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GLOSSARY OF MOVEMENT DISORDER TERMS



AKINESIA / BRADYKINESIA / HYPOKINESIA


Akinesia means absence of movement. Bradykinesia means slowness of movement. Hypokinesia means decreased amplitude or range of movement. These three medical terms are commonly grouped together for convenience and usually referred to under the term of bradykinesia. Bradykinesia is a prominent and important feature of parkinsonism. Bradykinesia is mild in early Parkinson's disease and becomes more severe in advanced Parkinson's disease as well as other forms of parkinsonism.

AKATHISIA


Akathisia is from the Greek word meaning unable to sit still. Akathisia refers to a feeling of inner general restlessness, which is reduced or relieved by moving about. When sitting, a person may caress his scalp, cross and uncross his legs, rock his trunk, squirm in the chair, get out of the chair often to pace back and forth and even make noises such as moaning. When standing, a person with akathisia may involuntarily march in place. Carrying out these motor acts brings relief from the sensations of akathisia. Akathitic movements are complex and occur over and over again. The person may feel very uncomfortable.

ATAXIA / DYSMETRIA / ASYNERGIA


Ataxia is an unsteady and swaying walk. The feet are often wide apart. People have difficulty walking a straight line with their heel touching the toe of the shoe in front. Dysmetria is misjudging the distance to a target. For example, a person with dysmetria will have problems reaching out and accurately touching a targeted object. Asynergia is a breakdown of movement, so that movements of arms and legs become irregular and clumsy.

For more information, visit the National Ataxia Foundation website at

www.ataxia.org.

ATHETOSIS


Athetosis means slow, writhing, continuous, involuntary movements. It is often used to describe the movements of someone with cerebral palsy. Athetosis sometimes resembles slow dance-like movements, changing randomly in a flowing pattern.

BLEPHAROSPASM


Blepharospasm is a focal dystonia of the muscles surrounding the eyes which can result in sustained or forceful eye lid closure.

See

DYSTONIA



BRADYKINESIA


See

AKINETIA

above.

BRADYPHRENIA


Bradyphrenia means slowed thinking. Many people with parkinsonism will have slowed thinking, a delay in answering questions or "tip of the tongue" phenomenon. "Tip of the tongue" phenomenon occurs when a person cannot immediately come up with the correct answer, but knows what the answer is. People with bradyphrenia often rely on others to speak for them. It is important to understand the difference between slowed thinking and being passive, indecisive or depressed.

CHOREA


Chorea refers to involuntary, irregular, purposeless, non rhythmic, abrupt, rapid or unsustained movements that seem to flow from one body part to another. A characteristic feature of chorea is that the movements are unpredictable in timing, direction and body parts affected. The person may be able suppress chorea when signs are mild and infrequent. People with chorea can often hide the movements by incorporating them into movements that appear to be purposeful. When choreic movements are infrequent, they appear as isolated, small, brief, somewhat slow dance-like movements. Children may develop Sydenham's chorea, after having a systemic infection. Chorea is the classic motor sign of an inherited disorder called Huntington's disease. Chorea is usually accompanied by an inability to maintain a sustained grip or posture.

CORTICAL-BASAL GANGLIONIC DEGENERATION (CBGD)


This is an uncommon form of parkinsonism affecting one side of the body more than the other. The person with CBGD may have rigidity, dystonia, a mixed tremor at rest and on action and difficulty carrying out a pretended action, such as combing hair without a comb, brushing teeth without a toothbrush, or inserting a key without a key. Some people will be depressed, irritable or be unable to begin to do a certain task. Still others will have an arm or leg that seems to lift up or do what it wants without the person realizing it.

DYSKINESIA


Dyskinesia is a general term for any abnormal involuntary movement. "Tardive dyskinesia" is a term used for abnormal involuntary movements that begin after taking certain medications used to treat nausea or emotional problems. Tardive dyskinesia sometimes resembles chorea, dystonia, myoclonus, tics or tremor. Therefore, it is important that dyskinesias are very precisely described by the examiner in terms of rhythm, speed, duration and pattern. It is very important for the individual to tell the examiner what brings on or helps control the dyskinesia and when during the day the dyskinesia is easier or more difficult to control.

