Movement Disorders Program at Rhode Island Hospital
Full Range of Conditions We Treat
Common conditions we treat include essential tremor, secondary Parkinsonism, and restless leg syndrome. We also treat less common, progressive, and highly debilitating conditions.
Essential tremor (ET) is a neurological disorder that causes rhythmic, involuntary movements of parts of the body, primarily the hands. The cause is unknown, but in most cases, it is an inherited condition (familial essential tremor). ET is the most common trembling disorder, and is often confused with Parkinson’s disease. For this reason, a careful diagnosis is extremely important.
Symptoms indicating ET include tremors that:
- occur during movement and are less noticeable when at rest
- are made worse by certain medicines, caffeine, or stress
- improve with ingestion of a small amount of alcohol (such as wine)
- get worse with age
- don’t affect both sides of the body in the same way
- make doing tasks with the hands more difficult
Less common symptoms could include a quivering sound in the voice, uncontrollable head-nodding, and tremors in the legs or feet.
ET is usually not life-threatening or severely debilitating. Stress reduction and avoidance of smoking, caffeine and alcohol may help minimize symptoms. If tremors are pronounced enough to interfere with daily life, ET is typically treated with medication. Severe tremors can be treated with surgery.
Secondary parkinsonism is similar to Parkinson’s disease, but the symptoms are caused by certain medications or by another illness. The term refers to any condition that causes the same type of symptoms as Parkinson’s disease. Medications used to treat Parkinson’s disease may help alleviate symptoms.
Restless Legs Syndrome
This syndrome is characterized by unusual itching, crawly or tingling sensations in the legs, usually while lying down or sleeping. “Restless legs” refers to the urge to move the legs to relieve the symptoms. This condition is very common, and is not life-threatening or seriously debilitating. However, it usually interferes with quality sleep, so it may lead to a sleep disorder.
Treatment usually begins with lifestyle changes, such as practicing good sleep routines, exercising, and avoiding smoking, caffeine and alcohol. In more troublesome cases, medication may be prescribed.
Tourette syndrome is a chronic neurological disorder characterized by repetitive and involuntary movements and vocalizations. Onset is in childhood, and symptoms often improve throughout adulthood. Medications may be prescribed if symptoms interfere with daily functioning.
Trigeminal Neuralgia and Hemifacial Spasm
Severe, unremitting pain on one side of the face, or involuntary contractions on one side of the face, are the hallmarks of trigeminal neuralgia and hemifacial spasm, respectively. Medications can often effectively control the worst of the symptoms. When medications are inadequate or cannot be tolerated due to side effects, and when the symptoms significantly impair the ability to carry on with routine daily activities, some surgical options may be available.
Our neurosurgeons are experts in the techniques needed to perform this surgery. Less invasive procedures are sometimes used. Ablations (targeted inactivations) of the nerve as it exits the skull are performed with minimally invasive techniques.
Conditions with Aggregate Symptoms Treated as Movement Disorders
Treated as movement disorders, some conditions describe aggregate symptoms, rather than specific diseases. Such disorders include:
- Ataxia and other gait disorders, which refers to the loss of muscle control in the arms and legs that can cause loss of balance and coordination, and may also involve fingers, hands, other parts of the body, speech, and eye movements. Ataxia is usually a symptom of another disorder, such as multiple sclerosis, stroke, or nerve damage. More rare types of ataxia are caused by hereditary degenerative conditions. Medications used to treat Parkinson’s disease may help alleviate symptoms.
- Dystonia, which is a disorder that affects the way the body moves. It causes the muscles to contract, which makes them move involuntarily or become stuck in an abnormal position. Dystonia can be genetic, caused by disease or injury, or a side effect of medication. There are various types defined by how it affects the body:
- Generalized dystonia can affect the entire body.
- Hemidystonia affects one side.
- Focal dystonia affects a specific body part.
- Multifocal dystonia affects two or more parts of the body.
When the eyes are affected, the condition is called blepharospasm, and the patient has difficulty controlling the eyelids and brow, which interferes with vision. Cervical dystonia refers to problems controlling the neck and shoulders. Other types cause problems with control of the face, jaw and mouth, hands, limbs, or extremities, etc.
Dystonia may be treated with anticonvulsants or injections of botulinum toxin.
