Parkinson's Disease

Parkinson's disease is a clinical syndrome characterized by bradykinesia (slowness of movements), tremor, rigidity, and postural instability (balance trouble that can result in falls). Additional symptoms that can be associated with parkinsonism include:

loss of sense of smell
decreased facial expression
depression and/or anxiety
speech changes (usually softening or mumbling)
swallowing difficulty
constipation
handwriting changes (smaller, cramped writing)
thinking difficulties
sleep disturbances
bladder problems (difficulty urinating or holding your bladder)

Few patients experience all of the above symptoms and there are additional ones that can be associated but are not mentioned above.

What causes Parkinson's disease?

Parkinson's disease is a neurodegenerative disorder caused by loss of brain cells that produce dopamine. Dopamine is a chemical messenger in the brain. Most cases occur without a known cause, but Parkinson's disease is sometimes caused by genetic mutations passed down from a parent. Many researchers think it's caused by a combination of genetic predisposition and environmental risk factors.

How is Parkinson's disease treated?

The current goal in treating Parkinson's disease is to maximize a person's quality of life. Treatments can improve symptoms, but they do not alter the underlying disease. Exercise is the only proven way to slow the progression of the disease. Patients who incorporate regular exercise into their routines fare better in the long term. Symptomatic treatments often include a combination of medications, rehabilitation therapy, and possibly surgery.

There are several medications used in Parkinson's disease, but they are directed at supplying dopamine back to the brain or stabilizing dopamine within the brain. Many people end up on multiple types of medications because they affect dopamine in different ways.

Rehabilitation therapy often includes physical therapy, occupational therapy, and speech therapy. Physical therapy can help with developing an exercise plan, working on balance and walking ability, and maintaining flexibility and range of motion. Occupational therapy can assess for potential adaptive equipment to help maintain independence. Speech therapy helps with eating and drinking safely and speaking more effectively.

Some patients benefit from surgery to help manage their Parkinson's disease. This is typically reserved for patients whose symptoms are not responding adequately to traditional treatments or who are having medication side effects that limit their effectiveness. Deep brain stimulation (DBS) involves the placement of wire electrodes deep in the brain to stimulate movement centers and improve mobility. Medication infusions are implanted medication devices that can deliver a consistent amount of medication throughout the day to improve symptom fluctuations.

What can I expect?

Parkinson's disease is a progressive disorder that will gradually worsen over time. Everyone is different in what their symptoms are and the rate of progression, so it's difficult to predict how they will respond to treatments. There is no known cure at this time, but treatments can allow patients to maintain a high level of function for many years.

Additional Information & Resources

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Interdisciplinary Clinic
Newly Diagnosed Education Visits
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Local Resouces

Clinical Trials

Exercise Classes

If you are interested in learning more about Parkinson's Disease, you can watch videos from our 2024 11th Annual Parkinson's Disease Symposium on our YouTube channel.

Tremor

Tremor is an involuntary, rhythmic muscle contraction leading to shaking movements in one or more parts of the body. It is the most common movement disorder. It most often affects the hands but can also occur in the arms, head, vocal cords, torso, and legs. Tremor may be intermittent (occurring at separate times, with breaks) or constant. It can occur sporadically (on its own) or as a result of another disorder.

Tremor is most common among middle-aged and older adults, although it can occur at any age, even in childhood. This disorder generally affects men and women equally.

Tremors are also characterized as a "resting" tremor or "action" tremor. Resting tremor occurs when the muscles are relaxed, such as when sitting still. This type of tremor can be seen in Parkinson's disease. An action tremor occurs when the muscles are being voluntarily moved.

What causes tremor?

Tremor is caused by faulty coordination of movements by brain structures such as the basal ganglia and cerebellum. Some types of tremor can run in the family or be genetic, but most often, they are not.

Tremors can be due to several different neurological conditions including, but not limited to, Parkinson's disease, essential tremor, physiologic tremor, dystonia, stroke, multiple sclerosis, orthostatic tremor, Huntington's disease, and functional tremor.

Tremor can be due to medications, but not limited to caffeine, albuterol, lithium, some seizure medications, and anti-depressants. It can also be caused by metabolic conditions such as alcohol withdrawal, abnormal thyroid function, liver or kidney disease, or anxiety.

How is tremor treated?

