Disorders We Treat

Tremor is an involuntary rhythmic shaking that can affect one or more parts of the body.  It can occur on its own or as a symptom of another neurologic disorder (Parkinson’s disease, multiple sclerosis e.g.) 

Essential Tremor (ET) is a neurological condition characterized by involuntary rhythmic shaking that typically worsens with action.  It predominantly affects the hands and arms but can also spread to the head, voice, trunk and legs.  ET is the most common movement disorder in the world, eight times more common than Parkinson’s disease, with which it can be confused. Typically it worsens with age and has a 50% chance of being inherited.  The exact cause is unknown, though one theory implicates the cerebellum (area involved in movement coordination) and its communication with other parts of the brain.

Parkinson’s disease (PD) is a progressive neurodegenerative disease (condition where cells relating to the brain or nerves degenerate) that primarily affects the neurons (nerve cells) that produce a chemical called dopamine.  Dopamine is a neurotransmitter that acts as a messenger between nerve cells.  This communication allows for coordination of movement which is then transmitted to the body.  The loss of dopamine causes many of the symptoms we see in PD, including rest tremor, stiffness (rigidity), slow movement (bradykinesia), as well as gait and balance changes.  Though this is a simplified view (dopamine affects other systems – e.g mood – and PD affects other neurotransmitters), it gives us a basis for understanding the disease and how we treat it. 

Parkinsonism refers to any combination of movement abnormalities that are found in Parkinson’s disease (those listed above).  As such, Parkinson’s disease is itself a cause of parkinsonism but there are other conditions that can cause it, such as the so-called atypical parkinsonisms aka Parkinson Plus syndromes.  These include progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD) and dementia with Lewy bodies.  There are also secondary causes of parkinsonism such as strokes or certain drugs.  Sometimes it is difficult to differentiate between PD and other causes of parkinsonism, especially early on, which is why an by a movement disorders specialist can be important for both diagnosis and management. 

Our clinic provides evaluation, care and research opportunities for PSP and other atypical parkinsonisms, while our behavioral and memory clinic focuses on Lewy Body dementia, Parkinson’s disease dementia and other causes of cognitive impairment.

Dystonia is a disorder that causes excessive involuntary muscle contractions resulting in abnormal postures, twisting, and movements that are characteristically patterned.  This causes difficulty for individuals to control their movements.  It is typically worsened by voluntary movements and can even be task-specific (e.g. writing).   Dystonia can affect any part of the body including the eyelids, face, jaw, tongue, vocal cords, neck, arms/hands, legs/feet, and torso.  It may also affect a single body party (focal) or two or more continuous parts (segmental) that may include the torso (generalized).  In some cases, the cause of dystonia is due to drugs, brain injury or other neurological or metabolic disorders, so called secondary or acquired dystonia.  In many other cases, dystonia is the only symptom and there is no clear etiology, so called primary or isolated dystonia, the processes of which we do not completely understand though genetics can be a part.

The treatment for dystonia can depend on the cause, however, in general botulinum toxin injections can offer improvement in function, pain and overall quality of life.  Please see our botulinum toxin program for more information.  In some cases deep brain stimulation or other surgery may be considered.

Hemifacial spasm is a neurological disorder characterized by involuntary twitching or pulling (spasms) of one side of the face.  Typically it starts under the eye with intermittent twitching and spreads all around the eye causing involuntary eye closure.  It may later affect the lower face with pulling of the lip and flaring of the neck.  Sometimes it is due to a blood vessel touching the facial nerve, but injury to the nerve itself can cause it or there may be no reason at all.  The standard treatment is botulinum toxin injections to the affected area(s), though in some cases surgery can be an option.

Huntington’s disease is a rare genetic disorder that causes the progressive degeneration of neurons in the brain.  It is classically characterized by involuntary “dance-like” movements called chorea as well as psychiatric and cognitive problems.  Personality changes are not uncommon including irritability and mood swings; patients also develop difficulty with problem solving and poor judgement.  Additional motor manifestations include gait impairment and speech and swallowing difficulty.  The disease is typically inherited with those afflicted having a 50/50 chance of passing it down to their children, though about 1-3% of patients have no family history.  Management involves a multidisciplinary team that usually includes neurology, psychiatry, genetic counseling and social work.  Please refer to the Samuel L. Baily Huntington's Disease Family Service Center at Rutgers Health for more information. 

Tardive syndromes refer to a category of movement disorders that are secondary to long-term use (months to years) of certain drugs called neuroleptics (typically those used to treat psychiatric disorders).  These include the classic tardive dyskinesia, which describes writhing/darting movements of the tongue, chewing movements, lip puckering or smacking, writhing of the limbs as well as dystonia (see above), parkinsonism, stereotypy (repeated voluntary purposeless movements), tremor, jerks, tics, or akathisia (sense of uncomfortable restlessness).  Treatment typically involves discontinuing/reducing the causative medication but if unable, additional medications may be used and in some cases botulinum toxin.

Tourette’s syndrome is a neurologic and psychiatric condition characterized by repetitive, stereotyped movements and vocalizations (tics), which are usually preceded by an urge.  While the movements/sounds may be suppressed somewhat, this may cause a large build-up of tension leading to an involuntary need to express them.   Most tic symptoms are not impairing and so no treatment is required.  However if they do interfere, Cognitive Behavioral Intervention for Tics (CBIT), which includes awareness training and competing response training, is recommended.  The treatment has been shown to be effective in large, multi-center, trials with significant reduction in tics and ability to function.  Medications may also be used to treat tics, the most effective of which are neuroleptics, though these may incur significant side effects (e.g. tardive syndromes, see above) and may not eliminate all the symptoms. 

• Ataxia
• Myoclonus
• Other forms of Chorea
• Restless Legs Syndrome