- Myoclonus, which refers to sudden, involuntary twitching or jerking of a muscle or group of muscles, caused by sudden muscle contractions (positive myoclonus) or muscle relaxation (negative myoclonus). Some forms of myoclonus are very common, such as hiccups or sudden jerks as one is falling asleep. Severe myoclonus could indicate a disorder of the brain or central nervous system.
- Spasticity, which is a condition in which certain muscles are continuously contracted, causing stiffness that affects movement and speech. Spasticity is prevalent in a number of neurological conditions, including cerebral palsy, multiple sclerosis, traumatic brain or spinal cord injury, and stroke, among others. Treatment involves physical therapy and medications.
- Tardive dyskinesia, which refers to uncontrollable stiff, jerking movement that are side effects of certain antipsychotic medications. The risk of developing tardive dyskinesia can be reduced by prescribing newer classes of medication at the lowest effective dosage, while monitoring long-term use.
Targeted Treatment for Movement Disorders with Progressive Symptoms
Certain movement disorders are far more debilitating than others, and are usually progressive in symptoms. Treatment is targeted at symptoms to relieve suffering and assist the quality of daily life.
Multiple System Atrophy (MSA): MSA is a rare, progressive, neurodegenerative disease that affects the body’s autonomic (involuntary) functions, including blood pressure, breathing, bladder function, and muscle control. Symptoms include stiffness or rigidity, slowed movements, loss of balance and coordination, swallowing and speaking difficulties, and a significant drop in blood pressure when standing, causing dizziness, lightheadedness, fainting or blurred vision. Medications may be prescribed to manage some symptoms.
Progressive Supranuclear Palsy (PSP): PSP is a rare, progressive condition that affects the ability to walk normally by impairing balance. It also affects the muscles controlling the eyes, making it difficult to focus and see things clearly. “Supranuclear” refers to the region of the brain affected by the disorder.
Although PSP isn’t fatal, symptoms do continue to worsen. While there is no cure, there are strategies and methods that can help manage many of the symptoms. To improve balance and improve flexibility of the muscles, medicines used to treat Parkinson’s disease may be effective.
Corticobasal Degeneration (CBD): CBD is a rare, progressive neurological disorder caused by cell loss and deterioration of specific areas of the brain. The symptoms, progression, severity and presentation of CBD can vary greatly. In many cases, affected individuals develop progressive stiffening or tightening of muscles in the limbs and are often unable to make purposeful movements with an affected limb (apraxia). Additional symptoms may include stiff or uncoordinated movement, slight tremor, exaggerated slowness (bradykinesia), lack of movement (akinesia), difficulty speaking or swallowing, and cognitive and behavioral problems, including dementia. There is no cure; however, medicines used to treat Parkinson’s disease may be helpful for some symptoms.
Choreas and Huntington’s Disease: Huntington’s disease is a genetic brain disorder in which brain cells, or neurons, in certain areas of the brain start to break down. As the neurons degenerate, the disease can lead to emotional disturbances, loss of intellectual abilities, and uncontrolled movements. The most common form is adult-onset, in which symptoms develop at ages mid-30s and 40s. In rare instances, children or adolescents develop the disease. Initial symptoms may include emotional changes such as mood swings, irritability, or depression, and intellectual problems such as difficulty learning new things, recalling facts, or making decisions.
In later stages, effects of the disease may include uncontrollable movement, memory loss, personality changes, difficulty swallowing or feeding oneself, difficulty speaking, or disorientation, hallucinations, paranoia and psychosis. There is no cure for Huntington’s disease, but treatment with medication for symptoms can help.
Rett Syndrome: Rett syndrome is a very rare neurological condition that almost exclusively affects girls. Infants seem healthy during their first six months, but then quickly develop symptoms that include loss of muscle control, respiratory problems, cognitive impairment, severe developmental delay, seizures, and many other symptoms. Therapy is geared toward managing symptoms and preventing complications.
Wilson’s Disease: Wilson’s disease is a rare genetic disorder characterized by the body’s inability to rid itself of excess copper. A small amount of copper is necessary for health, but too much copper is toxic. Normally, the liver rids the body of excess copper. Wilson’s disease prevents the liver from working normally.
The symptoms of Wilson’s disease vary depending on the organs that are affected. Neurological symptoms caused by excess copper in the central nervous system can cause symptoms such as: stiff muscles, weak muscles, tremors, shakes, or uncontrollable movements, repetitive movements, poor coordination and fine motor movements, and difficulty speaking or swallowing. Psychological symptoms may include anxiety, depression and psychosis. Treatment is with medications used to treat heavy metal toxicity.