its protective benefits in Parkinson's disease and is included in antioxidant multivitamins. However, there is lack of scientific evidence in humans in this area. Additional research is needed.
  • Trivalent chromium appears to be safe because side effects are rare or uncommon. However, hexavalent chromium may be poisonous. Avoid if allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver problems, weakened immune systems (such as HIV/AIDS patients or organ transplant recipients), depression, Parkinson's disease, heart disease, and stroke and in patients who are taking medications for these conditions. Use cautiously if driving or operating machinery. Use cautiously if pregnant or breastfeeding.
  • Coenzyme Q10: Coenzyme Q10, or CoQ10, is produced by the human body and is necessary for the basic functioning of cells. There is promising evidence to support the use of CoQ10 in the treatment of symptoms associated with Friedrich's ataxia and Parkinson's disease. Better-designed trials are needed to confirm early study results.
  • Allergic reactions have not been associated with Coenzyme Q10 supplements, although rash and itching have been reported rarely. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or if taking anticoagulants (blood thinners) or antiplatelet drugs, blood pressure drugs, blood sugar drgus, cholesterol drugs, or thyroid drugs. Avoid if pregnant or breastfeeding.
  • Cowhage: Cowhage (Mucuna pruriens) seeds have been used in traditional Ayurvedic medicine to treat Parkinson's disease. Traditional Ayurvedic medicine and preliminary evidence suggests that cowhage contains 3.6-4.2% levodopa, the same chemical used in several Parkinson's disease drugs. Cowhage treatments have yielded positive results in early studies. However, more research should be conducted to determine the treatment that is most effective.
  • Avoid if allergic or hypersensitive to cowhage (Mucuna pruriens), its constituents, or members of the Fabaceae family. Avoid with psychosis or schizophrenia. Use cautiously with diabetes or Parkinson's disease or if taking levodopa, dopamine, dopamine agonists, dopamine antagonists, or dopamine reuptake inhibitors. Use cautiously if taking monoamine oxidase inhibitors (MAOIs) or other antidepressants or anticoagulants (blood thinners). Avoid if pregnant or breastfeeding, as cowhage may inhibit prolactin secretion.
  • Creatine: There is currently not enough scientific information to make a firm conclusion about the use of creatine in Huntington's disease. High-quality studies are needed to clarify this relationship.
  • Numerous studies suggest that creatine may help treat various neuromuscular diseases and may delay the onset of symptoms when used with standard treatment. However, creatine ingestion does not appear to have a significant effect on muscle creatine stores or high-intensity exercise capacity in individuals with multiple sclerosis, and supplementation does not seem to help people with tetraplegia. Although early studies were encouraging, recent research reports no beneficial effects on survival or disease progression. Additional studies are needed to provide clearer answers.
  • It is unclear if creatine is helpful in patients with spinal cord injuries. Results from early studies have been mixed. Further studies are required before a firm conclusion can be made.
  • Avoid if allergic to creatine or if taking diuretics. Use cautiously with asthma, diabetes, gout, kidney disorders, liver or muscle problems, stroke, or with a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.
  • DHEA: There is conflicting scientific evidence regarding the use of DHEA (dehydroepiandrosterone) supplements for myotonic dystrophy. Better research is necessary before a clear conclusion can be drawn.
  • Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders or if taking anticoagulants or drugs, herbs, or supplements for diabetes, heart disease, seizure, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
  • Dong quai: Dong quai (Angelica sinensis), also known as Chinese Angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. There is insufficient evidence to support the use of Dong quai as a treatment for nerve pain. High-quality human research is lacking.
  • Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is unknown. Long-term studies of side effects are lacking. Avoid if allergic/hypersensitive to Dong quai or members of the Apiaceae/Umbelliferae family (like anise, caraway, carrot, celery, dill, parsley). Avoid prolonged exposure to sunlight or ultraviolet light. Use cautiously with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with diabetes, glucose intolerance, or hormone-sensitive conditions (like breast cancer, uterine cancer, or ovarian cancer). Do not use before dental or surgical procedures. Avoid if pregnant or breastfeeding.
  • Feldenkrais Method®: The Feldenkrais Method® involves stretching, reaching, and changing posture in specific patterns. In some cases, it includes a form of massage. Patients who practice complementary alternative medicine methods have reported that the Feldenkrais Method®, as well as breathing therapy, massage, and relaxation techniques, helped improve symptoms of dystonia. Further data are needed before a firm conclusion can be made. There is currently not enough clinical evidence to determine if the Feldenkrais Method® is an effective treatment for cerebral palsy.