The treatment of tremor is largely dependent upon the cause of the tremor and can be quite varied. Treatment is first aimed at treating reversible causes, like medication and lifestyle adjustments. Other non-medical treatments include the use of adaptive equipment or occupational therapy. Medications may be used as well if the tremor remains bothersome. Botulinum injections can be used for certain tremor, especially for tremors of the head and neck. Other types of tremor may require surgical intervention.

What can I expect?

Tremor is not life-threatening, but can interfere with daily work and life tasks. Tremor can be socially bothersome and can cause people to limit their activities to avoid being embarrassed or self-conscious.

Tremors due to a neurodegenerative condition will typically worsen with age. However, functional tremor, drug-induced tremors, and physiologic tremors do not typically worsen over time and can actually improve or resolve if the underlying cause is treated.

Additional Information & Resources

Chorea

Chorea is a common movement disorder consisting of random, irregular, flowing, dance-like movements throughout the body. The movements may be small, appearing like fidgeting, or can be larger movements that move the limbs uncontrollably. The movements are present even when the person is sitting still and can also be seen during activity. Chorea typically disappears with sleep. There may be limited control of the movement if one tries to stop them but will return once the mind is otherwise occupied.

What causes chorea?

Chorea has many causes. These include genetic disorders, medication side effects, problems with the body metabolism, infectious or autoimmune disorders, stroke, or tumors affecting the basal ganglia. The most common cause of inherited chorea is Huntington’s disease. The most common cause of chorea in children, Syndenham's chorea, is caused by a streptococcal infection.

How is chorea treated?

The treatment of chorea depends upon its cause. If the chorea is a result of a stroke, then it usually gets better by itself with time. If the chorea is part of an autoimmune response of the body, then treating the underlying autoimmune illness or cancer is the treatment of choice. For those with chorea due to medications that block dopamine in the brain, stopping the medication if possible is recommended. If abnormal body chemistries are causing chorea, then correction of these abnormalities will ease chorea. For chorea that is persistent, several medications are approved for use in controlling chorea movements.

What can I expect?

The chorea that results from stroke or medication exposure, if stopped, generally will improve over time. Chorea due to infection should also improve if the underlying cause is addressed. Correction of abnormal body chemistries should improve the chorea movements associated with metabolic disorders. At times, chorea of any cause may be permanent and medication can help control the movements. Those with inherited disorders will have ongoing chorea that may require medication for management.

Additional Information & Resources

If you are interested in learning more about Huntington's Disease, you can watch videos from our 2024 Huntington's Disease Rocky Mountain Education Day on our YouTube Channel.

Ataxia

Ataxia is the loss of muscle control and/or coordination of voluntary movements. Ataxia usually involves dysfunction or damage to the balance center of the brain, called the cerebellum. Common symptoms include vision disturbances, speech problems (slurring of words), difficulty swallowing, loss of balance and difficulty walking, and/or trouble with fine motor control (knitting, buttoning clothes).

What causes ataxia?

Ataxia can be caused by many different conditions. The most common causes are drug intoxication (including alcohol), side effects of medications such as seizure medications, strokes, tumors, inherited conditions like spinocerebellar ataxia, and degenerative disease like Multiple Systems Atrophy.

How is ataxia treated?

At the University of Colorado Movement Disorders Center, our neurologists have expertise in the complexities of the condition and its causes. Treatment focuses primarily on identifying reversible causes (such as vitamin deficiencies) and modifying behaviors (such as alcohol cessation). Many patients with ataxia benefit from physical, occupational, and speech therapy (for both speech and swallowing problems). Adaptive equipment such as canes and walkers may help maintain independence. Those with eye problems often benefit from a consultation with a neuro-ophthalmologist to discuss potential treatment options such as corrective lenses.

What can I expect?

The progression of ataxia varies widely depending on the cause of the symptoms. The specialists will examine the ataxia patient at each visit to monitor the progression of the symptoms and disease.

Additional Information & Resources

Dystonia

Dystonia is a movement disorders in which excessive muscle contractions cause abnormal postures, movements, tremor, or a combination of these. Dystonia is often brought our or worsened by specific actions.

Some common forms of dystonia are: blepharospasm (eyes and eyebrows), spasmodic dysphonia (vocal cords, especially while speaking), spasmodic torticollis (head and neck muscles), writer's cramp (hand, especially while writing), and musician's dystonia (body parts involved in playing an instrument).