DYSTONIA


Dystonia refers to twisting movements and postures that tend to be sustained at the peak of the movement, often patterned and repetitive. Dystonia can progress to prolonged abnormal postures. Opposing muscles contract simultaneously to produce the sustained quality of dystonic movements. When dystonia first appears, the movements typically occur when the affected body part is carrying out a voluntary action (action dystonia) and are not present when that body part is at rest. As dystonia worsens, dystonic movements can appear in a body part at rest when other parts of the body are voluntarily moving (overflow dystonia). When a single body part is affected, the condition is referred to as focal dystonia. Common forms of focal dystonia affect the eyelids (blepharospasm), the voice (spasmodic dysphonia), the neck (spasmodic torticollis or cervical dystonia), the eyelids (blepharospasm), and the hand (writer's cramp). There are focal task-specific dystonic postures that affect the well-practiced muscles of professional musicians (musicians' dystonia). Generalized dystonia indicates involvement of one or both legs, the trunk, and some other part of the body.

For more information, visit:

Dystonia Medical Research Foundation and the Musicians with Dystonia Project at

www.dystonia-foundation.org.

Benign Essential Blepharospasm Research Foundation at

www.blepharospasm.org.

National Spasmodic Dysphonia Association at

www.dysphonia.org.

National Spasmodic Torticollis Foundation at

www.torticollis.org.

Care4Dystonia, Inc. at

www.care4dystonia.org.

ESSENTIAL TREMOR (ET)


Essential tremor is the most common movement disorder among adults. It is also the most common cause of all the tremors. An estimated thirteen million people of all ages and ethnic groups are affected by essential tremor in the United States. Most people with ET have essential tremor affecting their hands or head. Although the condition is frequently labeled "benign essential tremor," this term is misleading. ET may worsen over the years and eventually interfere with basic daily activities such as dressing, eating, combing, brushing, bathing, writing, using keys and tools. ET can become disabling. Many people with ET do not seek help until the tremor begins to significantly interfere with their life.

For more information, visit: The Essential Tremor Centralized Brain Repository at

www.essentialtremor.us

International Tremor Foundation at

www.essentialtremor.org.

FREEZING


Freezing refers to being stuck in one place, usually lasting seconds. It is one of the possible signs of parkinsonism. When someone freezes, the opposing muscle groups are simultaneously contracting. The ability to move is "blocked" and the person is "glued to a position" and feels "stuck." Freezing most often affects walking. However, speech can suddenly stop and arms can become "stuck." The person is not weak and tries to exert force to move again. After a few seconds, the freezing clears spontaneously, and the patient is able to move at a normal pace again, until the next freezing episode occurs. Freezing often occurs in crowded spaces, revolving doors, at the top of the escalator, just before the elevator door closes, before reaching a chair or when an obstacle is ahead. Often the person has learned or invented a trick maneuver to stop the freezing episode sooner. For example, one useful strategy when walking is to continually step over the handle of an "inverted cane."

HEMIFACIAL SPASM


Hemifacial spasm refers to muscle contractions involving only one side of the face. Generally these are continual rapid, brief, repetitive spasms. Hemifacial spasm can also become sustained spasms mixed with periods when no spasms occur. Often the movements are triggered when the person contracts face muscles on purpose. When the face relaxes, the involuntary movements appear. Hemifacial spasm usually affects both upper and lower parts of the face at the same time. In some cases, it may be due to pressure on the facial nerve by a nearby blood vessel.

HUNTINGTON'S DISEASE


Once called Huntington's chorea, Huntington's Disease is an inherited progressively disabling disorder that causes problems with emotional control and thinking, as well as difficulty with coordination and stability. The classic sign of HD is a dance-like involuntary movement, called chorea. Other problems resemble dystonia, myoclonus, motor restlessness or tremor. The impact of an individual's HD diagnosis is often felt by the entire family. Therefore, families often choose to be seen at a family-centered, multi-disciplinary HD Center of Excellence.

To learn more about Huntington's Disease and the HD Center of Excellence at Columbia University, please visit

www.hdny.org.

LEWY-BODY DISEASE


This a condition in which the pathologic changes seen in Parkinson's disease have spread beyond the brainstem to involve the cerebral cortex. The symptoms are episodes of hallucinations and of decreased mental acuity.

