Treatement in Movement Disorders

Monday, August 3, 2009

Movement is triggered through the pyramidal system, the basal ganglia and the cerebellum in the brain.These are discrete parts of the brain which perform specific but different functions, which are wired to each other for the performance of normal movement. The movement disorders are a diverse group of pathological dysfunctions in the nervous system, giving rise to any of these: an abnormal movement, a paucity of movement, an abnormality of muscle tone or a disturbance in posturalreflex.

The common movement disorders are Tremors, Chorea, Parkinson's disease, Dystonia and Writer's cramp.

The patient gives a detailed history of what has been occurring in terms of the symptoms. The investigation is followed by a neurological physical examination. Scales are used(basically written proformas) to assess the severity and type of movement disorder. Various movement sequences are recorded on video as a baseline before any treatment, to later compare the patient's performance in specific functions. This is followed by basic bloods tests, a CT/ MRI brain scan and EEG or EMG along with some specific tests that may be needed, depending on the diagnostic possibilities that the physician is thinking of.

The various treatments in Movement Disorders that are generally followed includes

1) Medications: Medications that either stimulate or inhibit the specific receptors for central nervous system chemicals (neurotransmitters) are the mainstay of treating such disorders

2) Botulinum toxin injection: This toxin is injected into muscles to partially paralyze them, and thereby control the abnormal movement.Several sites are injected in one sitting, and several such sessions may be required at 4 week intervals.

3) Stereotactic surgery: After detailed visualisation using CT/ MRI and mapping the brain, ablation (destruction) of certain parts of the brain nuclei and/ or its circuits will generally give relief from the abnormal movement.

4) Deep brain stimulation: The position of the basal ganglia nuclei are identified using CT/ MRI brain scans. Electrodes are placed onto specific brain nuclei and electrical signals are sent from a generator placed under the skin, in the chest. The patient has the option of controlling the current from the generator, for symptom relief.

The first task of the physician is to arrive at a diagnosis, or a highly probable diagnosis, using variouslines of investigation.The best line of treatment: Each patient would need to be tried on a specific combination of drugs which may vary from 1 to 3 months, to assess the best outcome with drug management.

Specific Medical Concerns on Movement Disorders

Following this minor adjustment in drug dosages may be required once every three months
Likely outcomes: It is usually expected that the abnormal movement decreases to a remarkable extent. If the problem had been one of rigidity and paucity of movement, then movements should be more easily performed. A small sub-set of patients are not likely to improve on medications, for which deep brain stimulation or Stereotactic surgery should be considered to give optimal relief.

Movement disorders are generally progressive degenerative disorders, which means that the pathological course cannot be greatly altered, though significant improvement in function can be provided. However, the goal of management is to provide optimal relief and restore normal functionality, with the least side effects and thereby significantly improve the quality of life for the patients.


The Department of Neurology at Wockhardt Hospitals

Dr. Chandran Gnanamuthu ,
MD, DM, FIAN, FAAN DM PhD (Neuro Sciences)
Dr. C. Udaya Shankar,Specialist in Movement Disorder
Dr. Vijay Chockan,Consultant Neurologist Consultant Neurologist Consultant Neurophysiologist


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