# Movement disorder

Movement disorders are clinical syndromes with either an excess of movement or a paucity of voluntary and involuntary movements, unrelated to weakness or spasticity. Movement disorders present with extrapyramidal symptoms and are caused by basal ganglia disease. Movement disorders are conventionally divided into two major categories- hyperkinetic and hypokinetic.
Hyperkinetic movement disorders refer to dyskinesia, or excessive, often repetitive, involuntary movements that intrude upon the normal flow of motor activity.
Hypokinetic movement disorders fall into one of four subcategories: akinesia (lack of movement), hypokinesia (reduced amplitude of movements), bradykinesia (slow movement), and rigidity. In primary movement disorders, the abnormal movement is the primary manifestation of the disorder. In secondary movement disorders, the abnormal movement is a manifestation of another systemic or neurological disorder. Treatment depends upon the underlying disorder.

## Classification

| Movement Disorders | ICD-9-CM | ICD-10-CM |
| Hypokinetic Movement disorders |||
| Poliomyelitis, acute | 045 | A80 |
| Amyotrophic lateral sclerosis, ALS (Lou Gehrig's disease) | 335.20 | G12.21 |
| Parkinson's disease (Primary or Idiopathic Parkinsonism) | 332 | G20 |
| Secondary Parkinsonism | | G21 |
| Parkinson plus syndromes | | |
| Pantothenate kinase-associated neurodegeneration | | G23.0 |
| Progressive Supranuclear Ophthalmoplegia | | G23.1 |
| Striatonigral degeneration | | G23.2 |
| Multiple sclerosis | 340 | G35 |
| Radiation-induced polyneuropathy (brachial and lumbar plexopathies) | | G62.82 |
| Muscular dystrophy | 359.0 | G71.0 |
| Cerebral palsy | 343 | G80 |
| Rheumatoid arthritis | 714 | M05 |
| Hyperkinetic Movement disorders |||
| GLUT1 deficiency syndrome | | E74.810 |
| Attention-deficit hyperactivity disorder (with hyperactivity) | 314.01 | F90 |
| Tic disorders (involuntary, compulsive, repetitive, stereotyped) | | F95 |
| Tourette's syndrome | | F95.2 |
| Stereotypic movement disorder | | F98.5 |
| Huntington's disease (Huntington's chorea) | 333.4 | G10 |
| Dystonia | | G24 |
| Drug induced dystonia | | G24.0 |
| Idiopathic familial dystonia | 333.6 | G24.1 |
| Idiopathic nonfamilial dystonia | 333.7 | G24.2 |
| Spasmodic torticollis | 333.83 | G24.3 |
| Idiopathic orofacial dystonia | | G24.4 |
| Blepharospasm | 333.81 | G24.5 |
| Other dystonias | | G24.8 |
| Other extrapyramidal movement disorders | | G25 |
| Essential tremor | 333.1 | G25.0 |
| Drug induced tremor | | G25.1 |
| Other specified form of tremor | | G25.2 |
| Myoclonus | 333.2 | G25.3 |
| Chorea (rapid, involuntary movement) | | |
| Drug induced chorea | | G25.4 |
| Drug-induced tics and tics of organic origin | 333.3 | G25.6 |
| Paroxysmal nocturnal limb movement | | G25.80 |
| Painful legs (or arms), moving toes (or fingers) syndrome | | G25.81 |
| Sporadic restless leg syndrome | | G25.82 |
| Familial restless leg syndrome | | G25.83 |
| Stiff-person syndrome | 333.91 | G25.84 |
| Ballismus (violent involuntary rapid and irregular movements) | | G25.85 |
| Hemiballismus (affecting only one side of the body) | | G25.85 |
| Myokymia, facial | | G51.4 |
| Neuromyotonia (Isaacs Syndrome) | 359.29 | G71.19 |
| Opsoclonus | 379.59 | H57 |
| Rheumatic chorea (Sydenham's chorea) | | I02 |
| Abnormal head movements | | R25.0 |
| Tremor unspecified | | R25.1 |
| Cramp and spasm | | R25.2 |
| Fasciculation | | R25.3 |
| Athetosis (contorted torsion or twisting) | 333.71 | R25.8 |
| Dyskinesia (abnormal, involuntary movement) | | |
| Tardive dyskinesia | | |

## Diagnosis

Step I : Decide the dominant type of movement disorder
Step II : Make differential diagnosis of the particular disorder
Step II: Confirm the diagnosis by lab tests
* Metabolic screening
* Microbiology
* Immunology
* CSF examination
* Genetics
* Imaging
* Neurophysiological tests
* Pharmacological tests

## History

Vesalius and Piccolomini in 16th century distinguished subcortical nuclei from cortex and white matter. However Willis' conceptualized the corpus striatum as the seat of motor power in the late 17th century. In mid-19th-century movement disorders were localized to striatum by Choreaby Broadbent and Jackson, and athetosis by Hammond. By the late 19th century, many movement disorders were described, but for most no pathologic correlate was known.