MULTIPLE SYSTEM ATROPHY (MSA)


Multiple system Atrophy (MSA) is a sporadic, progressive disorder affecting four parts of the nervous system in varying degrees. These systems are basal ganglia (parkinsonism), cerebellum (balance problems), motor neurons (spasticity and weakness) and autonomic function problems (impotence, noisy breathing or snoring, low blood pressure when standing up, urinary problems, dizziness, cold pale hands). MSA now includes olivopontocerebellear atrophy (OPCA), striato-nigral degeneration (SND) and Shy-Drager syndrome.

See

PARKINSONISM



For more information, please visit the Shy-Drager/Multisystem Atrophy Support Group at

www.shy-drager.com

MYOCLONUS


Myoclonic jerks are sudden, brief, shock like involuntary movements caused by muscle contractions (positive myoclonus) or sudden loss of muscle contractions, called inhibitions (or negative myoclonus). Myoclonic jerks are usually irregular, but can be rhythmical. Myoclonic jerks may occur in only one part of the body. When the jerks occur in several different body parts, they are often synchronized. Myoclonus rarely if ever can be suppressed by the person experiencing them. The jerks may be triggered by sudden stimuli such as sound, light, visual threat, or movement. Myoclonus may travel with other neurological problems.

MYOKYMIA AND SYNKINESIS


Myokymia is a fine persistent quivering or rippling of muscles. Myokymia occurs most commonly in facial muscles and can continue during sleep. Synkinesis is the occurrence of involuntary movements in one part of the face when there is voluntary movement is another part of the face. For example, when a person with synkinesis smiles, the eyelid will close involuntarily.

OLIVOPONTOCEREBELLAR ATROPHY (OPCA)
See Multiple system atrophy (MSA)

.

PARKINSON'S DISEASE (PD)


The most common form of parkinsonism (a collection of motor signs) is Parkinson's disease. People with Parkinson's disease have one or several of the following signs: tremor at rest, rigidity, bradykinesia, loss of postural reflexes, flexed posture and freezing. The age at which Parkinson's disease usually begins is above the age of 40, but younger patients can be affected. When it begins between ages 20 40, it is called "young onset" Parkinson's disease. Parkinson's disease is more common in men. In the United States, there are about a million people with Parkinson's disease. Early PD is often very difficult to diagnose and is best managed by a movement disorder specialist in order to treat the symptoms that are most important to the person with PD. Many signs and symptoms remain mild and treatable for many years. No two people with PD are exactly alike.

See also

AKINESIA/BRADYKINESIA, FREEZING, POSTURAL REFLEXES, RIGIDITY, PARKINSONISM and TREMOR



For more information, visit the Parkinson's Disease Foundation at

www.pdf.org. The PDF supports much of the research done at Columbia University. Links to other PD foundations are found on this site.

PARKINSONISM


Parkinsonism is a neurological syndrome or collection of motor signs. Parkinsonism may be any combination of six cardinal features: tremor at rest, bradykinesia, rigidity, flexed posture, freezing, and loss of postural reflexes. There are many causes of parkinsonism. The specific diagnosis depends on details of the clinical history, the neurological examination, and laboratory tests. The specific diagnosis can be Parkinson's disease or any of the disorders that mimic Parkinson's disease such as Multisystem Atrophy, PSP, or CBGD.

See also

AKINESIA/BRADYKINESIA, CORTICOBASAL GANGLIONIC DEGENERATION (CBGD), FREEZING, MULTIPLE SYSTEM ATROPHY, PARKINSON'S DISEASE, POSTURAL REFLEXES, PROGRESSIVE SUPRANUCLEAR PALSY (PSP), RIGIDITY, TREMORS



PAROXYSMAL DYSKINESIAS


The paroxysmal dyskinesias are movements that start suddenly and then disappear after being present for seconds, minutes, or hours. The person may remain free of attacks for many months or there can be many attacks in one day. Two disorders are briefly mentioned here:
  • Paroxysmal kinesigenic dyskinesia (PKD) is triggered by a sudden movement. PKD is usually inherited and successfully treated.
  • Paroxysmal nonkinesigenic dyskinesia (PNKD) is triggered by stress, fatigue, caffeine or alcohol, and can last minutes to hours. PNKD is often inherited.

