Imagine if parts of your body moved when you didn't want them to. If you have a movement disorder, you experience these kinds of impaired movement. Dyskinesia is abnormal uncontrolled movement and is a common symptom of many movement disorders. Tremors are a type of dyskinesia.

Nerve diseases cause many movement disorders, such as Parkinson's disease. Other causes include injuries, autoimmune diseases, infections and certain medicines. Many movement disorders are inherited, which means they run in families.

Treatment varies by disorder. Medicine can cure some disorders. Others get better when an underlying disease is treated. Often, however, there is no cure. In that case, the goal of treatment is to improve symptoms and relieve pain.

What is cerebral palsy?

The term cerebral palsy refers to a group of neurological disorders that appear in infancy or early childhood and permanently affect body movement, muscle coordination, and balance. CP affects the part of the brain that controls muscle movements. The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later. The early signs of cerebral palsy usually appear before a child reaches 3 years of age. The most common are a lack of muscle coordination when performing voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, a crouched gait, or a “scissored” gait; and muscle tone that is either too stiff or too floppy. Other neurological symptoms that commonly occur in individuals with CP include seizures, hearing loss and impaired vision, bladder and bowel control issues, and pain and abnormal sensations. A small number of children have CP as the result of brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, or head injury from a motor vehicle accident, a fall, or child abuse. The disorder isn't progressive, meaning that the brain damage typically doesn't get worse over time. Risk factors associated with CP do not cause the disorder but can increase a child's chance of being born with the disorder. CP is not hereditary.

Is there any treatment?

Cerebral palsy can’t be cured, but treatment will often improve a child's capabilities. In general, the earlier treatment begins the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them. Early intervention, supportive treatments, medications, and surgery can help many individuals improve their muscle control. Treatment may include physical and occupational therapy, speech therapy, drugs to control seizures, relax muscle spasms, and alleviate pain; surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic devices; wheelchairs and rolling walkers; and communication aids such as computers with attached voice synthesizers.

What is the prognosis?

Cerebral palsy doesn’t always cause profound disabilities and for most people with CP the disorder does not affect life expectancy. Many children with CP have average to above average intelligence and attend the same schools as other children their age. Supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world. While one child with CP might not require special assistance, a child with severe CP might be unable to walk and need extensive, lifelong care.

Chorea is a movement disorder that causes sudden, unintended, and uncontrollable jerky movements of the arms, legs, and facial muscles. Chorea is seen in many diseases and conditions and is caused by an overactivity of the chemical dopamine in the areas of the brain that control movement.

The involuntary, irregular, and unpredictable movements make it appear as if the affected person is dancing, twisting, restless, clumsy, or fidgety. However, the movements may look different within various diseases, often get worse when the person is stressed or anxious and disappear when sleeping.

Chorea is usually a symptom of another disorder, such as Huntington's disease, and can be induced in rheumatic fever complications, known as Sydenham's chorea, by other disorders, certain medicines (including levodopa or some antiseizure or antipsychotic drugs), metabolic and endocrine disorders such as hyperthyroidism, or vascular diseases. It can also occur on its own or be inherited.

In addition to dance-like movements, signs and symptoms of chorea may include:

• Alternating squeezing and releasing of the fingers when trying to shake someone's hand (known as "Milkmaid's grip")
• Tongue moving in and out of the mouth (known as "Jack-in-the-Box tongue")
• Headaches and seizures in children with rheumatic fever

People at increased risk of chorea are those with a family history of Huntington's disease, those with autoimmune diseases such as lupus or certain metabolic disorders, someone who has had a stroke near the movement center in the brain, and children with rheumatic fever.

Chorea by itself is not life-threatening. The prognosis for someone with chorea varies depending on the associated disease. Treatment may involve the use of drugs that block dopamine. For disorders such as Sydenham's chorea, treatment includes antibiotic drugs and drug therapy.

What is psychogenic movement?

Psychogenic movement is an unwanted muscle movement such as a spasm or tremor that is caused by an underlying psychological condition. Psychogenic movement can involve any part of the body and resemble the same muscle movements that occur with a biological condition or structural abnormality. Most psychogenic movement is involuntary—done without being consciously initiated by the individual. Psychogenic movement may develop as part of a conversion disorder (in which a psychological event causes physical symptoms with no known medical cause). It also may result from a somatoform disorder (characterized predominantly by multi-system symptoms that are associated with distress and/or dysfunction), factitious disorder (an illness that simulates symptoms for psychological reasons), or malingering (not characterized as a psychiatric disorder but where illness is pretended as a way to achieve a secondary goal such as the acquisition of drugs or disability benefits). Unlike movement disorders caused by biological or structural conditions, psychogenic movement disorders commonly develop suddenly, progress rapidly to maximum severity, may increase in intensity, and come and go with complete or partial remissions. The movement may be less when the person is distracted, and the severity of symptoms varies among individuals. The course of the psychological condition may be short-lived or lead to chronic disability.

