Movement Disorders

What is considered a movement disorder?

Movement disorders are a group of neurological conditions that cause abnormal movements. They could be increased movement (like spasms, jerking or shaking) and/or decreased or slow movement. They can affect actions you choose to make (voluntary) or cause uncontrolled (involuntary) movements.

Every body movement you make, from lifting your leg to moving your jaw and tongue to talk, involves complex communication between your:

• Central nervous system (your brain and spinal cord).
• Motor nerves.
• Skeletal muscles.

Damage to or malfunction of the areas of your brain that control movement results in a movement disorder.

There are several different movement disorders, and they vary in severity. Some only affect one area of your body, while others can affect most of your body. Some may interfere with certain tasks, like writing, while others can lead to issues with walking and mobility.

Abnormal movements may be the only part of a condition, such as in essential tremor. Or they can be one of several symptoms or syndromes, like in Parkinson’s disease (PD). In addition, certain movement disorders can be both a condition by themselves and a symptom of other conditions, like myoclonus.

It’s important to note that conditions that result in a lack of movement (like paralysis) or weakened muscles (such as muscular dystrophy) aren’t considered movement disorders even though they affect mobility. Movement disorders cause abnormal, unwanted movements.

What are the types of abnormal movements?

There are two main types of abnormal movements:

• Hyperkinetic movement.
• Hypokinetic movement.

A movement disorder can have both of these or just one.

Hyperkinetic movement

Hyperkinetic movement disorders involve increased movement. “Hyper” means “over” or “beyond,” and “kinetic” means “motion.” It can affect voluntary movement (actions you choose to take) or cause involuntary movement (actions that are out of your control).

Types of hyperkinetic movement include:

• Akathisia: Akathisia makes it difficult to sit or remain still due to inner restlessness. Akathisia is associated with the use of certain types of medications, especially antipsychotic (neuroleptic) medications.
• Ataxia: Ataxia is when you have a problem with coordination, causing you to move in an uncertain, awkward or even clumsy way. Ataxia can be a condition or a symptom of another condition. It’s much more common as a symptom.
• Chorea, athetosis and ballism: Chorea is a movement disorder that causes involuntary, unpredictable muscle movements. The disorder can make you look like you’re dancing, restless or fidgety. It’s common in Huntington’s disease. Athetosis is a continuous stream of slow, twisting or squirming-like motions usually involving your hands and feet. Ballism usually involves more intense movements, such as forceful flinging of one arm or leg.
• Dystonia: Dystonia is sustained or intermittent muscle contractions causing abnormal, often repetitive movements or postures. Dystonia is a common symptom of cerebral palsy and several neurodegenerative conditions.
• Myoclonus: Myoclonus is brief, involuntary muscle twitching or jerking. People who experience myoclonic twitches or jerks have muscles that unexpectedly tighten (positive myoclonus) or relax (negative myoclonus).
• Spasticity: Spasticity is a disruption in muscle movement patterns that causes certain muscles to contract all at once when you try to move or even at rest. It interferes with movement and can also affect your speech and how you walk (gait).
• Stereotypies (stereotypic movements): Stereotypies are complex and usually bilateral (both sides of your body) movements. They’re patterned and look the same or very similar each time. Examples include rocking, hand flapping, pacing and body clenching. Stereotypies can be a feature of many conditions, including autism spectrum disorder and Rett syndrome.
• Tics: Tics are patterned, repetitive, nonrhythmic movements. Simple tics are brief and involve a small cluster of muscles. Examples include blinking, face scrunching, head jerking, throat clearing and grunting. Complex tics may last longer and involve more muscles. Examples include hopping and saying certain words or phrases. Tics are a part of Tourette’s syndrome but can be present in other conditions.
• Tremor: Tremor involves involuntary trembling or shaking movements. The movements may be in one or more parts of your body. Tremors happen when your muscles repeatedly contract and relax.

Hypokinetic movement

Hypokinetic movement disorders involve decreased or slow movement. “Hypo” means “below” or “beneath.” It generally affects voluntary movement.

Parkinsonism is the main type of hypokinetic movement. It’s an umbrella term that refers to brain conditions that cause slowed movements, rigidity (stiffness), tremor or balance trouble.

Neurodegenerative parkinsonism most commonly happens with Parkinson’s disease, but it can also be a feature of the following conditions:

• Multiple system atrophy.
• Corticobasal degeneration.
• Progressive supranuclear palsy.
• Lewy body dementia.

Parkinsonism can also develop due to repeated head injuries, toxic substances, use of psychiatric medications and a lack of blood flow to certain areas of your brain.

