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The Movewell Program

The MoveWell Program at Cushing Neuroscience Institute is an innovative program that works to improve your walk if you are affected by a medical condition or are recovering from surgery. Click on the image above to learn more.

Movement Disorder Symptoms

The Movement Disorders Center, part of the Cushing Neuroscience Institute at New York’s North Shore-LIJ Health System is dedicated to pushing the frontiers of specific neurological conditions through clinical treatment and research.

Parkinson’s disease
Parkinson’s disease belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. Parkinson's disease usually affects people over the age of 50, but can occur in people even younger. Early symptoms are subtle and occur gradually. In some people the disease progresses more quickly than in others. As the disease progresses, the shaking, or tremor, which affects the majority of patients, may begin to interfere with daily activities. Patients may also experience depression and other emotional changes, difficulty in swallowing, chewing and speaking, urinary problems or constipation, skin problems and sleep disruptions.

Many relatively uncommon movement disorders may have symptoms that overlap with the symptoms of Parkinson’s disease. These disorders are often referred to as atypical Parkinsonian syndromes or Parkinson’s plus syndromes. Like Parkinson’s, they often have tremors, stiffness and slowness and may even respond to the same anti-Parkinson’s medications. They usually have additional features that allow movement disorder specialists to distinguish them from typical Parkinson’s. Some of these disorders include:

  • Progressive supranuclear palsy — Parkinson's-like symptoms along with eye movement abnormalities and trouble with balance and mood
  • Multiple systems atrophy — Parkinson's-like symptoms with additional difficulties with balance or trouble regulating blood pressure and urine control
  • Corticobasal ganglionic degeneration — Parkinson's-like symptoms along with trouble controlling hand movements and performing certain tasks
  • Diffuse Lewy body disease — Parkinson's-like symptoms with significant memory trouble

Parkinson's disease Symptoms
The four primary symptoms of Parkinson’s disease are:

  • tremor, or trembling in hands, arms, legs, jaw and face
  • rigidity, or stiffness of the limbs and trunk
  • bradykinesia, or slowness of movement
  • postural instability, or impaired balance and coordination

As Parkinson's disease symptoms become more pronounced, patients may have difficulty walking, talking or completing other simple tasks.

Parkinson's disease Causes
Parkinson’s disease is believed to be caused by the degeneration of nerve cells in a part of the brain known as the substantia nigra pars compacta. These nerve cells produce a substance known as dopamine. Dopamine is a neurotransmitter—a chemical signal sent from one nerve cell to another during normal brain activity, such as movement. Reduction of the amount of dopamine in the brain interferes with the normal brain circuitry involved in movement in particular areas of the brain known as the basal ganglia, thalamus, subthalamic nucleus and motor cortex. An abnormality in the circuitry is believed to result in Parkinson’s disease symptoms.

Parkinson's disease Diagnosis
The diagnosis of most movement disorders is made based on the clinical exam and history. A neurological examination assesses motor and sensory skills, the functioning of one or more cranial nerves, hearing and speech, vision, coordination and balance, mental status and changes in mood or behavior, among other abilities. A movement disorder exam often focuses on additional features like tremor analysis, muscle tone, posture and balance. Movement disorder neurologists have the experience to more readily identify rarer subtypes of Parkinsonism and other, sometimes uncommon, movement disorders based on the clinical exam.

However, in many cases, additional screening tests are useful to clarify the diagnosis. Laboratory screening tests of blood, urine or other substances are used to help diagnose disease, better understand the disease process and monitor levels of therapeutic drugs. Certain tests provide general information, while others are used to identify specific health concerns.

Genetic testing or counseling can help parents who have a family history of a neurological disease determine if they are carrying one of the known genes that cause the disorder or find out if their child is affected. Some movement disorders, especially those affecting young patients, have a known genetic component that can be detected with a blood test.

Parkinson's disease Treatment and Diagnostic Testing
These are common tests used to help diagnose a neurological condition. Some of these are used for Parkinson's disease treatment and diagnosis:

Brain scans are imaging techniques used to diagnose tumors, blood vessel malformations, or hemorrhage in the brain. These scans are used to study organ function or injury or disease to tissue or muscle. Types of brain scans include computed tomography, magnetic resonance imaging, and positron emission tomography.