Psychogenic movement is uncommon before the age of 10 years. In children, the dominant limb is most often affected, while adults most frequently see movement in the nondominant limb.

Psychogenic movement disorders include:

• Psychogenic tremor (also called functional tremor) can appear as any form of tremor movement. Characteristics may vary but generally include sudden onset and remission, increased incidence with stress, change in tremor direction and/or body part affected, and greatly decreased or disappearing tremor activity when the person is being distracted. Many individuals with psychogenic tremor have a conversion disorder.
• Psychogenic dystonia involves involuntary muscle contractions that cause slow, repetitive movements or abnormal postures that are often severely painful. Onset may be abrupt or appear as part of a recurring attack. Psychogenic dystonia typically involves fixed postures, particularly from the start, whereas dystonia caused by a muscle or structural abnormality tends to involve more mobility and be action induced.
• Psychogenic myoclonus refers to sudden, involuntary muscle contractions (twitches) or jerking of a muscle or group of muscles that are caused by a psychological condition. Myoclonic jerks may occur alone or in sequence, in a pattern or without pattern. Increased startle or startle-like movements are frequent. Psychogenic myoclonus may occur spontaneously or be generated by an action or reflex. The twitching cannot be controlled by the person experiencing it.
• Psychogenic parkinsonism involves rigid movements that are extremely slow and often associated with a great sense of effort and rapid onset of severe fatigue. Individuals with psychogenic parkinsonism may also have tremor. Symptoms are usually seen on both sides of the body.
• Psychogenic gait disturbances feature unusual patterns of stance and gait. Individuals may stagger or veer from side to side when walking and appear to be losing their balance, but only rarely fall. Sudden knee buckling without falling is common.

Is there any treatment?

No single test can confirm psychogenic movement, which can prove difficult to diagnose. Physicians must rule out co-existing conditions and other recognizable movement disorders. There may be fluctuations during a neurological exam—particularly an increase of movement following attention and suggestion (an external influence on the will of the patient), and a decrease when the person is distracted. Electromyography (EMG) may be used to measure bursts of electrical activity from the brain and/or spinal cord to a peripheral nerve root (found in the arms and legs) that controls muscles during contraction and at rest. Electroencephalography (EEG) can correlate the movement and detect any changes in electrical activity patterns produced by the brain. Physicians also look for marked improvement in symptoms following psychotherapy, use of a placebo (a medicine with no specific pharmacological benefit for the disorder being treated but given to see if it produces psychological or physical benefits), or suggestion.

A multi-therapy approach to treating psychogenic movement includes psychotherapy, placebo, or suggestion; antidepressants for symptoms related to depression or anxiety; cognitive-behavioral therapy to identify and alter thoughts and feelings that may be causing the psychological illness; physical therapy; and rehabilitative and occupational therapy to improve performance of activities of daily living. An experimental treatment is transcranial magnetic stimulation (TMS), which can alter electrical activity in the brain’s cortex (the region that controls movement) and may reduce movement frequency.

What is the prognosis?

The severity of psychogenic movement symptoms and prognosis varies among individuals. Prognosis is considered poor when the movement disorder continues for many years. Outcome appears to be better in younger people with a shorter duration of symptoms than in older persons with more chronic symptoms. Also, people with few and mild symptoms that have an acute onset tend to have a more favorable outcome, particularly if the duration of symptoms is relatively short and is preceded by a stressful or traumatic event. Some individuals may continue to experience symptoms over time and develop new symptoms related to other parts of their body.

What is restless legs syndrome?

Restless legs syndrome (RLS) is characterized by unpleasant sensations in the legs and an irresistible urge to move them. Individuals affected with the disorder often describe the sensations as throbbing, pulling, or creeping. The sensations range in severity from uncomfortable to irritating to painful. Symptoms commonly occur in late afternoon or evening and are most severe at night, when the person is resting. Moving the legs or walking typically relieves the discomfort but the symptoms often recur. RLS is both a sleep and a neurological sensory disorder.

Is there any treatment?

Treatment is directed toward symptom relief. For those with mild to moderate symptoms, many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms. Decreased use of caffeine, alcohol, and tobacco may provide some relief. A trial of iron supplements is recommended for individuals with low or low-normal blood tests. Exercise may also provide relief from mild symptoms. The Food and Drug Administration (FDA) has approved ropinirole, pramipexole, gabapentin enacarbil, and rotigotine to treat moderate to severe RLS. Drugs that increase the effect of dopamine (called dopaminergic agents) also have been approved to reduce symptoms of RLS. Certain opioid and benzodiazepine drugs may help individuals obtain a more restful sleep but their use must be monitored by a physician. The FDA also has approved medical devices to treat RLS, including a foot wrap that puts pressure underneath the foot and a pad that delivers vibration to the back of the legs.

