The 7 types of movement disorders: characteristics and symptoms.
A summary of the different types of movement disorders that exist.
Movement disorders are a set of pathologies characterized by a decrease, loss or excessive presence of body movements that severely affect the quality of life of the people who suffer from them.
In this article we explain what they consist of, what types of disorders of the movement exist and which is its treatment..
What are movement disorders?
The movement disorders include a group of disorders in which the regulation of the motor activity is deteriorated and alterations in the form and the speed of the corporal movements are presented.without directly affecting strength, sensation or cerebellar function.
Such disorders may be caused by disease, genetic conditions, medications, or other factors. In addition, a movement disorder may be the sole clinical expression of a specific disease or may be part of a more complex set of neurological may be part of a cluster of neurological manifestations of more complex diseases..
The risk of developing a movement disorder increases with age. A previous history of stroke and the presence of cardiovascular risk factors, such as having high blood pressure or diabetes, may increase the risk of developing a circulation-related movement disorder.
Types of movement disorders
From a clinical perspective, two major groups of movement disorders can be distinguishedHypokinetic movement disorders: hypokinetic, characterized by slow or decreased movements; and hyperkinetic, characterized by excessive or abnormal involuntary movements.
Hypokinetic movement disorders
Hypokinetic movement disorders or syndromes include all those movement pathologies in which movement is impoverished and slowed, affecting the associated voluntary and spontaneous movements.
The most frequent hypokinetic disorder is the so-called parkinsonian syndrome, which consists of an alteration of the movement of the brain.which consists of an alteration in the functioning of the cortico-subcortical motor circuit responsible for the correct generation of body movements. This syndrome presents several common symptoms, such as bradykinesia, tremors and rigidity.
In bradykinesia, a motor slowing occurs at the beginning.Afterwards, repetitive or alternating movements of the extremities occur during the realization and completion of the voluntary movement, with a progressive reduction in speed and amplitude.
Three components can be distinguished in bradykinesia: motor slowing or bradykinesia itself, akinesia or poverty of spontaneous movements (with delay in the initiation of movement or change between fluid movements) and hypokinesia, which consists of a decrease in the amplitude of movement.
As for tremors, the most characteristic in hypokinetic movement disorders is the resting tremor, of low frequency (between 3 and 6 hz). This tremor usually appears when the muscles have not been activated and decreases when a specific action is performed. An action tremor may also exist, but it is less frequent. However, a parkinsonian syndrome can exist without evidence of tremor.
Finally, the term stiffness refers to the resistance of a body part to passive mobilization, The resistance of a part of the body to passive mobilization is called rigidity.. In parkinsonian syndromes, it may appear in the form of a cogwheel, with brief episodes of opposition alternating with episodes of relaxation.
It can also be manifested by a constant resistance, called a lead pipe, in which the intensity of the resistance remains constant throughout the range of motion, whether extended or flexed (without changing as the speed at which the body part is mobilized varies, unlike spasticity).
Hyperkinetic movement disorders
Hyperkinetic movement disorders are those in which there is an excess of abnormal and involuntary movements. The main forms are: tics, chorea, ballism, athetosis, myoclonias and dystonia. Let us see in what consists each one of them.
1. Tics
The tics are stereotyped movements, without a concrete aim, which are repeated irregularly.that are repeated irregularly. They are characterized because they can be suppressed voluntarily and increase with factors like stress or anxiety. They can be classified in primary tics (sporadic or hereditary) and secondary, motor and vocal, simple and complex.
The most severe form of multiple tics is the one known as Gilles de la Tourette's Syndromean autosomal dominant hereditary disorder, associated with defects in chromosome 18. This disorder manifests with multiple motor tics and one or more phonic tics. These tics occur several times a day, practically every day for more than a year. The severity and complexity of these tics can vary over time.
To treat this type of abnormal movements, such as tics, a pharmacological treatment based on neuroleptics, clonidine and antidopaminergic drugs is usually necessary.
2. Chorea
Chorea is a movement disorder that refers to refers to arrhythmic, irregular, rapid, rapid, uncoordinated, and continuous movements affecting any part of the body.