Computed tomography (CT scan) is a noninvasive, painless process used to produce rapid, clear two-dimensional images of organs, bones, and tissues. Neurological CT scans are used to view the brain and spine. They can detect bone and vascular irregularities, certain brain tumors and cysts, herniated discs, epilepsy, encephalitis, spinal stenosis, a blood clot or intracranial bleeding in patients with stroke, brain damage from head injury and other disorders. The CT scan can be normal in early Huntington’s disease but atrophy (reduction in overall brain size) can be seen in later disease, particularly involving regions of the basal ganglia deep in the brain.

Magnetic resonance imaging (MRI) uses computer-generated radio waves and a powerful magnetic field to produce detailed images of body structures including tissues, organs, bones, and nerves. Neurological uses include the diagnosis of brain and spinal cord tumors, eye disease, inflammation, infection, and vascular irregularities that may lead to stroke. MRI can also detect and monitor degenerative disorders such as multiple sclerosis and can document brain injury from trauma. A Functional MRI (fMRI) uses the blood’s magnetic properties to produce real-time images of blood flow to particular areas of the brain. As with CT scans, MRI findings generally become more evident with disease progression, showing atrophy over time in select areas.

Positron emission tomography (PET) scans provide two- and three-dimensional pictures of brain activity by measuring radioactive isotopes that are injected into the bloodstream. PET scans of the brain are used to detect or highlight tumors and diseased tissue, measure cellular and/or tissue metabolism, show blood flow, evaluate patients who have seizure disorders that do not respond to medical therapy and patients with certain memory disorders, and determine brain changes following injury or drug abuse, among other uses. PET may be ordered as a follow-up to a CT or MRI scan to give the physician a greater understanding of specific areas of the brain that may be involved with certain problems. Scans are conducted in a hospital or at a testing facility, on an outpatient basis.

Dystonia Description
The dystonias are movement disorders in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. The movements, which are involuntary and sometimes painful, may affect a single muscle, a group of muscles (such as those in the arms, legs or neck) or the entire body.

  • Torticollis is a focal dystonia that is limited to the head and neck. In most cases, due to the muscle contractions, the head tilts toward one shoulder while the chin tilts to the other. It can be associated with head tremors or jerking movements. Torticollis may cause pain, facial deformity and effect everyday functions if it is not treated. Oral and injectable medications combined with physical therapy are most commonly administered to relieve pain and reduce symptoms of this disorder. In extreme cases that do not respond to medications, deep brain stimulation surgery can be an effective option.
  • Blepharospasm is a focal dystonia that is limited mainly to the muscles around the eyes and can cause forceful closure of the eyes, especially when the eyes are exposed to bright light. This disorder can often be very effectively treated with botulinum toxin to relax the overactive eye muscles causing the eye closure.
  • Writer’s cramp is a focal dystonia that affects the upper extremity and tends to occur when the patient is writing or doing other specific tasks, such as typing or shaving. The hand tends to curl and cramp, making the task difficult. This can often be treated by injecting the overactive arm muscles with botulinum toxin. Other dystonias, referred to as task-specific dystonias, occur when a body part develops abnormal posturing during specific movements, such as playing a musical instrument. It is often treated similarly to writer’s cramp.
  • Spasmodic dystonia (sometimes referred to as spasmodic dysphonia) is a focal dystonia that involved the vocal cords and can cause the voice to sound whispery or constricted. Treatment often involves injecting the vocal cords with botulinum toxin to relax the overactive muscles that are affecting the speech.

Dystonia Symptoms
Early dystonia symptoms may include:

  • deterioration in handwriting
  • foot cramps
  • a dragging foot after running or walking some distance
  • tremor
  • voice or speech difficulties.

In some individuals, dystonia symptoms appear in childhood. For other individuals, the symptoms emerge in late adolescence or early adulthood. Dystonia can begin in one part of the body and spread to others over time. In many individuals, however, it remains confined to one part of the body and can remain stable for long periods of time.