What causes dystonia?

Dystonia can randomly affect a person without a clear cause, be inherited, or be caused by certain medications, brain injuries, or other neurological diseases such as Parkinson's disease. Dystonia symptoms are thought to result from abnormal signals in the brain leading to involuntary muscle contraction.

How is dystonia treated?

If dystonia is caused by another neurological disease, optimal treatment of that disease is often part of the treatment approach. Other treatment options for dystonia include physical and occupational therapy, prostheses and orthotics, oral medications such as muscle relaxers, Botulinum toxin injections, and surgeries like Deep Brain Stimulation.

What can I expect?

Dystonia symptoms typically stabilize and stay the same within a few years of onset, but some forms can progressively worsen and may spread to neighboring or distant muscles.

Additional Information & Resources

Functional Movement Disorder

A functional neurological disorder (FND) is a condition due to changes in the way the brain talks to itself and the rest of the body. The brain looks normal and all of the brain cells are trying to do their work, but the signals are getting crossed and the wrong information is being sent. When the neurological symptoms present are abnormal movements, then it is called a functional movement disorder (FMD). These abnormal movements can be tremors, walking difficulty, fixed postures, or muscle jerks. Functional movement disorders are very common, with up to one out of every five patients seen in a clinic like ours having a functional condition. It is important to know that functional movement disorders are very common, they are not being “made up” by the person experiencing them, and they are treatable.

What Causes a Functional Movement Disorder?

A functional movement disorder can be described as the brain responding to overwhelming stress. “Stress” does not just refer to anxiety or past traumatic experiences. Instead, it refers to any internal or external factor that requires too much of the brain’s energy. This includes other medical illnesses, chronic pain, poor sleep, and medication side effects. When the brain experiences chronic stress, it goes into a constant “fight or flight” mode. The amygdala, which is the brain center responsible for emotion, then becomes over-activated. When the amygdala is over-activated for too long, it becomes very strong and it can start overriding signals from other areas of the brain, such as the movement areas. In this way, the body is given the wrong information from the brain and abnormal movements can occur.

The symptoms of FMD are very real. However, people with FMD have often had many diagnostic tests with normal results. Because of this, sometimes they are told that it is “all in their head”. This is partly true – it is “all in their head” because their brain is in their head! This is a neurological condition and should be diagnosed and followed over time by a neurologist. The good news is that this condition is treatable and potentially completely reversible.

How is a Functional Movement Disorder Treated?

The best treatment for FMD is to first get a diagnosis from an experienced doctor who understands the condition. This is done by listening to the patient and examining them very carefully. No specialized tests need to be ordered to make this diagnosis.

The body needs to be retrained to listen to the brain correctly, and the brain needs to be retrained to send the right signals. Reinforcing normal body movements and ignoring abnormal ones with a trained physical therapist is the best treatment for FMD. Cognitive-behavioral therapy, in which a psychologist works with a patient to develop new methods for dealing with stress and difficult situations, has also been shown to be helpful for FMD recovery. If mental health conditions are present and contributing to symptoms, they will be addressed by a psychiatrist. Stress reduction and management techniques, such as deep breathing exercises or yoga, are also vital to recovery. Lowering the level of chronic stress placed on the brain will allow the amygdala and the “fight or flight” response to turn down back to normal levels. All members of the medical team, including the patient, need to work together to ensure optimal recovery.

Additional Information & Resources

Other Movement Disorders

Restless Legs Syndrome

Restless Legs Syndrome (RLS) is characterized by an uncomfortable sensation in the legs that occurs or worsens when the person is at rest or is inactive. It is usually worse in the evening or night than during the day. This sensation is typically accompanied by an urge to get up and move around. Movement in the legs, such as walking, will partially or completely resolve symptoms. When the person relaxes again and stops moving, the uncomfortable sensation returns. RLS can be related to genetics, iron levels, and dopamine dysfunction. It is usually more common in women than men.

RLS is a treatable condition, with several courses of action possible for each patient. There are medications used to successfully treat RLS symptoms. Supplementing a low iron level can help treat RLS and may be monitored by your doctor during your treatment. Avoiding known aggravating factors is also important. Sleep deprivation can make symptoms worse. Therefore, getting regular, high-quality sleep by following good sleep habits is important. Untreated sleep apnea (sleep-related breathing problems) can make RLS worse, so being assessed for this condition may be helpful. Caffeine, alcohol, and tobacco can also worsen symptoms and should be avoided.

