Movement Disorders

Movement Disorders

Movement disorders can be some of the most confusing and debilitating problems anyone can confront. When present, people lose control of their bodies, lose the ability to generate proper motor responses, and lose the ability to interact with the world.

 

In the broadest sense, movement disorders are either hyperkinetic, i.e. people move too much, or hypokinetic, i.e. they move too little. Unwanted and intrusive movements are considered to be hyperkinetic disorders. Slowing of movement and inability to properly initiate movement are hallmarks of hyperkinetic disorders. In some conditions such as Parkinson’s disease, both hyperkinetic tremors and hypokinetic slowing of movement can be part of the same clinical presentation.

 

Movement disorders are profoundly frustrating to struggle with. People describe themselves as feeling like marionettes, and feel that their bodies are being played by remote puppeteers. They attempt to activate a muscle or motor program and nothing happens, or a different muscle or program activates instead. Involuntary muscle spasms or contractures lead to involuntary posturing, changes in gait and balance, and pain. Tremors make handwriting illegible, and can even make it difficult to hold utensils to feed oneself. Falls are very common consequences of these conditions.

 

Most movement disorders involve several parts of the brain, including the basal ganglia, the cerebellum, the frontal motor cortex, and the parietal sensory cortex in various combinations. There is usually some form of genetic lesion that predisposes people towards unwanted patterns of movement, often coupled with some form of trauma or neurodegeneration that leads to expression of the disorder. Traditional treatment options are generally very limited, ranging from pharmaceutical dopamine replacement to facilitate basal ganglia function, to Botox injections to shut off dystonic muscles. These approaches only manage symptoms and do not halt the progression of the disorder. More invasive therapies such as deep brain stimulus show promise, however, these involve all the risks associated with brain surgery.

 

One essential component of these conditions is a failure of integration between sensory maps. The brain creates unconscious visual, vestibular (inner ear), and proprioceptive (muscle and joint) maps that help localize the body and its various parts in the visual and gravitational environment. The parietal lobe has a map in the sensory cortex, which is where you feel most of the physical sensations from your body parts. In many movement disorders, problems with the basal ganglia result in smearing of this sensory map, such that the brain’s definition between body parts breaks down. It loses the ability to coordinate individual muscles as a result. In other conditions, the brain perceives a mismatch between eyes and inner ear pathways, creating an inappropriate perception of where the body is in space and in relation to gravity. The posturing and muscle contractions that develop are reflexes that the brain creates to resist a perceived fall that is not actually taking place. In still other cases, systems that oscillate in the brainstem to create timing signals for motor coordination break down, or systems in the cerebellum that process sensory feedback from muscles and joints degenerate. The brain needs to essentially turn up the volume on the feedback to know where the body is in space, resulting in patterns of debilitating tremor.

 

Movement disorders often respond very well to functional neurological treatment. We start by precisely and objectively quantifying the function in all of your relevant systems, using cutting-edge technologies. We use this data to assess the function of all the relevant parts of your brain, cerebellum, brainstem, vestibular system, and basal ganglia. We compare this information with what we receive from your comprehensive neurological examination, to see how these systems are impacting your gait, balance, posturing, and coordination. We use all of your findings to design a very precise protocol of neurostimulation and neurorehabilitation exercises. This allows us to rebuild your sensory and motor maps, and get them all working together again. The changes we see in a short period of time are often dramatic. At the end of our treatment, most people usually need to spend a few minutes per day performing some of their exercises to maintain their gains. While our therapies do not cure the underlying condition, people can regain control of their bodies and can return to full engagement in their lives.

 

Regardless of how long you have suffered from your movement disorder, it’s never too late to start getting better.