  • There is currently a lack of available scientific studies or reports of safety of the Feldenkrais Method®.
  • Ginseng: A clinical study found that patients with neurological disorders may improve when taking Asian ginseng (Panax ginseng). This supports research findings that report Panax ginseng improving cognitive function. More research is needed in this area.
  • Avoid with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
  • Kava: Kava beverages, made from dried roots of the shrub Piper methysticum, have been used ceremonially and socially in the South Pacific for hundreds of years and in Europe since the 1700s. There is currently unclear evidence on the use of kava for Parkinson's disease. Kava has been shown to increase 'off' periods in Parkinson's patients taking levodopa and can cause a semicomatose state when given with alprazolam. Consult with a qualified healthcare professional before taking kava due to the risk of harmful side effects.
  • Avoid if allergic to kava or kavapyrones. Avoid with liver disease, a history of medication-induced extrapyramidal (the motor system related to the basal ganglia) effects, and chronic lung disease. Avoid if taking medications for liver disease or CNS depressants such as alcohol or tranquilizers. Avoid while driving or operating heavy machinery (may cause drowsiness). Use cautiously with depression or if taking antidpressants. Avoid if pregnant or breastfeeding.
  • L-carnitine: Although used traditionally for support of neurological conditions, one poorly designed preliminary clinical study reported that L-acetyl-carnitine (carnitine or L-carnitine) possesses neither efficacy nor toxicity towards the patients with Huntington disease. Further trials are required to determine is L-carnitine is beneficial in individuals with neurological disorders.
  • Early research on the use of carnitine for Rett's syndrome has produced promising results. However, additional research is needed before a firm conclusion can be made.
  • Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, or diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
  • Massage: Early evidence suggests a possible benefit of massage for cerebral palsy, Parkinson's disease, and spinal cord injuries. However, evidence is insufficient on which to base recommendations.
  • Avoid with bleeding disorders, low platelet counts, or if taking blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
  • Melatonin: Melatonin is a naturally occurring hormone that helps regulate sleep/wake cycles (circadian rhythm). Melatonin has been reported useful in neurological conditions including Parkinson's disease, periodic limb movement disorder, Rett's syndrome, and tardive dyskinesia (abnormal movements that can occur after long-term use of some older antipsychotic drugs). The use of melatonin in these conditions, however, is not supported by rigorous scientific testing. Better-designed research is needed to determine if melatonin is beneficial in individuals with neurological disorders.
  • Avoid melatonin supplementation in women who are pregnant or attempting to become pregnant. Use cautiously with bleeding disorders, seizure disorders, or if taking anticoagulants.
  • Moxibustion: Moxibustion uses the principle of heat to stimulate circulation and break up congestion or stagnation of blood and chi (energy). One small study reported treatment of trigeminal neuralgia with cupping to have a significant therapeutic effect. However, there is insufficient available evidence and more clinical studies are needed in this area.
  • Avoid with aneurysms, any kind of "heat syndrome," heart disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, or inflammatory conditions. Avoid areas with an inflamed organ, contraindicated acupuncture points, allergic skin conditions, ulcerated sores, or skin adhesions. Avoid over the face, genitals, head, or nipples. Avoid in patients who have just finished exercising or taking a hot bath or shower. Avoid if pregnant or breastfeeding. Use cautiously over large blood vessels and thin or weak skin. Use cautiously with elderly people with large vessels. It is considered not advisable to bathe or shower for up to 24 hours after a moxibustion treatment.
  • Physical therapy: There is evidence for the use of physical therapy for nerve or neurological disorders such as cerebral palsy, Guillain-Barre Syndrome (GBS), and Parkinson's disease. Additional high-quality studies are needed.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature, although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy, and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to help with problem solving. Supportive psychotherapy may or may not reduce the motor and vocal tics associated with Tourette's syndrome. More research needs to be done before conclusions can be made. Some forms of psychotherapy may evoke strong emotional feelings and expression.
  • Qi gong: Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. It is traditionally used for spiritual enlightenment, medical care, and self-defense. There is promising early evidence suggesting that internal Qi gong may help in the treatment of Parkinson's disease. However, the evidence is somewhat unclear, and further research is needed.
  • Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.
