Common movement disorders
Movement disorders encompass a wide range of neurological conditions characterised by abnormal voluntary or involuntary movements, or by problems with the planning, initiation or execution of movement. Parkinson's disease is the most common neurodegenerative movement disorder, presenting with rest tremor, bradykinesia (slowness), rigidity and postural instability. Essential tremor is the most common movement disorder overall, producing action-related rhythmic shaking that often runs in families. Dystonia involves sustained or intermittent muscle contractions causing abnormal postures or repetitive movements, affecting the neck (cervical dystonia), eyelids (blepharospasm), limbs or voice.
Other movement disorders include chorea (irregular, brief, flowing involuntary movements), tics (brief, stereotyped, repetitive movements or vocalisations), ataxia (coordination problems from cerebellar dysfunction), myoclonus (sudden, brief, shock-like jerks), and functional neurological movement disorder (abnormal movements not explained by structural neurological disease). Accurate characterisation of the movement pattern � rest vs action vs postural, rhythmic vs arrhythmic, suppressed by distraction or not � guides the diagnostic approach before any investigation is considered.
- Parkinson's disease � rest tremor, bradykinesia, rigidity, postural instability
- Essential tremor � action-related, often familial, bilateral
- Dystonia � sustained contractions, abnormal postures, task-specific
- Chorea � irregular, flowing involuntary movements
- Tics � brief, stereotyped, suppressible movements or vocalisations
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Evaluation approach
Evaluation of a movement disorder begins with detailed history: onset (acute, subacute, gradual), distribution (focal, segmental, generalised), timing (rest, action, postural), course (static, progressive, fluctuating), family history, medication history and associated features (sleep disturbance, cognitive changes, autonomic symptoms). The neurological examination characterises the movement pattern, assesses tone, power, reflexes, coordination, gait and postural stability, and screens for non-motor features that may narrow the differential.
Investigations are targeted rather than routine. Blood tests may exclude metabolic or medication-related causes (thyroid dysfunction, copper caeruloplasmin for Wilson's disease in younger patients). Brain imaging (MRI) is considered when structural causes are suspected or when the pattern is atypical. DaTscan (dopamine transporter imaging) may help distinguish Parkinsonian syndromes from essential tremor when clinical assessment is equivocal. The clinic discusses findings transparently and provides individualized management planning, including referral for specialist services such as deep brain stimulation evaluation when appropriate.
- Detailed history of onset, distribution, timing, course and family history
- Neurological exam: tone, power, reflexes, gait, postural stability
- Targeted labs: thyroid, copper/caeruloplasmin in younger patients
- MRI when structural cause suspected or pattern atypical
- DaTscan for equivocal Parkinsonian syndromes