What is the prognosis?

RLS is generally a life-long condition for which there is no cure. Symptoms may gradually worsen with age. Some individuals have remissions, periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear. If RLS symptoms are mild, do not produces significant daytime discomfort, or do not affect an individual's ability to fall asleep, the condition may not have to be treated.

When you play the piano or hit a tennis ball you are activating the cerebellum. The cerebellum is the area of the brain that controls coordination and balance. Problems with the cerebellum include

• Cancer
• Genetic disorders
• Ataxias - failure of muscle control in the arms and legs that result in movement disorders
• Degeneration - disorders caused by brain cells decreasing in size or wasting away

Treatment of cerebellar disorders depends on the cause. In some cases, there is no cure but treatment may help with symptoms.

A genetic brain disorder is caused by a variation or a mutation in a gene. A variation is a different form of a gene. A mutation is a change in a gene. Genetic brain disorders affect the development and function of the brain.

Some genetic brain disorders are due to random gene mutations or mutations caused by environmental exposure, such as cigarette smoke. Other disorders are inherited, which means that a mutated gene or group of genes is passed down through a family. They can also be due to a combination of both genetic changes and other outside factors.

Some examples of genetic brain disorders include

• Leukodystrophies
• Phenylketonuria
• Tay-Sachs disease
• Wilson disease

Many people with genetic brain disorders fail to produce enough of certain proteins that influence brain development and function. These brain disorders can cause serious problems that affect the nervous system. Some have treatments to control symptoms. Some are life-threatening.

Friedreich's ataxia is an inherited disease that damages your nervous system. The damage affects your spinal cord and the nerves that control muscle movement in your arms and legs. Symptoms usually begin between the ages of 5 and 15. The main symptom is ataxia, which means trouble coordinating movements. Specific symptoms include

• Difficulty walking
• Muscle weakness
• Speech problems
• Involuntary eye movements
• Scoliosis (curving of the spine to one side)
• Heart palpitations, from the heart disease which can happen along with Friedreich's ataxia

People with Friedreich's ataxia usually need a wheelchair 15 to 20 years after symptoms first appear. In severe cases, people become incapacitated. There is no cure. You can treat symptoms with medicines, braces, surgery, and physical therapy.

Degenerative nerve diseases affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Many of these diseases are genetic. Sometimes the cause is a medical condition such as alcoholism, a tumor, or a stroke. Other causes may include toxins, chemicals, and viruses. Sometimes the cause is not known.

Degenerative nerve diseases include

• Alzheimer's disease
• Amyotrophic lateral sclerosis
• Friedreich's ataxia
• Huntington's disease
• Lewy body disease
• Parkinson's disease
• Spinal muscular atrophy

Degenerative nerve diseases can be serious or life-threatening. It depends on the type. Most of them have no cure. Treatments may help improve symptoms, relieve pain, and increase mobility.

Your brain is the control center of your body. It controls your thoughts, memory, speech, and movement. It regulates the function of many organs. It's part of your nervous system, which also includes your spinal cord and peripheral nerves. The nervous system sends signals between your brain and the rest of the body. Your nerves take in information from your senses and send it to the brain to be processed. Your brain and nerves also communicate to help you move and to control your body's functions.

When the brain is healthy, it works quickly and automatically. But when you have a brain disease, it may affect how well you can function and do your daily activities. Some common brain diseases include:

• Brain tumors, which can press on nerves and affect brain function.
• Degenerative nerve diseases, which can affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Types include Alzheimer's disease and Parkinson's disease.
• Encephalitis (inflammation in the brain), which can lead to problems such as vision loss, weakness, and paralysis.
• Genetic brain disorders, which are caused by changes in genes (also called variants or mutations). These disorders can affect the development and function of the brain.
• Strokes, which can cause a loss of brain cells and can affect your ability to think clearly.
• Traumatic brain injuries (TBIs), which can affect brain function. They may range from mild to severe. The effects of a TBI may be temporary or permanent.

The symptoms of brain diseases vary widely, depending on the specific problem. In some cases, damage is permanent. In other cases, treatments such as surgery, medicines, or therapies such as physical, occupational, and speech therapies, may cure the disease or improve the symptoms.

Ataxia-telangiectasia (A-T) is a rare, inherited disease. It affects the nervous system, immune system, and other body systems. Symptoms appear in young children, usually before age 5. They include

• Ataxia - trouble coordinating movements
• Poor balance
• Slurred speech
• Tiny, red spider veins, called telangiectasias, on the skin and eyes
• Lung infections
• Delayed physical and sexual development

People with A-T have an increased risk of developing diabetes and cancers, especially lymphoma and leukemia. Although it affects the brain, people with A-T usually have normal or high intelligence.

A-T has no cure. Treatments might improve some symptoms. They include injections to strengthen the immune system, physical and speech therapy, and high-dose vitamins.

