Journal Mobile

DJ Burn
Journal Issue: 
Volume 36: Issue 4: 2006




The characteristic feature of all movement disorders is an abnormality of the form and velocity of movements of the body. The term ‘movement disorder’ has become synonymous with basal ganglia disease and extrapyramidal features. Although many movement disorders do arise from pathology within the basal ganglia, disorders such as myoclonus may also arise from other structures. Abnormality of movement may  be  the  only  manifestation  of  a  disease  process, or  may  be  part  of  a  more widespread  neurological  disorder.   It  is  important  not  to  divorce  the  disorder  of movement from general medical problems, since these may be directly or indirectly related  (for  example,  chorea  in  systemic  lupus  erythematosus;  DIP  caused  by amiodarone).   Basal  ganglia  disease  is  commonly  associated  with  neuropsychiatric symptoms and these may have a greater impact upon the patient and their family than the movement disorder itself.

An essential first step in the approach to the patient with a movement disorder is to  correctly  determine  the  phenomenology  of  the  problem  (for  example, is  the dominant  problem  chorea  or  dystonia?).   Once  this  first  step  has  been  made, appropriately  targeted  investigations  may  then  be  required  to  determine  the diagnosis. Thereafter, consideration is given to treatment, based upon clinical and social factors, as well as patient preference. This overview will describe a practical approach  to  the  patient  with  a  movement  disorder.  It  will  also  briefly  consider some broad principles in the investigation and management of such cases.