Tics

A tic is a sudden, quick, involuntary movement or vocalization. Tics can be simple or complex and can be characterized as motor tics (abnormal movements) or phonic tics (vocal sounds). Tics are brief and repetitive. A tick will be preceded by an urge or feeling to make the movement or sound and is relieved when the tick occurs. If the tic is suppressed, the urge will worsen. Symptoms of tics can increase and decrease at any time and can go into temporary remission. Tics are commonly associated with Obsessive Compulsive Disorder, Attention Deficit Disorder, and other impulse-related behaviors. Tourette syndrome describes the condition in which both motor and vocal tics occur with an onset of symptoms before age 18. It is common for the parent of a Tourette syndrome patient to have Tourette or other tics, suggesting it may be genetic. However, no causative genes for Tourette syndrome have been identified.

There are multiple medications that can help treat the symptoms of tics. Some non-medication options include habit reveal training (HRT), Comprehensive Behavioral Intervention for Tics (CBIT), and Cognitive Behavior Therapy (CBT). Deep brain stimulation surgery is also a treatment option.

Myoclonus

Myoclonus is a quick, involuntary muscle jerk or twitch involving muscle groups in one specific area or throughout the entire body. These muscle jerks or twitches can occur spontaneously or can be brought on by voluntary actions or sensations. Myoclonus can happen in healthy people, many of whom experience these jerks while falling asleep. This is known as a "hypnic jerk." Myoclonus can be seen in different neurological disorders including Parkinson's disease, dystonia, Alzheimer's disease, and Huntington's disease. Myoclonus can also be caused by metabolic deficiencies or medications. Genetics, another neurological disease, can also cause it, or it can occur sporadically.

Treatments include medication adjustments, restoring metabolic deficiencies, and the prescription of anticonvulsants, benzodiazepines, and muscle relaxers.

Paroxysmal Dyskinesias

Paroxysmal Dyskinesias are abnormal movements that occur abruptly and can repeat. These movements last from seconds to minutes. At the beginning of the movement, patients may experience variable sensations and affected speech. The movements can be described as dystonia (abnormal muscle contraction with poses) or chorea (flowing overactive movement) and can occur randomly or be caused by sudden movement, startle, or stress. The frequency and duration of attacks vary from patient to patient. Exercise, stress, fatigue, caffeine, and alcohol may be triggers. Genetics, another neurological disease can also cause paroxysmal dyskinesia, or occur sporadically. They are thought to be due to basal ganglia dysfunction. There is no loss of consciousness or pain during these events. Treatment includes avoiding exacerbating factors, medication with anticonvulsants, and specific treatments of underlying disorders.

Gait Disorders

Gait disorders involve difficulty with balance and walking. Problems with gait can stem from many different causes including stroke, nerve damage causing weakness or sensory changes, dysfunction of certain parts of the brain or spinal cord, or movement disorders such as Parkinson's disease. In some cases, there is more than one cause. Progression and treatment vary based on the cause of the gait problem. However, physical therapy is often a helpful tool regardless of the source of the disorder.

Hemifacial Spasms

Hemifacial spasms are an intermittent twitching of muscles on one side of the face. The muscles that are affected are supplied by one of the cranial nerves called the facial nerve. Twitching is often exacerbated by stress, fatigue, anxiety, and certain voluntary movements. Hemifacial spasms tend to affect women more than men. The average age of onset is 45-50, but it has been know to occur throughout adulthood. In approximately 90% of cases, symptoms start around the eye. While complete remission is rare, available treatment options include oral medications and botulinum toxin injections.

Tardive Dyskinesias

Tardive dyskinesia describes extra movements in the body due to medication depleting dopamine in the brain. Tardive (meaning late) refers to the fact that the extra movements typically do not present immediately after starting one of these drugs. The type of abnormal movement varies from patient to patient. In some cases, the abnormal movements may resolve by slowly stopping the offending drug. There are medications approved for use to treat tardive dyskinesia.

Parkinson's Disease

Tremor

Chorea

Ataxia

Dystonia

Functional Movement Disorders

Other Movement Disorders

Movement Disorders Center