Bradykinesia is another hypokinetic movement. It involves slowness of movement and speed or progressive hesitations or halts as you continue movements. It’s one of the main signs of Parkinson’s disease.

What are the types of movement disorders?

There are several movement disorders. Some include:

• Essential tremor: Essential tremor causes parts of your body to shake uncontrollably. It usually affects your hands and arms but can also affect your head, voice and other body parts.
• Huntington’s disease: Huntington’s disease is a genetic condition that affects your brain, causing unsteady and uncontrollable movements (chorea) in your hands, feet and face. Symptoms get worse over time.
• Multiple system atrophy (MSA): MSA is a rare condition that causes certain brain areas to deteriorate. It may cause ataxia and parkinsonism.
• Parkinson’s disease: Parkinson’s disease is a brain disorder that causes unintended or uncontrollable movements and difficulty with balance and coordination. It also causes cognitive (mental) decline.
• Periodic limb movement disorder (PLMD): PLMD involves repetitive limb movements that occur during sleep and may cause sleep disruption. The limb movements usually involve your lower extremities, consisting of extension of your big toe and flexion of your ankle, knee and hip.
• Progressive supranuclear palsy (PSP): PSP is a rare neurodegenerative disorder that damages certain areas of your brain. It affects how you walk, think, swallow and move your eyes.
• Restless leg syndrome (RLS): RLS is a sleep disorder that causes an intense, often irresistible urge to move your legs (and even your arms or body). It occurs along with other sensations in your limbs like pulling, creeping, tugging, throbbing, itching, aching, burning or crawling.
• Rett syndrome: Rett syndrome is a rare genetic condition that affects speech, purposeful hand use and coordination.
• Tardive dyskinesia: Tardive dyskinesia can result from taking antipsychotic (neuroleptic) medications for many years. It can cause involuntary facial tics. It can also cause uncontrollable movements like lip-smacking.
• Tourette syndrome: Tourette syndrome is a neurological disorder that affects your brain and nerves. It causes you to make sudden movements or sounds (tics) and is accompanied by anxiety, ADHD and often obsessive-compulsive disorder.
• Wilson disease: Wilson disease is a rare genetic condition that happens when your body accumulates too much copper, especially in your liver and brain. It can cause stiff muscles, tremors and uncontrolled movements.

What is the most common movement disorder?

The two most common movement disorders are Parkinson’s disease and essential tremor.

What are the symptoms of movement disorders?

The symptoms of movement disorders vary widely. All movement disorders cause abnormal movements. Some movement disorders have other symptoms, such as thinking and mood changes. The symptoms can range in severity from barely noticeable to disruptive.

In general, signs and symptoms of movement disorders include:

• Episodes of uncontrolled movement, like twitches, spasms, tremors, jerks, twisting and shaking.
• Problems with coordination and balance.
• Trouble with certain movement tasks, such as writing, swallowing or speaking.
• Difficulty walking or changes to your gait.
• Stiffness or rigidity of your limbs and trunk.

Abnormal movements can affect one or more of several parts of your body, including your:

• Limbs.
• Hands and fingers.
• Feet and toes.
• Facial muscles.
• Head and neck.
• Trunk and posture.
• Voice.

How do I know if I have a movement disorder?

We all experience uncontrollable movements at times, such as random muscle twitches, hypnic jerks or hiccups. However, unusual or persistent symptoms may be signs of a movement disorder. If you notice a consistent change in your or your child’s movements, it’s important to see a healthcare provider to receive a diagnosis and treatment.

What is the cause of movement disorders?

In general, movement disorders develop from damage to or malfunction of certain parts of your brain that control movement, including your:

• Primary motor cortex: The primary motor cortex is a strip of brain tissue in your frontal lobe. It’s responsible for initiating voluntary movements. Damage to your primary motor cortex can result in spasticity, myoclonus and issues with fine motor movements.
• Basal ganglia: Your basal ganglia help start and smooth out voluntary muscle movements, suppress involuntary movements and coordinate changes in your posture. Damage to your basal ganglia can result in chorea, athetosis, dystonia and parkinsonism.
• Cerebellum: Your cerebellum coordinates your movements, helps your limbs move smoothly and accurately, and helps maintain balance. Damage to this part of your brain results in loss of coordination.
• Thalamus: Your thalamus is an egg-shaped structure in the deeper part of your brain — one on either side. It’s a relay station of all incoming motor (movement) and sensory information. Damage to your thalamus can cause tremor and motor impairments.

