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INTRODUCTION

Movement disorders (MDs) are a broad spectrum of motor and nonmotor disturbances arising from the dysfunction of subcortical motor control circuitry, including basal ganglia and thalamus, as well as other parts of the nervous system, involving the cortex, cerebellum, and central and peripheral autonomic nervous systems. Patients suffering from MDs have normal muscle strength and sensation, but their normal voluntary motor activities are influenced or impaired by involuntary movement, alteration in muscle tone or posture, and loss of coordination or regulation—either facilitation or inhibition—of pyramidal motor activities as a result of malfunction. MDs can be classified into the following categories on the basis of their clinical manifestations: tremor, chorea and choreoathetosis, dystonia, myoclonus, tics, and ataxia. MDs involve less movement (hypokinesia or akinesia), excessive movement (hyperkinesias), or both (Table 44–1).

Table 44–1.Classification of movement disorders.

PARKINSON DISEASE

ESSENTIALS OF DIAGNOSIS

  • Cardinal motor parkinsonism syndrome features (Appendix 1).

    • Bradykinesia

    • Rest tremor, rigidity, or both.

  • Absence of secondary causes or atypical symptoms.

  • At lease two supportive criteria: response to dopaminergic therapy, presence of levodopa treatment complications, rest tremor of a limb, positive olfactory loss, or metaiodobenzylguanidine scintigraphy cardiac test.

Appendix 1.MDS clinical diagnostic criteria for PD—executive summary/completion form.

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