PEDIATRIC "NEUROTRANSMITTER" DISORDERS


These rare metabolic disorders are currently grouped together although the problems they cause are not necessarily the same. Children may have trouble controlling their eye muscles or have loss of muscle tone (a form of weakness) in their neck, trunk, arms or legs. Some children have tremors. Others may be irritable or have developmental delays.

To learn more about this expanding list of rare metabolic disorders of childhood, check the website for the PND Association at

www.pndassoc.org.

POSTURAL REFLEXES


Loss of postural reflexes is a feature of parkinsonism that can contribute to falls or walking faster and faster with tiny steps. A simple test (the "pull test") is the usual way to check a person's ability to recover their balance in one step. The examiner stands behind the patient with hands on the patient's shoulders. The patient stands with eyes open and feet comfortably apart. The examiner explains that he will suddenly without warning pull back on the patient's shoulders. The patient is instructed to keep his balance and take one step back, if needed.

PROGRESSIVE SUPRANUCLEAR PALSY (PSP)


Problems encountered soon after PSP begins are unsteady walking and early frequent falls. The person walks with feet wide apart, an erect posture and unbent knees. Some people with PSP move and think very slowly. They may complain about trouble looking down, trouble keeping their eyelids open, blurry vision, double vision and general eye discomfort. They can have stuttering speech or speech "blocks." While walking, many people with PSP "get stuck" when turning. These are examples of freezing. This disorder seems to occur sporadically, although there are rare families with more than one relative affected. PSP is also called Steele-Richardson-Olszewski syndrome. See also FREEZING.

For more information, visit the Society for PSP at

www.psp.org.

RESTLESS LEGS SYNDROME (RLS)


The term restless legs syndrome refers to more than just restless legs, where the person has unpleasant crawling, pulling or itchy feelings in the muscles or bones of the legs. RLS occurs particularly when sitting and relaxing in the evening and will disappear when walking. The complete restless legs syndrome consists of several problems. One or more may be present in any one person. While the unpleasant crawling sensations in the legs are the most common symptom, some people may have involuntary movements during sleep, myoclonic jerks, inner restlessness, dystonia. This is a very common problem occurring or worsening at night. RLS may begin before age 20 as a mild disorder. Most people seek medical advice in midlife when symptoms worsen.

For more information, visit the Restless Legs Syndrome Foundation at

www.rls.org.

RIGIDITY


Rigidity or stiffness is another sign of parkinsonism. Rigidity may occur in the neck, chest wall, elbows, hips and knees forcing a person to bend over when seated, standing or lying down. With elbows and knees slightly bent, the person tends to shuffle the feet. Rigidity is increased muscle tone which is felt when the examiner tries to move the totally relaxed neck, arm or leg.

See

PARKINSONISM



SHY-DRAGER SYNDROME


See Multiple System Atrophy (MSA)

STIFF PERSON SYNDROME


Stiff Person Syndrome is a progressive autoimmune disease in which a person experiences increased muscle rigidity, increased tone, and increased force required to move any body part associated with an inability to relax muscles. There can be painful muscle spasms triggered by voluntary moving, anxiety, emotions or sudden environmental events (such as a loud noise).

STRIATONIGRAL DEGENERATION (SND)


See Multiple System Atrophy (MSA)

SYDENHAM'S CHOREA


Sydenham's Chorea (formerly St. Vitus dance) is an uncommon autoimmune disease with dance-like movements, called chorea. It is often accompanied by emotional and thinking problems. Sydenham's tends to occur in children and is associated with a past streptococcal group A infection, the same infection that also causes rheumatic fever and rheumatic heart disease.

TARDIVE DYSKINESIA / TARDIVE DYSTONIA


Tardive Dystonia and Tardive Dyskinesia are abnormal involuntary movements that occur in people who are taking medication that "blocks the dopamine receptors" in order to treat gastrointestinal problems or emotional disturbances.

TICS


Tics are abnormal movements (motor tics) or abnormal sounds (phonic tics). When both types of tics are present, the diagnosis of Gilles de la Tourette syndrome or Tourette syndrome is commonly given. Tics frequently vary in severity. Some tics can fade away (remissions) or may later worsen (exacerbations). Motor and phonic tics can be simple or complex. They can occur abruptly for brief moments or occur continually.

