Movement disorder treatment

The symptoms of movement disorders vary according to the type and severity of the movement disorder, and which parts of your body are affected.

Symptoms of movement disorders may include:

• Stiffness or rigidity
• Uncontrolled movements such as spasms, twitches, jerks, or tremors
• Difficulty performing certain tasks, such as walking, writing, swallowing, or speaking
• Problems with balance and coordination
• Changes to your gait (the way you walk)

There are two main types of abnormal movements; hyperkinetic movements which involve increased movement, and hypokinetic movement which is characterised by decreased or slow movements.
A movement disorder may involve one or both types of abnormal movements.

Hyperkinetic movements include:

• Ataxia — problems with coordination
• Dystonia —involuntary muscle contractions causing repetitive, abnormal movements
• Spasticity — involuntary muscle contractions
• Myoclonus — involuntary muscle twitching or jerking
• Chorea — involuntary, unpredictable muscle movements
• Stereotypies — repeated movements such as rocking, pacing and hand flapping
• Tics — repetitive involuntary movements such as head jerking, blinking, face scrunching, and grunting
• Akathisia — difficulty keeping still
• Tremor —involuntary trembling or shaking

Hypokinetic movements include:

• Parkinsonism — an umbrella term that encompasses slowed movements, stiffness, tremor, and problems with balance
• Bradykinesia — slow movement
• Akinesia —   lack of movement

Movement disorders can have a variety of causes including acquired or inherited neurological conditions, traumatic brain injury, infection, toxins, or the side effects of some medications.

Some conditions that can cause movement disorders include:

• Huntington’s disease — a genetic disorder that causes uncontrollable movements (chorea) in your hands, feet, and face. Huntington’s disease is degenerative, meaning it gets worse over time
• Parkinson’s disease — a degenerative disease where nerve cells break down leading to a reduction in the production of dopamine and a range of symptoms including movement disorders
• Essential tremor — causes uncontrollable shaking, normally in your hands, but can affect other parts of your body
• Restless leg syndrome (RLS) — a condition that causes the sensation of creeping, throbbing, itching, aching, burning, or crawling in your legs accompanied by an intense urge to move your legs
• Periodic limb movement disorder (PLMD) —  A sleep disorder that causes repeated jerking, twitching, or cramping of the legs during sleep
• Rett syndrome — a rare genetic condition that affects your speech and co-ordination
• Progressive supranuclear palsy (PSP) —  a rare degenerative disorder where nerve cells in certain parts of the brain are damaged causing problems with body movements, walking, balance, and eye movements
• Tourette syndrome — a neurological disorder that affects your brain and nerves, causing tics, sudden movements, or involuntary sounds
• Wilson disease — a rare genetic condition where too much copper builds up in your body causing stiff muscles, tremors, and uncontrolled movements
• Tardive dyskinesia — a condition resulting from long-term use of antipsychotic medications that may cause facial tics and uncontrollable movements like lip-smacking
• Multiple system atrophy (MSA) —  a rare degenerative condition where areas of the brain atrophy (shrink) resulting in movement disorders such as ataxia and parkinsonism

At your first consultation, you will be seen by a consultant neurosurgeon or neurologist, a doctor specialising in conditions affecting the brain, spinal cord and nerves. Your consultant will ask you about your symptoms, general health, medical history, and any medications you are taking. They will perform a thorough physical and neurological examination.

Based on your symptoms and physical examination, your consultant may order tests or scans to confirm or rule out a diagnosis.

These may include:

• Blood tests to check for underlying disease
• Imaging tests such as CT or MRI scans to examine your brain, spinal cord, or nerves for abnormalities
• Electromyography (EMG) to assess your muscles and nerves
• Electroencephalogram (EEG) to check the electrical activity of your brain
• Nerve conduction studies to measure the electrical current that passes through your nerves to your muscles
• Lumbar puncture to analyse your cerebrospinal fluid (CSF)

How is a diagnosis made?

Your consultant will make a diagnosis based on your symptoms, physical examination, and the results of any tests or scans.

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it’s where your consultant will ask you about your symptoms, perform a full examination, order any necessary tests, provide a diagnosis, and discuss possible treatments.

Your first consultation is also where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible throughout your time with us, so please discuss any questions or concerns with your consultant at your appointment.

After making a diagnosis, your consultant will discuss possible treatment options with you and decide on the best option for you based on your symptoms and diagnosis.

In most cases, there’s no cure for movement disorders, but treatments are available to help ease the symptoms and improve your quality of life.

Non-surgical treatments for movement disorders

Medication

Your consultant may prescribe medication to help treat the symptoms of your movement disorder. The type of medication you are prescribed depends on your symptoms and diagnosis. Some medications used to treat movement disorders include:

• Muscle relaxants —can reduce muscle spasms, spasticity and cramping in some types of movement disorders
• Beta-blockers — this blood pressure medication can reduce shaking in people with essential tremor and some other movement disorders
• Dopaminergic medications (dopamine agonists) — work by activating dopamine receptors in your brain and can reduce symptoms of movement disorders like Parkinson’s disease
• Antianxiety medications — calm the central nervous system and relax the muscles, helping relieve muscle spasms and symptoms of dystonia
• Antiseizure medications — can help reduce tremors, particularly in the hands
• Anticholinergic Agents — work by reducing the effects of a brain chemical called acetylcholine, which decreases tremors and muscle stiffness. They may be used to treat people with dystonia
• Botulinum toxin (Botox®) injections — help relax the muscles in people with movement disorders and may be used to treat tics, essential tremor, dystonia, and spasticity

Physiotherapy

Physiotherapy can help manage symptoms of movement disorders in several ways including increasing muscle strength, improving muscle control and relaxing tight muscles. Some physiotherapy techniques to treat movement disorders include:

• Exercises to increase muscle strength and control, improve balance, and build stamina
• Repetitive movements to stimulate brain pathways and improve accuracy of movement
• Teaching correct posture to increase comfort and reduce pain
• Relaxation techniques and hydrotherapy to help relax tight muscles

Occupational therapy

Occupational therapists help improve your ability to perform daily tasks. They will teach you techniques or show you tools or devices to make day-to-day tasks easier.