The causes of this movement disorder are multiple and rare: hereditary (Huntington's disease, neuroacanthocytosis, Fahr's syndrome, etc.), metabolic and endocrine (hyperparathyroidism, hyperthyroidism, etc.), due to vasculitis (e.g. systemic lupus erythematosus), due to basal ganglia stroke and pharmacological.
Huntington's disease is the most common type of hereditary chorea.. It can begin at any age, although it has a higher incidence in people between 40 and 50 years of age, slowly progressing to death over a period ranging from 10 to 25 years. Survival is shorter among patients with juvenile onset of the disease.
Pneumonia and a number of other intercurrent infections are usually the most frequent cause of death. There is a family history in almost all patients with Huntington's disease. It is an autosomal dominant inherited disorder with complete penetrance, and is the result of a genetic defect on chromosome 4.
3. Ballismus
Ballismus is a severe form of chorea that produces jerky, involuntary movements produces jerky, involuntary, large-amplitude movements.. It usually appears suddenly but may develop over days or even weeks. This movement disorder usually subsides during sleep.
The movements of ballismus are so violent that they can lead to death by exhaustion or cause joint or skin lesions in the sufferer. It frequently affects one hemibody (hemiballism), although sometimes it can affect only one limb (monoballism), both lower limbs (paraballism) or, in rarer cases, all four limbs (biballism or lateral ballism).
4. Athetosis
Athetosis is a movement disorder that occurs in one fourth of the occurs in a quarter of all cases of cerebral palsy.. This disorder is caused by lesions in the extrapyramidal system and manifests itself in slow, meandering, uncontrolled, involuntary and aimless movements.
The muscles of the mouth are affected, which is why patients with athetosis often have language disorders. It may also occur as an abnormal reaction to estrogens or some Antidepressant drugs.
5. Myoclonias
The myoclonias consist of involuntary, abrupt and brief movements, caused by active muscle contraction or abrupt inhibitions of muscle tone.. They can be classified according to their origin: cortical, subcortical, spinal or peripheral.
By their distribution, they are classified as focal (involving a discrete group of muscles), segmental or generalized (generally of progressive cause and associated with epileptic disorders). And by their form of presentation, they can be spontaneous, action or reflex myoclonus.
6. Dystonia
This type of movement disorders are involuntary and sustained, and produce a deviation or torsion produce a deviation or torsion of an area of the body.. The person who suffers them cannot eliminate them voluntarily and they are produced due to specific movements or actions.
They are usually suppressed during sleep. They usually occur together with other movement disorders such as essential tremor. There is also a "dystonic tremor", which occurs when the patient tries to move a part of his body in the opposite direction to the force of the dystonia.
Treatment
Movement disorders should be treated according to their etiology and severity. One of the treatments applied is deep brain stimulation, which significantly reduces the movements of the patient.which significantly reduces involuntary movements. This is done by generating electrical pulses in the brain, with the patient himself adjusting the intensity of the impulse to control his symptoms.
Another treatment that has been used in these cases is magnetic resonance guided focused ultrasound (MRgFUS), a procedure that uses beams of sound energy to remove a small volume of brain tissue without affecting adjacent areas.
Use of drugs in therapy
Occasionally, drugs are also used to palliate symptoms, including:
1. beta-blockers
These are drugs that lower blood pressureThese are medications that lower blood pressure, thereby reducing the jerking and other physical symptoms of many movement disorders.
2. Antiepileptics
These drugs are used to reduce tremors (for example, in parkinsonian syndromes), especially those produced in the hands.
3. Anticholinergics
These drugs are used to treat dystonias by reducing the effects of acetylcholine, a neurotransmitter involved in muscle contractions, causing a decrease in tremors and rigidity.
4. Anxiolytics
Anxiolytics act on the central nervous system by causing muscle relaxation, which relieves, in the short term, muscle twitching and stiffness.which alleviates, in the short term, the effects of shaking and spasms.
5. Botulinum toxin
This toxin acts by blocking the neurotransmitters responsible for muscle spasms, helping to stop them.
Bibliographic references:
- Jankovic J. Treatment of hyperkinetic movement disorders. Lancet Neurol 2009; 8: 844 - 856.
- Leon-Sarmiento FE, Bayona-Prieto J, Cadena Y. Neural plasticity, neurorehabilitation and movement disorders: the change is now. Act Neurol Col 2008; 24: 40 - 42.
(Updated at Apr 13 / 2024)