Some of the other types of movement disorders that are treated at our centers:

Tourette's syndrome

This is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The first symptoms of Tourette's are almost always noticed in childhood. Some of the more common tics include eye blinking and other vision irregularities, facial grimacing, shoulder shrugging and head or shoulder jerking. Perhaps the most dramatic and disabling tics are those that result in self-harm, such as punching oneself in the face, vocal tics such as coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others). Many with Tourette's experience additional neurobehavioral problems, including inattention, hyperactivity and impulsivity and obsessive-compulsive symptoms such as intrusive thoughts/worries and repetitive behaviors. The underlying causes of Tourette's are not fully understood but it often has a genetic cause and likely relates to abnormal regulation of the brain chemical dopamine in the brain. The symptoms often, but not always, follow adolescence.

Treatment
Tourette’s syndrome does not always require treatment and many individuals live normal lives with Tourette's. When the tics are debilitating, however, treatment is often warranted. None-medications options include cognitive approaches like habit reversal therapy and biofeedback. Medications that can be effective include drugs that block the excessive dopamine activity. These dopamine-receptor blockers include medications like risperdal, haloperidol, pimozide and olanzapine. Medications like clonidine (also used for lowering blood pressure) can be helpful in some cases as well. Psychiatric follow-up and medications are sometimes necessary when attention-deficit and/or compulsive behaviors are an issue. For severe cases of Tourette's, deep brain stimulation is being investigated but is not yet approved by the Federal Drug Agency .

Hemifacial spasm

This is a neuromuscular disorder characterized by frequent involuntary contractions of the muscles on one side of the face. The disorder occurs in both men and women, although it more frequently affects middle-aged or elderly women. The first symptom is usually an intermittent twitching of the eyelid muscle that can lead to forced closure of the eye. The spasm may then gradually spread to involve the muscles of the lower face, which may cause the mouth to be pulled to one side. Eventually the spasms can involve all of the muscles on one side of the face and can occur continuously. The condition may be caused by a facial nerve injury or a tumor, or it may have no apparent cause. Very commonly, hemifacial spasm is caused by a blood vessel pressing on the facial nerve. Local injections to overactive muscles can relieve the symptoms.

Treatment
The most common treatment for hemifacial spasm involves injecting the affected, overactive facial muscles with low doses of botulinum toxin. This generally needs to be repeated every three to four months. In some cases, when the injections are not effective and an obvious cause can be found (such as a blood vessel pressing on the nerve), surgery can be performed to relieve the pressure of the facial nerve.

Restless legs syndrome (RLS)

This is a common neurological disorder characterized by unpleasant sensations of the legs and an urge to move them for relief. Individuals affected with the disorder describe the sensations as pulling, drawing, crawling, wormy, boring, tingling, pins and needles, prickly, and sometimes painful sensations that are usually accompanied by an overwhelming urge to move the legs. Movement provides temporary relief from the discomfort. The spells can occur at any time but most often occur at night. RLS varies from mild to severe and often responds very well to medications.

Treatment
Before treating, underlying causes like iron-deficiency should be ruled out and treated if present. If no underlying cause is found, treatment for RLS often involves using low doses of medications also used in Parkinson’s disease (even though the conditions are different). They include classes of medications that target the brain chemical dopamine and includes dopamine agonists (like pramipexole and ropinerole) and carbidopa/levodopa. Mild opioids like codeine are also sometimes used as are other medications when the above are not effective.

Spincerebellar ataxia (SCA)

This is a diverse group of genetic disorders that are characterized by progressive difficulties with coordination. The SCAs are sub-divided into different categories based on additional features. SCA 3, for example, can have features similar to Parkinson’s in addition to coordination problems. Many SCAs can be diagnosed with genetic tests.

Treatment
Unfortunately, at this time, treatment for ataxia (imbalance) is somewhat limited. Physical, balance and occupational therapy can be very helpful. There are some medications that have demonstrated some benefit in select cases. These can be reviewed with your specialist to determine if they may be appropriate.

Normal pressure hydrocephalus

This is often referred to as “water on the brain” by the general public. It is a poorly understood syndrome where the cerebrospinal fluid (the fluid surrounding the brain and spinal cord) does not drain properly. The result is a combination of memory trouble, gait difficulties and urinary incontinence. These symptoms sometimes can look like either Parkinson’s or Alzheimer’s. An MRI of the brain can be helpful in making the diagnosis.

Treatment
Treatment involves placing a shunt to help drain the fluid. Sometimes this is preceded by a drain trial during which time the patient is evaluated in the hospital to see the effect of draining spinal fluid before placement of the permanent shunt.