  • Reiki: Reiki is a system of laying on of the hands that originated in as a Buddhist practice approximately 2,500 years ago. Human study suggests that reiki may have an effect on autonomic nervous system functions such as heart rate, blood pressure, or breathing activity, important in neurological disorders that may damage autonomic function, including neurological conditions. Large, well-designed studies are needed before conclusions can be drawn.
  • Reiki is not recommended as the sole treatment approach for potentially serious medical conditions and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Use cautiously with psychiatric illnesses.
  • Rolfing® Structural Integration:Rolfing® Structural Integration involves deep tissue massage aimed at relieving stress and improving mobility, posture, balance, muscle function and efficiency, energy, and overall well being. Rolfing® Structural Integration may slightly improve movement in cerebral palsy patients. More studies are needed to confirm these possible benefits.
  • Rolfing® Structural Integration should not be used as the sole therapeutic approach to disease, and it should not delay the time it takes to speak with a healthcare provider about a potentially severe condition. Rolfing® Structural Integration is generally believed to be safe in most people. Avoid in patients taking blood thinners and in patients with broken bones, severe osteoporosis, disease of the spine or vertebral disks, skin damage or wounds, bleeding disorders, blood clots, tooth abscesses, acute disc problems, aneurysm, fever, recent scar tissue, connective tissue disease, cancer, and in patients who have just received cortisone shots or who are on chronic cortisone therapy. Use cautiously in patients with varicose veins or phlebitis, joint diseases, psychosis or bipolar disorder, severe kidney, liver, or intestinal disease, diabetes, menstruation, infectious conditions, colostomies, high blood pressure, and stenoses or strictures.
  • Safflower: In clinical research, safflower (Carthamus tinctoria) decreased deterioration caused by Friedreich's ataxia. More high-quality studies with larger sample sizes are needed to establish safflower's effect on neurological conditions.
  • Avoid if allergic/hypersensitive to safflower, Carthamus tinctorius, safflower oil, daisies, ragweed, chrysanthemums, marigolds, or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, immunodepressants or pentobarbital. Use cautiously with diabetes, low blood pressure, liver problems, bleeding disorders, or skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.
  • Selenium: Studies have consistently shown that antioxidants may not have clinical benefits in motor neuron diseases, such as amyotrophic lateral sclerosis (ALS). Although the research thus far does not discourage selenium supplementation in patients, more research is needed to determine if selenium is an effective treatment for central nervous system disorders.
  • Avoid if allergic or sensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th Century China. Tai chi techniques aim to address the body and mind as an interconnected system and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility, and strength. Community-based fitness programs, which include tai chi classes, may improve balance in patients with Parkinson's disease and may motivate individuals to participate in routine exercise. Additional research is warranted in this area.
  • Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.
  • Taurine: Taurine may affect cellular hyperexcitability by increasing membrane conductance to potassium and chloride ions, possibly by altering intracellular (within the cell) availability of calcium. Study results suggest that taurine supplementation may result in improvements in myotonic dystrophy. Well designed clinical trials are needed.
  • Taurine is an amino acid, and it is unlikely that there are allergies related to this constituent. However, allergies may occur from multi-ingredient products that contain taurine. Use cautiously in patients with high cholesterol, low blood pressure, bleeding disorders, potential for mania, or epilepsy. Avoid consuming energy drinks containing taurine, caffeine, glucuronolactone, B vitamins, and other ingredients before drinking alcohol or exercising. Use cautiously if pregnant or breastfeeding because taurine is a natural component of breast milk.
  • TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. Several studies have reported benefits of TENS therapy in patients with trigyminal neuralgia (facial pain), hemiplegia/hemiparesis, and spinal cord injury. Additional research is needed before a firm conclusion can be drawn.
  • Avoid with implantable devices, such as defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation (such as neuropathy) or with seizure disorders. Avoid if pregnant or breastfeeding.
  • Therapeutic touch: Therapeutic touch (TT) practitioners hold their hands a short distance from the patient without actually making physical contact. The purpose of this technique is to detect the patient's energy field, allowing the TT practitioner to correct any perceived imbalances. There is some evidence that therapeutic touch may affect some properties of the central nervous system. However, further research is needed to examine whether therapeutic touch could have any effects on central nervous system disorders.
  • Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation and on body areas with cancer.
