Motor Disorder
Overview
Motor disorders are disorders of the nervous system that cause abnormal and involuntary movements. They can result from damage to the motor system. The seven motor disorders listed in the DSM-5 include:
- Developmental Coordination Disorder
- Stereotypic Movement Disorder
- Tourette Syndrome (also called Tourette's disorder)
- Persistent (chronic) vocal or motor tic disorder
- Provisional tic disorder
- Other Specified Tic Disorder
- Unspecified Tic Disorder
Causes movement disorders are conditions that cause spasms, jerking or shaking. They may reduce or slow movement, and they can affect activities such as writing or playing the piano.
There are generally three types of movement disorders: excessive movement (hyperkinetic), abnormally reduced intentional movement (hypokinetic), and abnormal involuntary movement (dyskinesia).
Genetic conditions, traumatic injury, nervous system disease, infections, medication side effects, and other factors may cause a movement disorder. A history of stroke, high blood pressure, and diabetes may increase your risk, which increases with age.
Causes of movement disorders include
- Genetics
- Infections
- Medicines
- Damage to the brain, spinal cord, or peripheral nerves
- Metabolic disorders
- Stroke and vascular diseases
- Toxins
Symptoms
Symptoms for developmental coordination disorder include:
- Clumsiness
- Problems suckling and swallowing during the first 12 months of life
- Delayed sitting, crawling, and walking
- Difficulties with gross motor skills (i.e. jumping, hopping, and standing on one foot)
- Difficulties with fine motor skills (i.e. writing, cutting with scissors, tying shoes)
Symptoms for Stereotypic movement disorder:
- Head banging (against a wall or other solid form)
- Rocking back and forth
- Shaking or waving hands for no reason
- Nail biting
- Biting of self
- Hitting self
Symptoms for tourette’s disorder:
- Simple tics – sudden, brief, and repetitive small movements
- Complex tics – coordinated strings of larger, more complex movements
- Vocal tics – short, random sounds or words
Symptoms for Persistent (chronic) Vocal or Motor Tic Disorder:
- Eye blinking
- Facial grimaces
- Jerking of the arms, legs, or head
- Vocal sounds (grunting, throat clearing)
Symptoms for Provisional Tic Disorder:
- Repetitive, non-rhythmic movements
- Intense urge to make the movement
-
Quick movements that include:
- Eye blinking
- Fist clenching
- Toe curling
- Nostril flaring
- Facial grimaces
- Jerking of arms or legs
- Eyebrow raising
- Shoulder shrugging
- Other brief, purposeless movements
-
Vocal tics may include:
- Grunting
- Moaning
- Sniffing
- Throat clearing
- Clicking
- Hissing
- Snorting
Symptoms of motor disorders include tremors, jerks, twitches, spasms, contractions, or gait problems. Tremor is the uncontrollable shaking of an arm or a leg. Twitches or jerks of body parts may occur due to a startling sound or unexpected, sudden pain.
Treatments
In many cases, movement disorders cannot be cured, and the goal of treatment is to minimize symptoms and relieve pain. Some are severe and progressive, impairing your ability to move and speak. While treatment for movement disorders will depend on the underlying cause of your condition, options your doctor may suggest include:
- Drug therapies to control your symptoms
- Physical or occupational therapy to help maintain or restore your ability to control your movements
- Botulinum toxin injections to help prevent muscle contractions
- Deep brain stimulation, a surgical treatment option that uses an implant to stimulate the areas of your brain that controls movement
Treatment for tic disorders
The best-known behavioral treatment for tic disorders is a form of cognitive-behavioral therapy (CBT) called habit reversal training. A child is taught to recognize the premonitory urge that precedes an oncoming tic, and to identify the situations that may trigger the tics. The child and therapist develop a “competing” response—an action the child performs when he feels the urge—that is incompatible with the tic, and less noticeable to others. For example, a child whose tic involves sniffing his nose may do a breathing exercise instead. Children may also be taught relaxation techniques to decrease the frequency of the tics.
Medicines
Blood Pressure Medication
People with essential tremor or tremors from another cause may be treated with a blood pressure medication called a beta blocker to alleviate symptoms. Beta blockers, such as metoprolol, have been shown to reduce the physical symptoms of movement disorders, such as shaking.
Anti Seizure Medications
Doctors may prescribe anti seizure medications, such as primidone or topiramate, for essential tremor or other forms of tremor. These medications are most effective for reducing tremors in the hands.
Anticholinergic Agents
For a person with dystonia, a doctor may prescribe a class of medications called anticholinergic agents. Anticholinergics work by reducing the effects of a brain chemical called acetylcholine, resulting in decreased tremors or muscle stiffness. Medications in this group include trihexyphenidyl and benztropine.
Side effects may include hallucinations, confusion, decreased short-term memory, blurred vision, and urinary problems. Your doctor works with you to monitor any additional symptoms and adjust your medication if needed.
Anti-anxiety Medications
Doctors may prescribe anti-anxiety medications, such as clonazepam, for dystonia. Anti-anxiety medications calm the central nervous system and relax the muscles to provide short-term relief from muscle spasms.
Botulinum Toxin
Some people with movement disorders may benefit from injections of botulinum toxin, commonly known as Botox®, in the affected muscles. Botox® works by blocking the brain chemicals, or neurotransmitters, responsible for muscle spasms.
Botox® may be used alone or in combination with other medication. The injections typically need to be repeated every few months. Side effects may include redness, swelling, or mild pain at the injection site.