Mobility aids

Using mobility aids, such as walking canes, walkers, and wheelchairs, can help you get around safely, and increase your mobility and independence.

Speech therapy

A qualified speech therapist will work with you to help improve your speech, language skills and swallowing ability.

Talking therapies

People with movement disorders have an increased risk of developing mental health conditions such as mood disorders, anxiety, and depression. Talking therapies like cognitive behavioural therapy can offer support and help identify and change negative thought patterns and behaviours.

Surgical treatments for movement disorders

Deep brain stimulation (DBS)

Deep brain stimulation (DBS) is a type of brain surgery that uses mild electrical stimulation to treat the symptoms of some movement disorders such as tremors. It works by interrupting the abnormal electrical signals in the brain that cause tremor and other symptoms of movement disorder.

DBS may be recommended to treat conditions such as Parkinson’s disease, essential tremor, Tourette syndrome and conditions that cause dystonia.

What happens during deep brain stimulation surgery?

Deep brain stimulation surgery is performed in two stages; brain surgery to implant the electrodes and chest wall surgery to implant the pulse generator.

The brain surgery is normally carried out under local anaesthetic, which means you’ll be awake, but the area being operated on will be numb, and you won’t feel any pain. For the chest wall surgery, you’ll be given a general anaesthetic.

Before your surgery, you’ll be fitted with a special head frame to keep your head still during the procedure.

During the first part of the procedure, your consultant will implant electrodes or leads into a specific area of your brain. They will check they are in the correct position with CT or MRI imaging scans.

During the second part of the surgery, your consultant will implant a small device similar to a pacemaker under the skin of your chest. This device, called a pulse generator, is connected to the electrodes in your brain with wires under your skin.

A few weeks after your deep brain stimulation surgery, when you have recovered from the procedure, your pulse generator will be programmed to send electrical pulses to your brain. Your neurologist will programme your pulse generator in a way that works best to treat your symptoms. You may need several appointments with your neurologist to programme your pulse generator in a way that works best for you.

Deep brain stimulation surgery normally takes three to four hours.

How do I prepare for deep brain stimulation surgery?

Your consultant will tell you everything you need to do to prepare for your surgery. If there’s anything you’re not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication, including over-the-counter medicines you are taking.

Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

You will not be able to eat or drink anything from midnight on the day of your operation.

What lifestyle changes can I make before my surgery?

Being as healthy as possible before your surgery can help to reduce the risk of complications and speed up your recovery.

In the weeks before your deep brain stimulation surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

Recovering from deep brain stimulation surgery

Recovering from any type of surgery is different for everyone and depends on several factors such as your age, general health and what happened during your procedure.

You can expect some swelling and bruising around your surgical sites after your procedure. You may also have bruising and swelling around your eyes. This will resolve gradually over the next week or two.

You may experience mild pain for a few days after your procedure. The nursing team will give you pain medications to manage this.

Your healthcare team will give you instructions on how to care for your surgical wounds after your surgery. Your stitches will be removed after ten to fourteen days.

You should rest for the first two weeks after your procedure and avoid strenuous activity and heavy lifting for four to six weeks.

How many nights will I need to stay in hospital?

You can expect to spend one to two nights in hospital after your deep brain stimulation surgery.

Will I be able to drive home?

You will not be able to drive yourself home from hospital after your deep brain stimulation surgery. Please make arrangements for someone to collect you, or we can organise a taxi if you prefer.

How soon can I go back to work?

Depending on the type of job you do, you can expect to return to work after between two and six weeks. Talk to your consultant about when you can go back to work after your deep brain stimulation surgery.

How soon can I drive?

Do not drive for six weeks after your deep brain stimulation surgery. Get the clear from your consultant and inform the DVLA about your DBS surgery before driving after your procedure.

When will I be back to normal?

Recovery from deep brain stimulation surgery is a gradual process. You may feel quite tired for the first couple of weeks but should start to feel a little better each day. Go at your own pace and listen to your body. You can help your recovery to go more smoothly by following your healthcare team’s instructions carefully after your surgery. Call the hospital if you have any questions or concerns.

It normally takes around four to six weeks to recover fully from deep brain stimulation surgery.

Deep brain stimulation surgery is a relatively safe procedure, but like all types of surgery, there is a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery. It’s important that you are fully informed about any potential risks and complications before your surgery as this will allow you to make an informed decision.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to deep brain stimulation surgery include:

• Coma
• Stroke
• Swelling in or around your brain
• Problems with the leads such as shifting, incorrect placement, or coming loose
• Failure of the leads or pulse generator

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about movement disorder treatment, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in March 2024. Next review due March 2027.

• About Movement Disorders International Parkinson and Movement Disorder Society
• Cognitive Behavioral Therapy in Movement Disorders: A Review Research Gate
• Deep Brain Stimulation for Movement Disorders National Institute of Neurological Disorders and Stroke
• Movement Disorders American Association of Neurological Surgeons