  • Vitamin B6: Vitamin B6 (pyridoxine) is required for the synthesis of the neurotransmitters serotonin and norepinephrine and for myelin formation. Pyridoxine deficiency in adults principally affects the peripheral nerves, skin, mucous membranes, and the blood cell system. In children, the central nervous system (CNS) is also affected. Major sources of vitamin B6 include cereal grains, legumes, vegetables (carrots, spinach, and peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Some prescription drugs called neuroleptics, which are used in psychiatric conditions, may cause movement disorders as an unwanted side effect. Vitamin B6 has been studied for the treatment of acute neuroleptic-induced akathisia (NIA, a neuromuscular disorder characterized by a feeling of "inner restlessness" or a constant urge to be moving) in schizophrenic and schizoaffective disorder patients. Preliminary results indicate that high doses of vitamin B6 may be useful additions to the available treatments for NIA, perhaps due to its combined effects on various neurotransmitter systems. Further research is needed to confirm these results.
  • There is also early evidence that pyridoxine supplementation may be of benefit in hyperkinetic cerebral dysfunction syndrome and tardive dyskinesia. Further research is needed before a recommendation can be made.
  • Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA). Avoid vitamin B6 products if sensitive or allergic to any of their ingredients. Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Use cautiously if pregnant or breastfeeding.
  • Vitamin E: Vitamin E has been studied in the management of tardive dyskinesia (abnormal movements that can occur after long-term use of some older antipsychotic drugs) and Parkinson's disease, although the results of existing studies are not conclusive enough to form a clear recommendation. More research is needed.
  • Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid doses greater than the recommended daily level in pregnant women and breastfeeding women.
  • Yohimbe bark extract: The terms yohimbine, yohimbine hydrochloride, and yohimbe bark extract are related but not interchangeable. Yohimbine is an active chemical (indole alkaloid) found in the bark of the Pausinystalia yohimbe tree. Yohimbine hydrochloride is a standardized form of yohimbine that is available as a prescription drug in the United States. It is theorized that yohimbine may improve orthostatic hypotension (lowering of blood pressure with standing) or other symptoms of autonomic nervous system dysfunction. However, yohimbe bark extract may not contain significant amounts of yohimbine, and therefore may not have these proposed effects. More research is needed before a recommendation can be made.
  • Yohimbine is generally well tolerated in recommended doses. However, many side effects have been reported with yohimbine hydrochloride and may apply to yohimbe bark. Avoid if allergic to yohimbe, any of its components, or yohimbine-containing products. Use cautiously with peptic ulcer disease, kidney disease, high blood pressure, heart disease, or if taking drugs that affect blood sugar levels. Avoid with benign prostate hypertrophy (enlarged prostate), anxiety, mania, depression, stress disorders, post-traumatic stress disorders, bipolar disorders, or schizophrenia. Avoid use in children or in pregnant or breastfeeding women.
  • Fair negative scientific evidence:
  • Choline: Choline is possibly ineffective when taken by mouth for treating cerebellar ataxia. More research is needed in this area.
  • Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
  • Coenzyme Q10: There is negative evidence from studies that used coenzyme Q10 in the treatment of Huntington's disease. More studies are needed to confirm these results.
  • Allergy associated with coenzyme Q10 supplements has not been reported in the available literature, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution if history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners) or antiplatelet drugs (like aspirin, warfarin, clopidogrel (like Plavix®), blood pressure, blood sugar, cholesterol or thyroid drugs. Avoid if pregnant or breastfeeding.
  • Creatine: Overall, the evidence suggests that creatine supplementation may not offer benefit to individuals with amyotrophic lateral sclerosis (ALS).
  • Avoid if allergic to creatine or if taking diuretics. Use cautiously with asthma, diabetes, gout, kidney disorders, liver or muscle problems, stroke, or with a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.
  • Octacosanol: Policosanol is a mixture of very long chain alcohols that is purified from sugar cane wax. About 67% of policosanol is octacosanol. Although some research has been conducted using policosanol, little research is currently available that focuses on octacosanol alone. Early study does not show any evidence of benefit in brain or lung symptoms of amyotropic lateral sclerosis (ALS) patients. Additional study is needed in this area.
  • Avoid if allergic or hypersensitive to octacosanol or policosanol. Use cautiously if taking nitrates, lipid-lowering agents, cholesterol absorption inhibitors, nutraceuticals, aspirin, or agents that lower blood pressure. Avoid if pregnant or breastfeeding.