A single simple motor tic may be an abrupt, sudden, isolated movement. Examples include a shoulder shrug, head jerk, blink, dart of the eyes, and twitch of the nose. Most simple tics are repetitive, such as a run of eye blinking or a sequence of several simple tics in a row. Tics are usually preceded by an uncomfortable feeling or urge that is relieved by carrying out the movement. When suppressed, inner tension builds up and is only relieved by an increased burst of more tics.

Even when tics are simple jerks, more complex forms of tics may also be present in the same individual. Complex motor tics are very distinct, consisting of coordinated patterns of sequential movements which can appear in different parts of the body and are not necessarily identical from one occurrence to another. Examples include touching, head shaking with shoulder shrugging, kicking legs or obscene gesturing.

Abnormal sounds (phonic tics) can range from simple throat clearing sounds, sniffing or grunts to more complex words, phrases or curses.

See

TOURETTE SYNDROME



TORTICOLLIS


Torticollis is a focal dystonia of the neck muscles in which there is a simultaneous contraction of opposing muscle groups causing the neck to twist, tilt, shift, pull forwards or backwards.

See

DYSTONIA



TOURETTE SYNDROME


Tics consist of abnormal movements (motor tics) or abnormal sounds (phonic tics). When both types of tics are present, the diagnosis of Gilles de la Tourette syndrome or Tourette syndrome is commonly given. Tics frequently vary in severity. Some tics fade away. Some tics worsen. It is difficult to predict.

See

TICS



For more information, visit the Tourette Syndrome Association at

www.tsa-usa.org/.

TREMOR


Tremor is an oscillation that is usually rhythmical and regular that affects one or more body parts, such as the arms, legs, neck, tongue, chin or vocal cords. Jerky, irregular "tremor" is usually a sign of another movement disordered called myoclonus. Tremor is produced by rhythmic alternating or simultaneous contractions of opposing muscles. Tremors can be classified as tremor at rest, postural tremor, action tremor or intention tremor. It is helpful to determine whether the tremor is present at rest (with the person seated or lying down), with posture holding (with the arms or legs extended in front of the body), with action (such as writing or pouring water), or with intention maneuvers (such as holding a finger on a target). Some tremors may be present only during a specific task (such as writing) or with a specific posture, such as standing (orthostatic tremor). These are called task specific or position specific tremors. Other tremors seem to run in families and are often referred to as essential tremor. The diagnosis and treatment of tremors differ according to the type of tremor.

See also

ESSENTIAL TREMOR and TREMOR AT REST



TREMOR AT REST


Tremor at rest is usually present in the fingers, wrists or lips while "at rest" and is a common sign of parkinsonism (part of a collection of motor signs). Involuntary "pill rolling" tremor of the fingers is a common tremor at rest. Tremor at rest stops when the body part is moved on purpose. Resting tremor can also occur in a person with action tremor

WALKING OR GAIT PROBLEMS


There are many unusual ways to walk. These problems often occur with movement disorders. Hesitant, uncertain or cautious gait is slow, with short steps and feet placed far apart. Fear of falling occurs either because the person thinks they are unable to walk independently or has lost postural reflexes. Primary freezing gait is the problem of getting started. Once started, the person walks fairly briskly and balance is preserved. Other problems in walking may be due to dizziness or severe disequilibrium.

See also

ATAXIA, FREEZING and POSTURAL REFLEXES



For more information, visit the National Ataxia Foundation website at

www.ataxia.org.

WILSON'S DISEASE


Wilson's disease is caused by an abnormal metabolic condition which allows copper to build up in the brain, eyes, liver and other tissues of the body. It is curable. Because the signs and symptoms are so different from person to person, anyone under the age of 50 with a movement disorder should have the complete Wilson's disease testing to be absolutely sure that they do not have Wilson's disease.

For more information, visit the Wilson's Disease Association website at

www.wilsondisease.org.

WRITER'S CRAMP AND MUSICIAN'S CRAMP


Writer's Cramp is a focal dystonia of the finger, hand or forearm in which there is a simultaneous contraction of those muscles while writing or doing specific skilled tasks. Writer's cramp may begin after repetitive use and is therefore often considered an occupational dystonia, more commonly experienced by typists, draftsmen, musicians and sportsmen. When musicians are affected, it is called musician's cramp. When its involvement occurs around the mouth (ex. horn players), it is called emboouchredystonics.

See

DYSTONIA.





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