Sydenham chorea (SC) is a neurological disorder that happens in childhood. It is caused by the same bacteria that causes rheumatic fever. Rheumatic fever is a disease that may develop after an infection with group A streptococcus bacteria, such as strep throat or scarlet fever, and can cause severe illness in the heart, joints, skin, and brain.

SC affects girls more often than boys, and usually happens between ages 5 and 15. Symptoms can happen slowly over time or all at once, and may include:

• Clumsy movements
• Muscle weakness
• Stumbling or falling down
• Not being able to speak clearly

• Having a hard time focusing or writing
• Having a hard time keeping emotions stable

Some kids will have a sore throat a few weeks before their symptoms start. SC can also happen up to six months after a child has a fever, or the strep throat infection goes away.

There is no treatment for SC. People that have mild symptoms may feel better with bed rest. Other individuals may need medications to help.

Most children will completely heal from SC. Very few will have symptoms that last for a long time. Symptoms usually last for three to six weeks, but sometimes they can last for months. Some children with SC may have another episode of symptoms after the first illness. This usually happens one and a half to two and a half years later.

What is deep brain stimulation?

Deep brain stimulation (DBS) is a surgical procedure used to treat several disabling neurological symptoms—most commonly the debilitating motor symptoms of Parkinson’s disease (PD), such as tremor, rigidity, stiffness, slowed movement, and walking problems. The procedure is also used to treat essential tremor, dystonia, and focal epilepsy (epilepsy that originates in just one part of the brain). At present, the procedure is used only for individuals whose symptoms cannot be adequately controlled with medications. However, only individuals who improve to some degree after taking medication for Parkinson’s benefit from DBS.

DBS uses a surgically implanted, battery-operated medical device called an implantable pulse generator (IPG)—similar to a heart pacemaker and approximately the size of a stopwatch to—deliver electrical stimulation to specific areas in the brain that control movement, thus blocking the abnormal nerve signals that cause symptoms. The DBS system consists of three components: the lead, the extension, and the IPG. The lead (also called an electrode)—a thin, insulated wire—is inserted through a small opening in the skull and implanted in the brain. The tip of the electrode is positioned within the specific brain area. The extension is an insulated wire that is passed under the skin of the head, neck, and shoulder, connecting the lead to the implantable pulse generator. The IPG (the "battery pack") is the third component and is usually implanted under the skin near the collarbone. In some cases it may be implanted lower in the chest or under the skin over the abdomen.

Before the procedure, a neurosurgeon uses magnetic resonance imaging or computed tomography scanning to identify and locate the exact target within the brain for surgical intervention. Generally, these areas are the thalamus, subthalamic nucleus, and globus pallidus.

Once the system is in place, electrical impulses are sent from the IPG up along the extension wire and the lead and into the brain. These impulses block abnormal electrical signals and alleviate motor symptoms.

Is there any treatment?

DBS uses electrical stimulation to regulate electrical signals in neural circuits to and from identified areas in the brain to improve movement symptoms. Thus, if DBS causes unwanted side effects or newer, more promising treatments develop in the future, the implantable pulse generator can be removed, and the DBS procedure can be halted. Also, stimulation from the IPG is easily adjustable—without further surgery—if the person’s condition changes. Some people describe the pulse generator adjustments as "programming."

DBS involves minimal permanent surgical change to the brain. Although minimally invasive, DBS is a surgical procedure that carries some associated risk. There is a low chance that placement of the stimulator may casue bleeding or infection in the brain. Complications may include bleeding and swelling of brain tissue, headaches, seizures, and temporary pain following the surgery.

What is the prognosis?

Most individuals still need to take medication after undergoing DBS. Many people with Parkinson’s disease experience considerable reduction of their motor symptoms after DBS and are able to reduce their medications. People with dystonia may respond better to DBS than medications in reducing involuntary muscle contractions. DBS targeting the thalamus can improve involuntary movement of the hands, arms, and head that is associated with involuntary tremor. DBS for epilepsy may reduce the number of seizures over time. DBS does not improve cognitive symptoms in PD and indeed may worsen them, so it is not generally used if there are signs of dementia. DBS changes the brain firing pattern but does not slow the progression of the neurodegeneration.

Dystonia is a movement disorder that causes involuntary contractions of your muscles. These contractions result in twisting and repetitive movements. Sometimes they are painful.

Dystonia can affect just one muscle, a group of muscles or all of your muscles. Symptoms can include tremors, voice problems or a dragging foot. Symptoms often start in childhood. They can also start in the late teens or early adulthood. Some cases worsen over time. Others are mild.

Some people inherit dystonia. Others have it because of another disease. Researchers think that dystonia may be due to a problem in the part of the brain that handles messages about muscle contractions. There is no cure. Doctors use medicines, Botox injections, surgery, physical therapy, and other treatments to reduce or eliminate muscle spasms and pain.