Prevention
  • Diet: Nutritional changes along with the addition of supplements (vitamins, minerals, and herbs) may be effective in reducing symptoms associated with neurological disorders.
  • It is best to avoid caffeine and other stimulants, alcohol, and smoking.
  • It may be best to eliminate potential food allergens, including dairy (milk, cheese and sour cream), eggs, nuts, shellfish, wheat (gluten), corn, preservatives, and food additives (such as dyes and fillers). Food allergies can be a contributing factor in neurological imbalance.
  • It may be best to avoid refined foods such as white breads, pastas, and sugar. Doughnuts, pastries, bread, candy, soft drinks, and foods with high sugar content may all contribute to worsening symptoms of neurological disorders.
  • Food can be cut into small pieces, softened, or pureed to ease swallowing and prevent choking. While some foods may require the addition of thickeners, other foods may need to be thinned. Dairy products, in particular, tend to increase the secretion of mucus, which in turn increases the risk of choking.
  • Exercise: Maintaining physical fitness is important to those suffering from movement disorders. Those with movement disorders who exercise and keep active tend to do better, with less symptoms and a slower disease progression, than those who do not. A daily regimen of exercise can help the person feel better physically and mentally. Individuals should walk as much as possible, even if assistance is necessary. Talking with a healthcare provider about an exercise program is important.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Bonelli RM, Hofmann P. A systematic review of the treatment studies in Huntington's disease since 1990. Expert Opin Pharmacother. 2007 Feb;8(2):141-53. .
  2. Chou KL, Borek LL, Friedman JH. The management of psychosis in movement disorder patients. Expert Opin Pharmacother. 2007 May;8(7):935-43. .
  3. Hermanowicz N. Drug therapy for Parkinson's disease. Semin Neurol. 2007 Apr;27(2):97-105. .
  4. Huntington 's Disease Association. . Accessed April 16, 2009.
  5. Kenney C, Simpson R, Hunter C, et al. Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders. J Neurosurg. 2007;106(4):621-5. .
  6. Moro E, Lang AE. Criteria for deep-brain stimulation in Parkinson's disease: review and analysis. Expert Rev Neurother. 2006 Nov;6(11):1695-705. .
  7. Movement Disorder Society. . Accessed April 16, 2009.
  8. National Association of Neurological Disorders and Stroke. . Accessed April 16, 2009.
  9. National Student Speech Language Hearing Association. . Accessed April 16, 2009.
  10. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed April 16, 2009.
  11. Tourette's Syndrome Association. . Accessed April 16, 2009.
  12. Worldwide Education and Awareness for Movement Disorders. . Accessed April 16, 2009.

Causes
  • Movement is produced and coordinated by several interacting brain centers, including the motor cortex, the cerebellum, and a group of structures in the inner portions of the brain called the basal ganglia. Sensory information provides critical input on the current position and movement of body parts and spinal nerve cells (neurons) help prevent opposing muscle groups from contracting at the same time.
  • Motor cortex: Voluntary (willed) motor commands begin in the motor cortex located on the outer, wrinkled surface of the brain. Movement of the right arm is begun by the left motor cortex, which generates a large volley of signals to the involved muscles. These electrical signals pass along upper motor neurons through the midbrain to the spinal cord. Within the spinal cord, they connect to lower motor neurons that convey the signals out of the spinal cord to the surface of the muscles involved. Electrical stimulation of the muscles causes contraction and the force of contraction pulling on the skeleton causes movement of the arm, hand, and fingers.
  • Damage to or death of any of the neurons along this path causes weakness or paralysis of the affected muscles.
  • Antagonistic muscle pairs: Contraction of the biceps muscle, located on the top of the upper arm, pulls on the forearm to flex the elbow and bend the arm. Contraction of the triceps, located on the opposite side, extends the elbow and straightens the arm. Within the spine, these muscles are normally wired so that voluntary contraction of one is automatically accompanied by blocking of the other. In this way, these antagonist muscles are kept from resisting one another. Spinal cord or brain injury can damage this control system and cause involuntary simultaneous contraction and spasticity, an increase in resistance to movement during motion.