Some types of dystonia remain a focal problem while others spread to involve other parts of the body over time. In general, adults tend to have focal dystonias that affects one body part only (like turning of the neck or closure of the eyes) and often remain confined to that area alone.

Dystonia Causes
About half the cases of dystonia have no apparent connection to any other disease or injury and are called primary or idiopathic dystonia. Of the primary dystonias, many cases appear to be genetic and are inherited. Dystonias can also be symptoms of other diseases, some of which may be hereditary. In these cases, and in cases were dystonia occurs following damage to the brain (such as after a birth-related injury or stroke), it is referred to as a secondary dystonia.

Dystonia Diagnosis
The diagnosis of most movement disorders is made based on the clinical exam and history. A neurological examination assesses motor and sensory skills, the functioning of one or more cranial nerves, hearing and speech, vision, coordination and balance, mental status, and changes in mood or behavior, among other abilities. A movement disorder exam often focuses on additional features like tremor analysis, muscle tone, posture and balance.

However, in many cases, additional screening tests are useful to clarify the diagnosis. Laboratory screening tests of blood, urine or other substances are used to help diagnose disease, better understand the disease process and monitor levels of therapeutic drugs. Certain tests provide general information, while others are used to identify specific health concerns.

Genetic testing or counseling can help parents who have a family history of a neurological disease determine if they are carrying one of the known genes that cause the disorder or find out if their child is affected. Some movement disorders, especially those affecting young patients, have a known genetic component that can be tested in the blood.

Dystonia Testing
These are common tests used to help diagnose a neurological condition. Some are used to diagnose dystonia and prepare a dystonia treatment plan:

Brain scans are imaging techniques used to diagnose tumors, blood vessel malformations or hemorrhage in the brain in order to prepare an effective dystonia treatment plan. These scans are used to study organ function or injury or disease to tissue or muscle. Types of brain scans include computed tomography, magnetic resonance imaging and positron emission tomography. In most genetic or primary forms of dystonia routine brain scans are normal. In secondary dystonias, however, areas of brain injury may be observed.

Computed tomography (CT) scan is a noninvasive, painless process used to produce rapid, clear two-dimensional images of organs, bones and tissues. Neurological CT scans are used to view the brain and spine. They can detect bone and vascular irregularities, certain brain tumors and cysts, herniated discs, epilepsy, encephalitis, spinal stenosis, a blood clot or intracranial bleeding in patients with stroke, brain damage from head injury and other disorders. CT scans are often normal in dystonia but may be abnormal in secondary dystonias, such as those that follow a severe head trauma or stroke.

Magnetic resonance imaging (MRI) uses computer-generated radio waves and a powerful magnetic field to produce detailed images of body structures, including tissues, organs, bones and nerves. Neurological uses include the diagnosis of brain and spinal cord tumors, eye disease, inflammation, infection and vascular irregularities that may lead to stroke. MRI can also detect and monitor degenerative disorders such as multiple sclerosis and can document brain injury from trauma. A functional MRI (fMRI) uses the blood’s magnetic properties to produce real-time images of blood flow to particular areas of the brain. Routine brain MRIs are often normal in primary dystonia, but may show abnormalities in secondary dystonias, such as dystonia following a stroke or when it is related to other brain diseases. FMRIs may be abnormal in dystonia but are often done only as part of research protocols.

Positron emission tomography (PET) scans provide two- and three-dimensional pictures of brain activity by measuring radioactive isotopes that are injected into the bloodstream. PET scans of the brain are used to detect or highlight tumors and diseased tissue, measure cellular and/or tissue metabolism, show blood flow, evaluate patients who have seizure disorders that do not respond to medical therapy and patients with certain memory disorders and determine brain changes following injury or drug abuse, among other uses. PET may be ordered as a follow-up to a CT or MRI scan to give the physician a greater understanding of specific areas of the brain that may be involved with certain problems. Scans are conducted in a hospital or at a testing facility on an outpatient basis.

Your movement disorders specialist at the Movement Disorders Center will choose the best tests to diagnose your movement disorder and prepare an effective dystonia treatment plan.