Neuromuscular disorders affect your neuromuscular system. They can cause problems with

• The nerves that control your muscles
• Your muscles
• Communication between your nerves and muscles

These disorders can cause your muscles to become weak and waste away. You may also have symptoms such as spasms, twitching, and pain.

Examples of neuromuscular disorders include

• Amyotrophic lateral sclerosis
• Muscular dystrophy
• Myasthenia gravis
• Spinal muscular atrophy

There can be different causes for these diseases. Many of them are genetic.This means they are inherited (run in families) or are caused by a new mutation in your genes. Some neuromuscular disorders are autoimmune diseases. Sometimes the cause is unknown.

Many neuromuscular diseases have no cure. But treatments may improve symptoms, increase mobility, and lengthen life.

Parkinson's disease (PD) is a type of movement disorder. It happens when nerve cells in the brain don't produce enough of a brain chemical called dopamine. Sometimes it is genetic, but most cases do not seem to run in families. Exposure to chemicals in the environment might play a role.

Symptoms begin gradually, often on one side of the body. Later they affect both sides. They include

• Trembling of hands, arms, legs, jaw and face
• Stiffness of the arms, legs and trunk
• Slowness of movement
• Poor balance and coordination

As symptoms get worse, people with the disease may have trouble walking, talking, or doing simple tasks. They may also have problems such as depression, sleep problems, or trouble chewing, swallowing, or speaking.

There is no lab test for PD, so it can be difficult to diagnose. Doctors use a medical history and a neurological examination to diagnose it.

PD usually begins around age 60, but it can start earlier. It is more common in men than in women. There is no cure for PD. A variety of medicines sometimes help symptoms dramatically. Surgery and deep brain stimulation (DBS) can help severe cases. With DBS, electrodes are surgically implanted in the brain. They send electrical pulses to stimulate the parts of the brain that control movement.

Like Alzheimer’s disease, Parkinson’s disease is a neurodegenerative disease. It was first characterized by James Parkinson in 1817. Each year, 50,000-60,000 people in the United States are diagnosed with the disease. Parkinson’s disease causes the loss of dopamine neurons in the substantia nigra, a midbrain structure that regulates movement. Loss of these neurons causes many symptoms including tremor (shaking of fingers or a limb), slowed movement, speech changes, balance and posture problems, and rigid muscles. The combination of these symptoms often causes a characteristic slow hunched shuffling walk, illustrated in the figure below. Patients with Parkinson’s disease can also exhibit psychological symptoms, such as dementia or emotional problems.

Although some patients have a form of the disease known to be caused by a single mutation, for most patients the exact causes of Parkinson’s disease remain unknown: the disease likely results from a combination of genetic and environmental factors (similar to Alzheimer’s disease). Post-mortem analysis of brains from Parkinson’s patients shows the presence of Lewy bodies—abnormal protein clumps—in dopaminergic neurons. The prevalence of these Lewy bodies often correlates with the severity of the disease.

There is no cure for Parkinson’s disease, and treatment is focused on easing symptoms. One of the most commonly prescribed drugs for Parkinson’s is L-DOPA, which is a chemical that is converted into dopamine by neurons in the brain. This conversion increases the overall level of dopamine neurotransmission and can help compensate for the loss of dopaminergic neurons in the substantia nigra. Other drugs work by inhibiting the enzyme that breaks down dopamine.

Parkinson’s patients often have a characteristic hunched walk.

Neurologist

Neurologists are physicians who specialize in disorders of the nervous system. They diagnose and treat disorders such as epilepsy, stroke, dementia, nervous system injuries, Parkinson’s disease, sleep disorders, and multiple sclerosis. Neurologists are medical doctors who have attended college, medical school, and completed three to four years of neurology residency.

When examining a new patient, a neurologist takes a full medical history and performs a complete physical exam. The physical exam contains specific tasks that are used to determine what areas of the brain, spinal cord, or peripheral nervous system may be damaged. For example, to check whether the hypoglossal nerve is functioning correctly, the neurologist will ask the patient to move his or her tongue in different ways. If the patient does not have full control over tongue movements, then the hypoglossal nerve may be damaged or there may be a lesion in the brainstem where the cell bodies of these neurons reside (or there could be damage to the tongue muscle itself).

Neurologists have other tools besides a physical exam they can use to diagnose particular problems in the nervous system. If the patient has had a seizure, for example, the neurologist can use electroencephalography (EEG), which involves taping electrodes to the scalp to record brain activity, to try to determine which brain regions are involved in the seizure. In suspected stroke patients, a neurologist can use a computerized tomography (CT) scan, which is a type of X-ray, to look for bleeding in the brain or a possible brain tumor. To treat patients with neurological problems, neurologists can prescribe medications or refer the patient to a neurosurgeon for surgery.

