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 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.
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 tic will be preceded by an urge or feeling to make the movement/sound that is relieved when the tic 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 that 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 reversal training (HRT), Comprehensive Behavioral Intervention for Tics (CBIT), and Cognitive Behavior Therapy (CBT). Deep Brain Stimulation surgery is also a treatment option.
Myoclonus is a quick, involuntary muscle jerk or twitch that can involve 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 “hypnic jerk”. Myoclonus can be seen in different neurological disorders including Parkinsonism, dystonia, Alzheimer’s disease, and Huntington’s disease. Myoclonus can also be caused by metabolic deficiencies or medications. It can also be caused by genetics, another neurological disease, or occur sporadically.
Treatments include medication adjustments, restoring metabolic deficiencies, and the prescription of anticonvulsants, benzodiazepines, and muscle relaxers.
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 contractions 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. Paroxysmal dyskinesias can also be caused by genetics, another neurological disease, 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 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 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 around 45-50, but it has been known 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 dyskinesia describes extra movements in the body due to medication depleting dopamine in the brain. Tardive (“late”) refers to the fact that the extra movements typically do not present immediately after starting one of these drugs. The type of abnormal movements 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.