Movement Disorders

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Treatment

Treatment for movement disorders depends on the underlying cause. In most cases, the goal of treatment is to relieve symptoms. Treatment may include medication, botulinum toxin injection therapy (BOTOX® therapy), and surgery.

Medications that may be used include the following:

• Antiepileptics (e.g., carbamazepine [Tegretol®], valproate [Depakote®])
• Antiseizure medications (e.g., primidone [Mysoline®], gabapentin [Neurontin®])
• Beta-blockers (e.g., propranolol [Inderal®])
• Dopamine agonists (e.g., bromocriptine [Parlodel®], pergolide [Permax®])
• Tranquilizers (benzodiazepines such as diazepam [Valium®] and clonazepam [Klonopin®])

Side effects of antiepileptics include dizziness, drowsiness, nausea, and vomiting. Antiseizure medications may cause a lack of coordination and balance (ataxia), dizziness, nausea, and fatigue. Benzodiazepines may cause blood clots (thrombosis), drowsiness, and fatigue. Side effects caused by beta-blockers include slowed heart rate (bradycardia), depression, light-headedness, and nausea. Dopamine agonists may cause nausea, headache, dizziness, and fatigue.

Parkinson's disease may be treated using a number of different medications.

Botulinum toxin injection therapy (BOTOX® therapy) is used to treat some types of movement disorders (e.g., spasmodic torticollis, blepharospasm, myoclonus, tremor). In this treatment, a potent neurotoxin (produced by the bacterium Clostridium botulinum) is injected into a muscle to inhibit the release of neurotransmitters that cause muscle contraction.

In some cases, treatment is repeated every 3 to 4 months. Patients may develop antibodies to the toxin over time, causing treatment to become ineffective. Side effects include temporary weakness in the group of muscles being treated and rarely, flu-like symptoms.

When medication is ineffective, severe movement disorders may require surgery. In deep brain stimulation (DBS), a surgically implanted, battery-operated medical device (neurostimulator) is used to deliver electrical stimulation to areas of the brain that control movement. The electrical charge blocks nerve signals that trigger abnormal movement.

In DBS, an electrode (lead) is inserted through a small incision in the skull and is implanted in the targeted area of the brain. An insulated wire (extension) is then passed under the skin in the head, neck, and shoulder, connecting the lead to the neurostimulator, which is surgically implanted in the chest or upper abdomen.

Side effects of deep brain stimulation include:

• Bleeding at the implantation site
• Depression
• Impaired muscle tone
• Infection
• Loss of balance
• Slight paralysis (paresis)
• Slurred speech (dysarthia)
• Tingling (parethesia) in the head or the hands

Ablative surgery locates, targets, and then destroys (ablates) the clearly defined area of the brain that produces chemical or electrical impulses that cause abnormal movements.

In this surgery, a heated probe or electrode is inserted into the targeted area. The patient remains awake during the procedure to determine if the problem has been eliminated. A local anesthetic is used to dull the outer part of the brain and skull. The brain is insensitive to pain, so the patient does not feel the actual procedure. In some cases, it may be difficult to estimate how much tissue to destroy and the amount of heat to use.

This type of surgery involves either ablation in the part of the brain called the globus pallidus (called pallidotomy) or ablation of brain tissue in the thalamus (called thalamotomy). A related procedure, cryothalamotomy, uses a supercooled probe that is inserted into the thalamus to freeze and destroy areas that produce tremors.

Pallidotomy may be used to eliminate uncontrolled dyskinesia (e.g., jerky, involuntary movements) and thalamotomy may be performed to eliminate tremor. These procedures are successful in approximately 75% of cases.

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