What is Parkinson's disease?

Parkinson's disease (PD) belongs to a group of conditions called motor system disorders, which cause unintended or uncontrollable movements of the body. The precise cause of PD is unknown, but some cases are hereditary while others are thought to occur from a combination of genetics and environmental factors that trigger the disease. In PD, brain cells become damaged or die in the part of the brain that produces dopamine--a chemical needed to produce smooth, purposeful movement.

The four primary symptoms of PD are:

• tremor--shaking that has a characteristic rhythmic back and forth motion
• rigidity--muscle stiffness or a resistance to movement, where muscles remain constantly tense and contracted
• bradykinesia--slowing of spontaneous and automatic movement that can make it difficult to perform simple tasks or rapidly perform routine movements
• postural instability--impaired balance and changes in posture that can increase the risk of falls.

Other symptoms may include difficulty swallowing, chewing, or speaking; emotional changes; urinary problems or constipation; dementia or other cognitive problems; fatigue; and problems sleeping.

PD usually affects people around the age of 70 years but can occur earlier. PD affects men more than women. Currently there are no specific tests that diagnose sporadic PD.

Is there any treatment?

At present, there is no cure for PD, but a variety of medications provide dramatic relief from the symptoms. Usually, affected individuals are given levodopa combined with carbidopa. Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain. Nerve cells can use levodopa to make dopamine and replenish the brain's dwindling supply. Although levodopa helps most people with PD, not everyone responds equally to the drug. Bradykinesia and rigidity respond best, while tremor may be only marginally reduced. Problems with balance and other symptoms may not be alleviated at all. Anticholinergic drugs may help control tremor and rigidity. Other drugs, such as pramipexole, apomorphine, and ropinirole, mimic the role of dopamine in the brain, causing the nerve cells to react as they would to dopamine. An antiviral drug, amantadine, also appears to reduce symptoms. Safinamide tablets, istradefylline tablets, and opicapone are add-on treatments for individuals with PD who are currently taking levodopa/carbidopa and experiencing "off" episodes (when the person's medications are not working well, causing an increase in PD symptoms). Other drugs to treat PD include COMT inhibitors, which prolong the effects of levodopa by preventing the breakdown of dopamine, and MAO-B inhibitors, which block or reduce activity of the MAO-B enzyme that breaks down dopamine in the brain.

In some cases, surgery may be appropriate if the disease doesn't respond to drugs. One option is deep brain stimulation (DBS), in which electrodes are implanted into the brain and connected to a small electrical device called a pulse generator to painlessly stimulate the brain to block signals that cause many of the motor symptomms of PD. DBS is generally appropriate for people with levodopa-responsive PD who have developed dyskinesias or other disabling "off" symptoms despite drug therapy. However, DBS does not stop PD from progressing and some problems may gradually return.

What is the prognosis?

PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time. Although some people become severely disabled, others experience only minor motor disruptions. Tremor is the major symptom for some individuals, while for others tremor is only a minor complaint and other symptoms are more troublesome. It is currently not possible to predict which symptoms will affect an individual, and the intensity of the symptoms also varies from person to person.

What is progressive supranuclear palsy (PSP)?

Progressive supranuclear palsy (PSP) is a rare brain disease. It happens because of damage to nerve cells in the brain. PSP affects your movement, including control of your walking and balance. It also affects your thinking and eye movement.

PSP is progressive, which means that it gets worse over time.

What causes progressive supranuclear palsy (PSP)?

The cause of PSP is unknown. In rare cases, the cause is a mutation in a certain gene.

One sign of PSP is abnormal clumps of tau in nerve cells in the brain. Tau is a protein in your nervous system, including in nerve cells. Some other diseases also cause a buildup of tau in the brain, including Alzheimer's disease.

Who is at risk for progressive supranuclear palsy (PSP)?

PSP usually affects people over 60, but in some cases it can start earlier. It is more common in men.

What are the symptoms of progressive supranuclear palsy (PSP)?

Symptoms are very different in each person, but they may include

• A loss of balance while walking. This is often the first symptom.
• Speech problems
• Trouble swallowing
• A blurring of vision and problems controlling eye movement
• Changes in mood and behavior, including depression and apathy (a loss of interest and enthusiasm)
• Mild dementia

How is progressive supranuclear palsy (PSP) diagnosed?

There is no specific test for PSP. It can be difficult to diagnose, because the symptoms are similar to other diseases such as Parkinson's disease and Alzheimer's disease.

To make a diagnosis, your health care provider will take your medical history and do physical and neurological exams. You may have an MRI or other imaging tests.

What are the treatments for progressive supranuclear palsy (PSP)?

There is currently no effective treatment for PSP. Medicines may reduce some symptoms. Some non-drug treatments, such as walking aids and special glasses, may also help. People with severe swallowing problems may need gastrostomy. This is a surgery to insert a feeding tube into the stomach.

