What are the causes and treatments of movement disorders?

From the Guidelines

Movement disorders, such as functional tremor, functional jerks, dystonia, and functional limb weakness, can be effectively managed with occupational therapy interventions, including strategies to promote normal movement patterns and resting postures, as well as anxiety management and distraction techniques 1.

Key Interventions

• For functional tremor, interventions such as superimposing alternative rhythms, using the unaffected limb to dictate a new rhythm, and assisting the person to relax the muscles in the limb can be helpful 1.
• For functional jerks, addressing unhelpful pre-jerk cognitions and movement, general relaxation techniques, and sensory grounding can be effective 1.
• For dystonia, encouraging optimal postural alignment, even distribution of weight, and grading activity to increase the time that the affected limb is used can be beneficial 1.
• For functional limb weakness, engaging the person in tasks that promote normal movement, good alignment, and even weight-bearing can be helpful 1.

Additional Considerations

• Anxiety management and distraction techniques can be useful in undertaking tasks and reducing symptoms 1.
• Video recording interventions can be helpful in identifying changes in symptoms and demonstrating changeability 1.
• Splinting may prevent restoration of normal movement and function, and its use should be carefully considered, with removable splints potentially having an overall positive effect in some cases 1.

Recent Guidelines

• The American Academy of Sleep Medicine has published clinical practice guidelines for the treatment of restless legs syndrome and periodic limb movement disorder, which include recommendations for the use of ferrous sulfate, dipyridamole, extended-release oxycodone, and bilateral high-frequency peroneal nerve stimulation 1.
• The guidelines also discuss the importance of iron treatment, the use of opioids, and the potential risks and benefits of different treatments 1.

Management of REM Sleep Behavior Disorder

• The American Academy of Sleep Medicine has published clinical practice guidelines for the management of REM sleep behavior disorder, which include conditional recommendations for the use of clonazepam, immediate-release melatonin, pramipexole, and rivastigmine 1.
• The guidelines discuss the importance of customizing therapy for patients based on each agent's unique mechanism of action and therapeutic profile, as well as the patient's comorbidities 1.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Mechanism of Action Parkinson's disease is a progressive, neurodegenerative disorder of the extrapyramidal nervous system affecting the mobility and control of the skeletal muscular system. Its characteristic features include resting tremor, rigidity, and bradykinetic movements. The carbidopa (PO) is used to treat Parkinson's disease, which is a type of movement disorder. The drug works by increasing the availability of levodopa in the brain, which helps to relieve symptoms of Parkinson's disease, such as resting tremor, rigidity, and bradykinetic movements 2.

• The mechanism of action of carbidopa is to inhibit the decarboxylation of peripheral levodopa, allowing more levodopa to be transported to the brain.
• The pharmacodynamics of carbidopa and levodopa show that the combination of the two drugs increases the plasma levels and half-life of levodopa, and decreases plasma and urinary dopamine and homovanillic acid.

From the Research

Movement Disorders Overview

• Movement disorders are a complex and broad field within neurology, often requiring a specific set of medications 3
• These disorders can be challenging to manage and may include conditions such as essential tremor, Parkinson's disease, rapid eye movement sleep behavior disorder, and restless leg syndrome 3

Treatment Options

• Levodopa combined with carbidopa is still the most effective treatment for symptoms of Parkinson's disease 4
• Dopamine agonists, such as pramipexole and ropinirole, can be used alone or as an adjunct to levodopa to reduce motor fluctuations in patients with advanced disease 4, 5
• Other treatment options include the addition of a peripherally-acting COMT inhibitor or an MAO-B inhibitor to levodopa, as well as the use of amantadine and anticholinergics 4

Diagnosis and Clinical Approach

• Establishing the phenomenology of the clinical syndrome is key to diagnosing movement disorders, and involves determining the dominant movement disorder and associated neurological and non-neurological abnormalities 6
• A practical step-by-step approach can help clinicians in their 'pattern recognition' of movement disorders, and may involve ancillary investigations guided by the dominant movement disorder 6

Rehabilitation and Neurorehabilitation

• Growing evidence supports the efficacy of neurorehabilitation for the treatment of movement disorders, and specific forms of training may drive and modulate neuroplasticity to restore circuitries dysfunctions and achieve behavioral gains 7
• Tailored rehabilitation strategies should be adopted for the management of different movement disorders, taking into account the alterations expressed in terms of clinical signs and symptoms and plasticity 7