Several situations can result in damage to these areas, including:

• Genetic conditions and mutations.
• Traumatic brain injury.
• Infections.
• Toxins.
• Acquired or inherited metabolic disorders.
• Stroke and vascular diseases.
• Medication side effects.

Some movement disorders have a single cause that healthcare providers can identify. But in many cases, the condition results from multiple factors. Some movement disorders have unknown causes.

How are movement disorders diagnosed?

As movement disorders are often complex and mimic other conditions, your healthcare team will likely perform multiple tests to make a diagnosis. They’ll first start with a detailed history, physical exam and a neurological exam.

Based on your symptoms, they may order any of these tests:

• Blood tests to help diagnose certain kinds of movement disorders or rule out other causes.
• Electromyography (EMG) to assess the health of your muscles and the nerves that control them.
• Electroencephalogram (EEG) to check the electrical activity of your brain.
• Lumbar puncture to analyze your cerebrospinal fluid.
• Muscle biopsy to distinguish between nerve and muscle conditions.
• Nerve conduction study to measure the flow of electrical current through a nerve before it reaches a muscle.

Providers also often use imaging tests to help diagnose movement disorders. They may look at your brain, spinal cord or nerves. These tests may include:

• Computed tomography (CT).
• Magnetic resonance imaging (MRI).

How are movement disorders treated?

The treatment for movement disorders varies based on the type. Most movement disorders don’t have a cure, so the goal of treatment is to manage symptoms. But some movement disorders, such as medication-induced parkinsonism, are often treatable.

Examples of treatments for movement disorders include:

• Medication: Several medications can help the symptoms of movement disorders. For example, muscle relaxants can help with spasticity. Dopaminergic medications may help with Parkinson’s disease and restless leg syndrome. Antianxiety medications may help with dystonia. There are also specific medications for specific conditions.
• Physical therapy: Physical therapy helps improve how your body performs physical movements. Physical therapists help you manage symptoms like pain, stiffness and discomfort that make it hard to move.
• Occupational therapy: Occupational therapy helps improve your ability to perform daily tasks. An occupational therapist helps you learn how to safely stand, sit, move or use different tools to participate in your activities.
• Mobility aids: Mobility aids, like canes, walkers and wheelchairs, can help you move more safely and increase your independence.
• Speech therapy: Speech therapy helps improve your speech, language skills and swallowing ability.
• Psychotherapy: Psychotherapy (talk therapy) is a term for a variety of treatment techniques that aim to help you identify and change unhealthy emotions, thoughts and behaviors. Movement disorders often lead to mental health conditions, like depression and anxiety. Psychotherapy can help.
• Botulinum toxin (Botox®) injections: These can help relax your muscles if you have dystonia or spasticity.
• Deep brain stimulation: This is a brain surgery for people with advanced Parkinson’s disease, dystonia and other tremors. It may reduce involuntary movements.
• Clinical trials: Clinical trials are a type of research that studies new tests and treatments for specific conditions. There may be a clinical trial you can be a part of.

What can I expect if I have a movement disorder?

No two people with a movement disorder are affected in the same way. The best way to know what to expect is to talk to healthcare providers who specialize in researching and treating your condition.

You may benefit from a team of healthcare providers, including:

• Neurologists.
• Neurosurgeons.
• Physical therapists.
• Occupational therapists.
• Speech therapists.
• Psychologists.

How do I take care of myself or my child?

If you or your child have a movement disorder, it’s important to advocate for the best medical care possible. Advocating for care helps ensure the best possible quality of life.

You and your family may also want to consider joining a support group to meet others who can relate to your experiences.

When should I see my healthcare provider?

You should see a healthcare provider any time you have changes in how you usually move or issues that affect your routine and activities. The quicker your provider diagnoses a movement disorder, the sooner you’ll be able to start treatment.

If you have a movement disorder, you should also seek care when:

• Your healthcare team has you scheduled for an appointment: Making these appointments helps your team monitor your condition and recommend adjustments to treatment that might help.
• You notice changes in your symptoms: These kinds of changes can be important information for your team to consider as they work to monitor and care for you.
• You notice side effects or changes in treatment effectiveness: It may take time to find the right treatment for you, or medication may become less effective with time. Tell your team if your treatment isn’t working or if you notice bothersome side effects.

Your healthcare team can also tell you about other signs to watch for that mean you need to see them soon or that you need medical care right away.

A note from Cleveland Clinic

Receiving a movement disorder diagnosis can be overwhelming. Your healthcare team will help you find a treatment plan that’s unique to your needs. It’s important to make sure you’re getting the support you need and to stay attentive to your health. Know that your healthcare team will be there to support you.