PSP gets worse over time. Many people become severely disabled within three to five years after getting it. PSP isn't life-threatening on its own. It can still be be dangerous, because it increases your risk of pneumonia, choking from swallowing problems, and injuries from falling. But with good attention to medical and nutritional needs, many people with PSP can live 10 or more years after the first symptoms of the disease.

If you have Tourette syndrome, you make unusual movements or sounds, called tics. You have little or no control over them. Common tics are throat-clearing and blinking. You may repeat words, spin, or, rarely, blurt out swear words.

Tourette syndrome is a disorder of the nervous system. It often occurs with other problems, such as

• Attention deficit hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder (OCD)
• Anxiety
• Depression

The cause of Tourette syndrome is unknown. It is more common in boys than girls. The tics usually start in childhood and may be worst in the early teens. Many people eventually outgrow them.

No treatment is needed unless the tics interfere with everyday life. Excitement or worry can make tics worse. Calm, focused activities may make them better. Medicines and talk therapy may also help.

Tourette Syndrome (TS) is a condition of the nervous system. TS causes people to have “tics”.

Tics are sudden twitches, movements, or sounds that people do repeatedly. People who have tics cannot stop their body from doing these things. For example, a person might keep blinking over and over again. Or, a person might make a grunting sound unwillingly.

Having tics is a little bit like having hiccups. Even though you might not want to hiccup, your body does it anyway. Sometimes people can stop themselves from doing a certain tic for awhile, but it’s hard. Eventually the person has to do the tic.

Types of Tics

There are two types of tics—motor and vocal:

Motor Tics

Motor tics are movements of the body. Examples of motor tics include blinking, shrugging the shoulders, or jerking an arm.

Vocal Tics

Vocal tics are sounds that a person makes with his or her voice. Examples of vocal tics include humming, clearing the throat, or yelling out a word or phrase.

Tics can be either simple or complex:

Simple Tics

Simple tics involve just a few parts of the body. Examples of simple tics include squinting the eyes or sniffing.

Complex Tics

Complex tics usually involve several different parts of the body and can have a pattern. An example of a complex tic is bobbing the head while jerking an arm, and then jumping up.

Symptoms

The main symptoms of TS are tics. Symptoms usually begin when a child is 5 to 10 years of age. The first symptoms often are motor tics that occur in the head and neck area. Tics usually are worse during times that are stressful or exciting. They tend to improve when a person is calm or focused on an activity.

The types of tics and how often a person has tics changes a lot over time. Even though the symptoms might appear, disappear, and reappear, these conditions are considered chronic.

In most cases, tics decrease during adolescence and early adulthood, and sometimes disappear entirely. However, many people with TS experience tics into adulthood and, in some cases, tics can become worse during adulthood.

Although the media often portray people with TS as involuntarily shouting out swear words (called coprolalia) or constantly repeating the words of other people (called echolalia), these symptoms are rare, and are not required for a diagnosis of TS.

Diagnosis

There is no single test, like a blood test, to diagnose TS. Health professionals look at the person’s symptoms to diagnose TS and other tic disorders. The tic disorders differ from each other in terms of the type of tic present (motor or vocal, or combination of the both), and how long the symptoms have lasted. TS can be diagnosed if a person has both motor and vocal tics, and has had tic symptoms for at least a year.

Treatments

Although there is no cure for TS, there are treatments available to help manage the tics. Many people with TS have tics that do not get in the way of their daily life and, therefore, do not need any treatment. However, medication and behavioral treatments are available if tics cause pain or injury; interfere with school, work, or social life; or cause stress.

Other Concerns and Conditions

TS often occurs with other conditions (called co-occurring conditions). Almost 9 out of 10 children diagnosed with TS, 86% also have been diagnosed with at least one additional mental, behavioral, or developmental condition. The two most common conditions are attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). It is important to find out if a person with TS has any other conditions, and treat those conditions properly.

Risk Factors and Causes

Doctors and scientists do not know the exact cause of TS. Research suggests that it is an inherited genetic condition. That means it is passed on from parent to child through genes.

Who Is Affected?

Studies that included children with diagnosed and undiagnosed TS have estimated that 1 of every 162 children have TS. In the United States, 1 of every 360 children 6 through 17 years of age have been diagnosed with TS, based on parent report. This suggests that about half of children with TS are not diagnosed.

TS can affect people of all racial and ethnic groups. Boys are affected three to five times more often than girls.

What is a tremor?

A tremor is a rhythmic shaking movement in one or more parts of your body. It is involuntary, meaning that you cannot control it. This shaking happens because of muscle contractions.

A tremor is most often in your hands, but it could also affect your arms, head, vocal cords, trunk, and legs. It may come and go, or it may be constant. Tremor can happen on its own or be caused by another disorder.

What are the types of tremor?

