Movement disorders are neurologic conditions that cause problems with movement due to affect on brain. They can affect different parts of the body, including the limbs, hands, feet, facial muscles, head, neck, trunk, posture, and voice. Some common types of movement disorders include Parkinson’s disease, Tourette syndrome, Huntington’s disease, tremors, and dystonia.

According to Dr. Pettarusp Wadia, a Consultant Neurologist who runs the Movement Disorder Clinic at the Jaslok Hospital and Research Center, while many of these conditions are treatable, an early diagnosis is important. “Timely intervention can significantly improve patients' quality of life. It is also a day to acknowledge the sacrifices made by caregivers, who play a crucial role in enhancing the well-being of their loved ones,” he said.

Dr. Wadia also listed a patient’s case, who developed a movement disorder – Parkinson’s disease due to medication.

Case No.1

A 70-year-old surgeon reported experiencing changes in handwriting, hand tremors and slowed movements over the past year and a half. Suspecting Parkinson's disease, he sought a consultation for movement disorders. Upon further investigation, it was discovered that he had been taking Levosulpiride, a medication prescribed for an intestinal issue 1.5 years ago, which he continued using.

Levosulpiride can cause drug-induced Parkinsonism, and upon discontinuing the medication, his condition improved significantly. Within a month, his symptoms were more than 80% better, and his UPDRS motor scores dropped from 26/108 to 4/108 (higher scores indicate greater abnormality). “He did not require any additional medication for Parkinson’s disease. This case highlights how certain drugs can lead to movement disorders such as drug-induced dystonia, tremors, or Parkinsonism, and how discontinuing the offending drug can lead to substantial improvement,” he said.

Case No. 2

Another case highlights how a businessman, prescribed antidepressants for stress got diagnosed with restless leg syndrome.

Abdul (name changed) had been under significant business stress and was prescribed three different antidepressants by his psychiatrist. The following day, he experienced sleeplessness, jerking legs, and a pins-and-needles sensation in his legs at night. He was urgently referred to the movement disorder clinic. He reported experiencing occasional "creepy crawly" sensations in his legs, particularly at night or after long car or plane trips, a symptom suggestive of Restless Leg Syndrome (RLS).

Before the stress, his symptoms had been mild and manageable. The antidepressants exacerbated his RLS, leading to a severe flare-up. He was prescribed Gabapentin, a medication for RLS, and his antidepressants were discontinued. Since then, he has been sleeping well without leg jerks or discomfort.

According to Dr. Wadia, restless leg syndrome is an underrecognized movement disorder affecting 7-10 per cent of the general population.

“Parkinsonism and Restless Leg Syndrome are both types of movement disorders, a group of conditions that affect motor control. Movement disorders are a group of disorders which either cause slowness of day-to-day movements or cause excess or involuntary movements which cause difficulty in performing tasks,” he said.

Caregiver burnout is a common issue. Caregivers need to take time for themselves, whether it’s pursuing hobbies like yoga or simply taking a walk. Engaging in personal activities is not only acceptable but beneficial for both the caregiver and the patient. Many centers offer respite care, allowing caregivers to take short breaks while their loved ones are cared for in an assisted living facility.

Conditions such as Parkinson’s disease, Atypical Parkinsonism, and Huntington’s disease can have non-motor symptoms, including hallucinations and paranoia. These behaviours can be difficult to manage. Adjusting certain dopaminergic medications (especially dopamine agonists and Amantadine) and introducing neuroleptic medications like Quetiapine or Clozapine can help significantly reduce these symptoms.

Excessive shopping and gambling could be a sign of impulse control disorder, which can be caused by dopaminergic medications, particularly dopamine agonists. Reducing medication doses and adding neuroleptic drugs can help manage this behavior.

Swallowing difficulties are common in patients with movement disorders such as Parkinson’s disease, Atypical Parkinsonism, and Huntington’s disease. Speech therapy and swallowing exercises can be helpful for most patients. In advanced stages, a feeding tube may be necessary. Early intervention is key to preventing complications such as aspiration pneumonia, which could lead to hospitalization.

A sudden worsening of a patient’s condition could indicate an underlying issue such as an infection or metabolic imbalance (e.g., low sodium or high calcium) or severe constipation. Identifying and treating these factors promptly can often lead to a rapid improvement in the patient's overall condition, even in the context of a neurodegenerative disorder.

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