By Dr Ananya Mandal, MD
Movement disorders commonly affect normal fluency, speed and ease of movements and gait. Most of them are cause due to faulty genes that may or may not be inherited.
Movement disorders begin with the pathology within the brain and there are drugs that may help in therapy of these conditions.
The most common areas affected are the basal ganglia, thalamus and globus pallidum deep within the brain. The cerebellum at the back of the brain may be affected in abnormalities of gait.
Treatment depends on type of movement disorder
Outlining therapy of movement disorders it is important to note that there are a range of movement disorders and each need spate attention and diagnosis although most of them are treated with the same armament of medications.
Treatment involves many types of specialists and primarily neurologists. Early stages respond well to medications. During mid- to late-stage disease additional surgery may be suggested.
The primary problem is depletion of chemical messenger Dopamine in the basal ganglia of the brain.
Levodopa helps to restore this Dopamine and is the mainstay of drug therapy for Parkinson’s disease. Carbidopa helps in the activity of Levodopa.
There are other drugs like Amantadine, Selegiline, Ropinirole, Entacapone, Tolcapaone, and Pramipexole that help in treatment of Parkinson’s disease by replacing or increasing the dopamine in the brain.
Those with Parkinson’s disease caused by certain drugs like antipsychotic agents need to be evaluated and the offending drug needs to be stopped. Drugs like Trihexyphenydyl help these patients. Neuroprotective agents help in protecting the damaged neurons of the brain.
Some surgeries like Deep brain stimulation (DBS), thalamotomy, Pallidotomy are other options for advanced cases. DBS surgery uses electrodes to cause stimulation of certain affected areas of the brain.
Stem cell transplantation has also been tried in treatment of Parkinson’s disease.
Overall good nutrition is essential for treatment of Parkinson’s disease. Good nursing care is vital.
Exercise helps keep the patient with the disease from losing muscle mass and can improve mobility and diminish injury from falls.
Psychotherapy is necessary for patients with concomitant psychiatric conditions.
Dystonias are treated with anticholinergic drugs like trihexyphenidyl, Benzodiazepines like diazepam, lorazepam and Skeletal muscle relaxants like baclofen. Levodopa with carbiidopa, clozapine and tetrabenazine is also used in therapy.
Botulinum toxin or botox may be used to relieve the muscle spasm.
For patients with severe dystonia who have not responded to therapy surgery is considered to relieve the muscle spasm and pain. Brain surgery may also be performed as treatment.
Tremors, especially essential tremors, are treated with:
- betablockers like Propranolol
- other drugs like Primidone
- Benzodiazepines like alprazolam, clonazepam
- gaba analogues like gabapentin
- antipsychotics like Mirtazapine, clozapine
Surgery and DBS is recommended in severe cases.
Tourette's syndrome is usually treated with antipsychotics like Haloperidol. Clonidine a blood pressure lowering agent has been found useful in certain tic disorders.
Botox is useful in facial spasms, blepharospasm and torticollis (dystonia of the neck muscles).
Anti-seizure drugs like carbamazepine, phenytoin, gabapentin, baclofen are also useful in the treatment of movement disorders.
Phenytoin and Pramipexole (originally drug for Parkinson’s disease) is useful in restless legs syndrome.
Treatment of movement disorders caused by drugs
Common side effects of dopamine increasing drugs include nausea, headache, dizziness, and fatigue and rarely abnormal movements like dyskinesias.
Beta blockers like Propranolol may cause slowed heart rate, light-headedness, depression and nausea.
Benzodiazepines lead to drowsiness, and fatigue.
Anti-seizure medications may cause lack of coordination and balance, nausea, dizziness and fatigue.
Botox may cause temporary weakness in the group of muscles being treated and rarely, flu-like symptoms due to allergies. (1-4)
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)