There are several types of tremor, including

• Essential tremor, sometimes called benign essential tremor. This is the most common type. It usually affects your hands, but it can also affect your head, voice, tongue, legs, and trunk.
• Parkinsonian tremor, which is a common symptom in people who have Parkinson's disease. It is usually affects one or both hands when they are at rest, but it can affect the chin, lips, face, and legs.
• Dystonic tremor, which happens in people who have dystonia. Dystonia is a movement disorder in which you have involuntary muscle contractions. The contractions cause you to have twisting and repetitive movements. It can affect any muscle in the body.

What causes tremor?

Generally, tremor is caused by a problem in the deep parts of the brain that control movements. For most types, the cause is unknown. Some types are inherited and run in families. There can also be other causes, such as

• Neurologic disorders, including multiple sclerosis, Parkinson's disease, stroke, and traumatic brain injury
• Certain medicines, such as asthma medicines, amphetamines, caffeine, corticosteroids, and medicines used for certain psychiatric and neurological disorders
• Alcohol use disorder or alcohol withdrawal
• Mercury poisoning
• Hyperthyroidism (overactive thyroid)
• Liver or kidney failure
• Anxiety or panic

Who is at risk for tremor?

Anyone can get tremor, but it is most common in middle-aged and older adults. For certain types, having a family history raises your risk of getting it.

What are the symptoms of tremor?

Symptoms of tremor may include

• Rhythmic shaking in the hands, arms, head, legs, or torso
• Shaky voice
• Difficulty writing or drawing
• Problems holding and controlling utensils, such as a spoon

How is tremor diagnosed?

To make a diagnosis, your health care provider

• Will take your medical history
• Will do a physical exam, which includes checking
  • Whether the tremor happens when the muscles are at rest or in action
  • The location of the tremor
  • How often you have the tremor and how strong it is
• Will do a neurological exam, including checking for
  • Problems with balance
  • Problems with speech
  • Increased muscle stiffness
• May do blood or urine tests to look for the cause
• May do imaging tests to help figure out if the cause is damage in your brain
• May do tests which check your abilities to do daily tasks such as handwriting and holding a fork or cup
• May do an electromyogram. This is a test which measures involuntary muscle activity and how your muscles respond to nerve stimulation

What are the treatments for tremor?

There is no cure for most forms of tremor, but there are treatments to help manage symptoms. In some cases, the symptoms may be so mild that you do not need treatment.

Finding the right treatment depends on getting the right diagnosis of the cause. Tremor caused by another medical condition may get better or go away when you treat that condition. If your tremor is caused by a certain medicine, stopping that medicine usually makes the tremor go away.

Treatments for tremor where the cause is not found include

• Medicines. There are different medicines for the specific types of tremor. Another option is Botox injections, which can treat several different types.
• Surgery may be used for severe cases that do not get better with medicines. The most common type is deep brain stimulation (DBS).
• Physical, speech-language, and occupational therapy, which may help to control tremor and deal with the daily challenges caused by the tremor

If you find that caffeine and other stimulants trigger your tremors, it may be helpful to cut them from your diet.

The pattern of how you walk is called your gait. Many different diseases and conditions can affect your gait and lead to problems with walking. They include:

• Abnormal development of the muscles or bones of your legs or feet
• Arthritis of the hips, knees, ankles, or feet
• Cerebellar disorders, which are disorders of the area of the brain that controls coordination and balance
• Foot problems, including corns and calluses, sores, and warts
• Infections
• Injuries, such as fractures (broken bones), sprains, and tendinitis
• Movement disorders, such as Parkinson's disease
• Neurologic diseases, including multiple sclerosis and peripheral nerve disorders
• Vision problems

Huntington's disease is a progressive brain disorder that causes uncontrolled movements, emotional problems, and loss of thinking ability (cognition).

Adult-onset Huntington's disease, the most common form of this disorder, usually appears in a person's thirties or forties. Early signs and symptoms can include irritability, depression, small involuntary movements, poor coordination, and trouble learning new information or making decisions. Many people with Huntington's disease develop involuntary jerking or twitching movements known as chorea. As the disease progresses, these movements become more pronounced. Affected individuals may have trouble walking, speaking, and swallowing. People with this disorder also experience changes in personality and a decline in thinking and reasoning abilities. Individuals with the adult-onset form of Huntington's disease usually live about 15 to 20 years after signs and symptoms begin.

A less common form of Huntington's disease known as the juvenile form begins in childhood or adolescence. It also involves movement problems and mental and emotional changes. Additional signs of the juvenile form include slow movements, clumsiness, frequent falling, rigidity, slurred speech, and drooling. School performance declines as thinking and reasoning abilities become impaired. Seizures occur in 30 percent to 50 percent of children with this condition. Juvenile Huntington's disease tends to progress more quickly than the adult-onset form; affected individuals usually live 10 to 15 years after signs and symptoms appear.