Huntington’s disease Description
Huntington's disease results from genetically programmed degeneration of brain cells, called neurons, in certain areas of the brain. This degeneration causes uncontrolled movements, loss of intellectual faculties and emotional disturbances.

Huntington's disease Symptoms
It is impossible to predict when the symptoms of Huntington’s disease will develop. This can cause a great deal of anxiety for individuals who know their Huntington’s disease gene status. For this reason, it is recommended that both symptomatic and non-symptomatic individuals with Huntington’s disease or at risk for Huntington’s disease consider routine visits to a movement disorder center. A specialist can review your condition and discuss any changes or potential treatments.

Some early Huntington's disease Symptoms are:

  • Mood swings
  • Depression
  • Irritability
  • Trouble driving
  • Difficulty learning new things
  • Difficulty remembering
  • Difficulty making a decision

As the disease progresses, concentration on intellectual tasks becomes increasingly difficult and the patient may have difficulty feeding himself or herself and swallowing. The rate of disease progression and the age of onset vary from person to person.

Huntington's disease Causes
Huntington's disease is a familial disease, passed from parent to child through a mutation in the normal gene. Each child of a Huntington's disease parent has a 50% chance of inheriting the Huntington's disease gene. If a child does not inherit the Huntington's disease gene, he or she will not develop the disease and cannot pass it to subsequent generations. A person who inherits the Huntington's disease gene will eventually develop the disease. Whether one child inherits the gene has no bearing on whether others will or will not inherit the gene. In one-to-three percent of individuals with Huntington’s disease, no family history of it can be found.

Huntington's disease Diagnosis
The diagnosis of most movement disorders are made based on the clinical exam and history. A neurological examination assesses motor and sensory skills, the functioning of one or more cranial nerves, hearing and speech, vision, coordination and balance, mental status and changes in mood or behavior, among other abilities. A movement disorder exam often focuses on additional features like tremor analysis, muscle tone, posture and balance.

However, in many cases, additional screening tests are useful to clarify the diagnosis. Laboratory screening tests of blood, urine or other substances are used to help diagnose disease, better understand the disease process and monitor levels of therapeutic drugs. Certain tests provide general information, while others are used to identify specific health concerns.

Genetic testing or counseling can help parents who have a family history of a neurological disease determine if they are carrying one of the known genes that cause the disorder or find out if their child is affected. Some movement disorders, especially those affecting young patients, have a known genetic component that can be tested in the blood.

Huntington's disease Testing
These are common tests used to help diagnose a neurological condition. Some are used to diagnose Huntington's disease and prepare a Huntington's disease treatment plan:

Brain scans are imaging techniques used to diagnose tumors, blood vessel malformations and hemorrhage in the brain. These scans are used to study organ function or injury or disease to tissue or muscle. Types of brain scans include computed tomography, magnetic resonance imaging and positron emission tomography.

Computed tomography (CT scan) is a noninvasive, painless process used to produce rapid, clear two-dimensional images of organs, bones, and tissues. Neurological CT scans are used to view the brain and spine. They can detect bone and vascular irregularities, certain brain tumors and cysts, herniated discs, epilepsy, encephalitis, spinal stenosis, a blood clot or intracranial bleeding in patients with stroke, brain damage from head injury, and other disorders. The CT scan can be normal in early Huntington’s disease but atrophy (reduction in overall brain size) can be seen in later disease, particularly involving regions of the basal ganglia deep in the brain.

Magnetic resonance imaging (MRI) uses computer-generated radio waves and a powerful magnetic field to produce detailed images of body structures including tissues, organs, bones, and nerves. Neurological uses include the diagnosis of brain and spinal cord tumors, eye disease, inflammation, infection, and vascular irregularities that may lead to stroke. MRI can also detect and monitor degenerative disorders such as multiple sclerosis and can document brain injury from trauma. A Functional MRI (fMRI) uses the blood’s magnetic properties to produce real-time images of blood flow to particular areas of the brain. As with CT scans, MRI findings generally become more evident with disease progression, showing atrophy over time in select areas.