  • The cerebellum: Once the movement of the arm is initiated, sensory information is needed to guide the finger to its precise destination. In addition to sight, the most important source of information comes from the "position sense" provided by the many sensory neurons located within the limbs (proprioception). Proprioception is what allows an individual to touch their nose with their finger even with the eyes closed. The balance organs in the ears provide important information about posture. Both postural and proprioceptive information are processed by a structure at the rear of the brain called the cerebellum. The cerebellum sends out electrical signals to modify movements as they progress, organizing the voluntary commands into a tightly controlled pattern. Cerebellar disorders cause ataxia (inability to control the force, fine positioning, and speed of movements). Disorders of the cerebellum may also impair the ability to judge distance so that a person under- or overreaches the target (dysmetria). Tremor during voluntary movements can also result from cerebellar damage.
  • The basal ganglia: Both the cerebellum and the motor cortex send information to the basal ganglia (a set of structures deep within the brain that help control involuntary components of movement). The basal ganglia send output messages to the motor cortex, helping to initiate movements, regulate repetitive or patterned movements, and control muscle tone.
  • Circuits of neurons (nerve cells) within the basal ganglia are very complex. Within the structure, some groups of cells begin the action of other basal ganglia components and some groups of cells block the action. These complicated feedback circuits are not entirely understood. Disruptions of these circuits are known to cause several distinct movement disorders. A portion of the basal ganglia called the substantia nigra sends electrical signals that block output from another structure called the subthalamic nucleus. The subthalamic nucleus sends signals to the globus pallidus, which in turn blocks the thalamic nuclei. Finally, the thalamic nuclei send signals to the motor cortex. The substantia nigra then begins movement and the globus pallidus blocks it.
  • This complicated circuit can be disrupted at several points. For instance, loss of substantia nigra cells, as in Parkinson's disease, increases blocking of the thalamic nuclei, preventing them from sending signals to the motor cortex. The result is a loss of movement (motor activity), a characteristic of Parkinson's.
  • In contrast, cell loss in early Huntington's disease decreases blocking of signals from the thalamic nuclei, causing more cortex stimulation and stronger but uncontrolled movements.
  • Disruptions in other portions of the basal ganglia are thought to cause tics, tremors, dystonia, and a variety of other movement disorders, although the exact mechanisms are not well understood.
  • Movement disorders can result from causes including age-related changes, environmental toxins, genetic disorders (such as Huntington's disease and Wilson disease), medications (antipsychotic drugs), metabolic disorders (hyperthyroidism and diabetes), Parkinson's disease, and stroke (neurological damage due to lack of blood supply to the brain).
  • Some movement disorders, including Huntington's disease and inherited ataxias, are caused by inherited genetic defects. Some diseases that cause focal dystonia, or sustained muscle contraction limited to a particular muscle group, are inherited, but others are caused by trauma. The cause of most cases of Parkinson's disease is unknown, although genes have been found for some familial forms.

Risk factors
  • Age: Parkinson's disease affects about one percent of people older than 65 and 0.4% of those older than 40. The mean age at onset is about 57 years of age. Rarely, Parkinson's disease begins in childhood or adolescence (juvenile parkinsonism). Tourette's syndrome usually becomes apparent in children between ages two and 15, with approximately 50% of patients affected by age seven. The age of symptom onset is typically before the age of 18.
  • Genetics: Some movement disorders are due to inheriting genes that carry the genetic condition. One or both parents can have the gene and pass it on to their children. Some individuals may carry the gene but not exhibit symptoms of the neurological condition. Examples of movement disorders that are genetically inherited include dystonia musculorum deformans (a rare dystonia characterized by movements resulting in bizarre postures), Huntington's disease (results in chorea or uncontrolled movements, loss of intellectual faculties, and emotional disturbance), and Tourette's syndrome (multiple motor and vocal tics or repeated muscle contractions).
  • Sex: The sex of the individual predisposes certain people to movement disorders. In Tourette's syndrome, at-risk males are more likely to have tics and at-risk females are more likely to have obsessive-compulsive symptoms. Seven of every 10 girls who inherit the gene, and nearly all boys who inherit it, will develop symptoms of Tourette's syndrome. Huntington's disease affects both sexes equally.

Types of movement disorders
  • Ataxias: Ataxias are a group of degenerative disorders affecting the brain, brain stem, or spinal cord that erode muscular coordination, causing weakness, atrophy, and other problems depending on the tissues involved. The disorders are often inherited and there is no treatment.