Positron emission tomography (PET) scans provide two- and three-dimensional pictures of brain activity by measuring radioactive isotopes that are injected into the bloodstream. PET scans of the brain are used to detect or highlight tumors and diseased tissue, measure cellular and/or tissue metabolism, show blood flow, evaluate patients who have seizure disorders that do not respond to medical therapy and patients with certain memory disorders, and determine brain changes following injury or drug abuse, among other uses. PET may be ordered as a follow-up to a CT or MRI scan to give the physician a greater understanding of specific areas of the brain that may be involved with certain problems. Scans are conducted in a hospital or at a testing facility, on an outpatient basis.

Your movement disorders specialist at the Movement Disorders Center will choose the best tests to diagnose your movement disorder and prepare an effective Huntington's disease treatment plan.

Essential Tremor Symptoms
One of the most common types of tremor syndromes is an action-type tremor called essential tremor and often runs in families. Typically, essential tremor symptoms affect the hands and head, but can affect the legs and voice as well. Essential tremor symptoms are a rhythmic, involuntary muscular contraction characterized by oscillations (to-and-fro movements) of a part of the body. The most common of all involuntary movements can affect various body parts such as the hands, head, facial structures, vocal cords, trunk and legs, however most tremors occur in the hands. Tremors can be characterized by whether they are present when the affected limb is at rest (a resting tremor) or when the limb is being moved (an action tremor). Tremor symptoms often accompany neurological disorders, and determining their cause is important in choosing the appropriate treatment. Although the essential tremor movement disorder is not life-threatening, it can be responsible for functional disability and social embarrassment. After properly diagnosing an essential tremor movement disorder, neurologists at the Movement Disorders Center prepare a comprehensive essential tremors treatment plan.

Tourette's syndrome Symptoms
Tourette's syndrome is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The earliest Tourette's syndrome symptoms 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 syndrome 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 syndrome 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. Tourette's syndrome symptoms often, but not always, follow adolescence.

Hemifacial Spasm Symptoms
Hemifacial spasm is a neuromuscular disorder characterized by frequent involuntary contractions of the muscles on one side of the face. The movement disorder occurs in both men and women, although it more frequently affects middle-aged or elderly women. The first hemifacial spasm 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 hemifacial spasm symptoms.

Restless Leg Syndrome (RLS) Symptoms
Restless legs syndrome 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 their restless legs syndrome symptoms 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 and can vary from mild to severe. Medications are usually a very effective restless leg syndrome treatment.

Spinocerebellar Ataxia (SCA) Symptoms
Spinocerebellar ataxia 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 symptoms similar to Parkinson’s disease symptoms, in addition to coordination problems. Many kinds of spinocerebella ataxia symptoms can be diagnosed with genetic tests.

Tardive Dyskinesia Symptoms
Tardive dyskinesia is a relatively uncommon form of dystonia caused by the long-term use of neuroleptic drugs. Neuroleptic drugs are generally prescribed for psychiatric disorders, as well as for some gastrointestinal and neurological disorders. Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements. Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing and rapid eye blinking. Rapid movements of the arms, legs and trunk may also occur. It can also present as a dystonia, like torticollis. Involuntary movements of the fingers may appear as though the patient is playing an invisible guitar or piano. Dystonia treatment often involves medications as well as stopping the neuroleptic that may be causing the syndrome if possible.

Normal Pressure Hydrocephalus Symptoms
Normal Pressure Hydrocephalus is often referred to as “water on the brain” by the general public. It is a 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 normal pressure hydrocephalus symptoms sometimes can look like either Parkinson’s disease symptoms or Alzheimer’s disease symptoms. An MRI of the brain can be helpful in making the diagnosis and preparing an effective normal pressure hydrocephalus treatment plan.  Please visit our Normal Pressure Hydrocephalus Center for more information.


Make an appointment at the Movement Disorders Center:
Cushing Neuroscience Institute’s Movement Disorders Center makes it easy for you to take the first steps in ensuring the best neurological and neurosurgical care for yourself or your family. Simply fill out our Request an Appointment form, email us at neuro@nshs.edu or call us at (516) 325-7050.

 

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