  • Dystonia: Individuals diagnosed with dystonia often experience involuntary muscle contractions that force certain parts of the body into abnormal, sometimes painful, movements or postures. Dystonia can affect any part of the body including the arms and legs, trunk, neck, eyelids, face, or vocal cords. When these involuntary muscle contractions interfere with normal function, dystonia can cause impairments such as difficulty walking, writing, or speaking. In general, though, dystonia patients experience no impairment of cognition, strength, and the senses, including vision and hearing. General dystonia involves the entire body. Focal dystonias involve only one body location, including spasmodic torticollis (in the neck), blepharospasm (in the eyelids), Meige syndrome (in the lower face), or writer's cramp or limb dystonia (in the hands).
  • Essential tremor: Essential tremors are an uncontrolled shaking or trembling, most often affecting the hands. However, some individuals experience tremors of the head and neck, jaw, face, and even the tongue and voice. In rare instances, essential tremor can also affect the legs and feet. Although emotionally distressing, the condition is usually less debilitating than Parkinson's disease.
  • Huntington's disease: Huntington's disease is a progressive, degenerative disease caused by the deterioration of certain nerve cells in the brain. The condition is hereditary. Symptoms include a wide, prancing gait; hesitant speech; involuntary, jerky movements in the arms, neck, trunk, and face; personality changes; and intellectual deterioration. The disease affects approximately four to eight per 100,000 people in the United States. Onset is usually between the ages of 35 and 50.
  • Multiple system atrophy: Shy-Drager syndrome is the distinctive disorder in this term. The syndrome is characterized by abnormalities in the autonomic nervous system that cause blood pressure to drop excessively when standing or sitting up, resulting in dizziness or momentary blackouts. Blood pressure tends to fluctuate up and down, causing severe headaches. Other symptoms may include Parkinson's-like slow movements and mild tremors, balance problems, generalized weakness, double vision, speech impairment, and sensory changes.
  • Myoclonus: Myoclonus is the twitching or intermittent spasm of a muscle or group of muscles.
  • Parkinson's disease: Parkinson's disease is a progressive degeneration of nerve cells in the area of the brain controlling muscle movement. Resulting symptoms include a tremor or shaking at rest, slowed movement, shuffling gait, and stiff or rigid limbs on one or both sides of the body. Parkinson's disease affects both men and women in almost equal numbers, though men are slightly more likely to be diagnosed. Anyone in any social or ethnic group in any geographic area can be diagnosed with Parkinson's disease. In the United States, about 60,000 new cases are diagnosed each year. Today, between 1-1.5 million Americans currently have Parkinson's disease. While the condition usually develops after the age of 65, 15% of those diagnosed are younger than 50.
  • Progressive supranuclear palsy: Progressive supranuclear palsy is a rare brain disorder that causes serious and permanent problems with gait and balance control. Symptoms include frequent falls and balance problems, an inability to aim the eyes properly, and changes in mood and behavior. Symptoms vary widely among patients. It is sometimes misdiagnosed as Parkinson's disease.
  • Restless legs syndrome: Restless leg syndrome is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move them for relief. Symptoms are usually worse in the evening and can result in insomnia. Medical treatments are available.
  • Rhett syndrome: Rhett syndrome is a progressive neurological disorder that causes reduced muscle tone, autistic-like behavior, wringing and waving hand movements, diminished ability to express feelings, avoidance of eye contact, a lag in brain and head growth, gait abnormalities, and seizures. Loss of muscle tone is usually the first symptom. It affects about one in every 10,000-15,000 baby girls. Symptoms usually appear between six and 18 months.
  • Spasticity: Spasticity is increased muscle contractions causing stiff and awkward movement due to stroke, cerebral palsy, multiple sclerosis, amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease), spinal cord, or brain injury.
  • Tardive dyskinesia: Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements such as grimacing, lip smacking, eye blinking or rapid leg and arm movements. It is caused by long-term use of neuroleptic drugs.
  • Tourette's syndrome: Tourette's syndrome is an inherited disorder characterized by repeated involuntary movements and uncontrollable vocal sounds called tics. Symptoms generally appear before age 18.
  • Wernicke-Korsakoff syndrome: Wernicke-Korsakoff syndrome is a severe memory disorder usually associated with chronic excessive alcohol consumption, although the direct cause is a deficiency in thiamin (vitamin B1).
  • Wilson's disease: Wilson's disease is an inherited disorder that causes excessive amounts of copper to accumulate in the body. Symptoms begin appearing between the ages of six and 40. Liver disease is a consequence in many patients. In others, the first symptoms are neurological or psychiatric and can include tremor, rigidity, personality changes, or grossly inappropriate behavior.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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