Movement Disorders
What are Movement Disorders?
Movement disorders in children refer to a group of neurological conditions that affect a child's ability to control their movements. These disorders can manifest as abnormal movements, reduced movements, or a combination of both. Movement disorders can have a significant impact on a child's motor skills, coordination, and overall quality of life.
What are the Types of Movement Disorders in Children?
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Cerebral Palsy: Cerebral palsy is a group of disorders that affect movement and muscle coordination. It is often caused by brain damage before or shortly after birth. Children with cerebral palsy may have difficulties with muscle tone, balance, posture, and coordination. Types of cerebral palsy include spastic, dyskinetic (athetoid), ataxic, and mixed types.
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Dystonia: Dystonia involves involuntary muscle contractions that lead to repetitive or twisting movements, abnormal postures, or sustained muscle contractions. Dystonia can affect different parts of the body and can be primary (idiopathic) or secondary to other conditions.
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Tourette Syndrome: Tourette syndrome is characterized by motor and vocal tics, which are repetitive, sudden, and involuntary movements and sounds. Tics can range from mild to severe and often start in childhood.
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Myoclonus: Myoclonus refers to sudden, brief, shock-like muscle contractions. These movements can affect different muscle groups and may be caused by various factors, including genetic and metabolic disorders.
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Ataxia: Ataxia is characterized by problems with coordination and balance. Children with ataxia may have difficulty walking, performing fine motor tasks, and maintaining proper posture.
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Hemiballismus: Hemiballismus is a rare movement disorder characterized by violent and flinging movements of one side of the body. It is often caused by damage to a specific area of the brain.
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Wilson's Disease: This rare genetic disorder can cause movement problems, including tremors, dystonia, and chorea, due to abnormal copper metabolism.
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Rett Syndrome: Rett syndrome is a genetic disorder that primarily affects girls. It leads to severe cognitive and physical impairments, including movement problems such as hand-wringing and repetitive movements.
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Parkinsonism: Some children can develop symptoms similar to Parkinson's disease, including tremors, rigidity, and bradykinesia (slowness of movement). These cases are often due to genetic or secondary causes.
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Chorea: Chorea involves involuntary, rapid, and jerky movements that can affect various parts of the body. It can be seen in conditions like Huntington's disease or Sydenham's chorea (associated with rheumatic fever).
What Might Cause a Movement Disorder in Children?
Movement disorders in children can have various underlying causes, including genetic, neurological, metabolic, or acquired factors. The specific cause of a movement disorder can vary depending on the type of disorder and the individual child. Here are some common causes of movement disorders in children:
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Genetic Factors: Many movement disorders have a genetic basis, meaning they are caused by mutations or abnormalities in specific genes. Examples include:
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Tourette Syndrome: Genetic factors are thought to contribute to the development of Tourette syndrome and its associated motor and vocal tics.
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Dystonia: Some forms of dystonia are hereditary and caused by genetic mutations.
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Rett Syndrome: Rett syndrome is caused by mutations in the MECP2 gene.
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Neurological Conditions: Various neurological disorders can lead to movement problems in children. These include:
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Cerebral Palsy: Brain damage before or shortly after birth can result in cerebral palsy, leading to movement difficulties and muscle coordination problems.
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Wilson's Disease: A genetic disorder that affects copper metabolism and can lead to movement problems like tremors and dystonia.
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Metabolic Disorders: Some movement disorders can be caused by metabolic imbalances or abnormalities. Examples include:
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Dopa-Responsive Dystonia: A rare genetic disorder that responds to treatment with levodopa, a medication that increases dopamine levels in the brain.
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Glutaric Aciduria Type 1: A metabolic disorder that can cause movement problems and brain damage due to the accumulation of certain substances.
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Infections and Inflammation: Certain infections or inflammatory conditions can affect the brain and result in movement disorders. For example:
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Sydenham's Chorea: A movement disorder that can occur as a complication of rheumatic fever, an inflammatory condition.
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Encephalitis: Inflammation of the brain can lead to a range of neurological symptoms, including movement abnormalities.
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Medications and Toxins: Some movement disorders can be triggered or exacerbated by certain medications or exposure to toxins.
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Acquired Brain Injuries: Traumatic brain injuries, infections, or other insults to the brain can lead to movement disorders in children.
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Autoimmune Disorders: Some autoimmune conditions, where the immune system mistakenly attacks the body's own tissues, can affect the nervous system and cause movement problems.
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Unknown Causes: In some cases, the exact cause of a movement disorder may be unclear or idiopathic, meaning it is not yet understood.
How are Movement Disorders Treated in Children?
Once your child’s has been diagnosed with a movement disorder, I (as a pediatric neurosurgeon in New York) will work with you, your child, and other medical professionals (i.e. physical medicine and rehab, physical therapy, occupational therapy, and orthopedic surgery) at Children's Hospital at Montefiore (CHAM) to formulate a customized treatment strategy tailored to your child’s needs. This customized treatment may utilize any one or a combination of the following interventions:
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Surgical Interventions: In some cases, surgical procedures may be considered when other treatments are not effective. Surgical options include:
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Deep Brain Stimulation (DBS): This procedure involves implanting electrodes in specific brain areas to deliver electrical impulses that can help control movement symptoms.
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Drug Pump: Direct delivery of medication (Baclofen)to the nervous system for relief of spasticity and pain.
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Dorsal Root Rhizotomy: Disruption of the abnormal neurologic feedback loop to the spinal cord, to alleviate persistent and worsening spasticity.
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Selective Dorsal Root Rhizotomy: Selective disruption of nerve fibers to the spinal cord, responsible for proximal leg and hip movements, to ease the burden of muscle spasticity that prevents a patient from walking.
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Botox Injection: Targeted treatment of appropriate muscle group to allow overall balance to agonist and antagonist muscles.
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Lesioning Procedures: These involve making controlled lesions in certain brain regions to interrupt abnormal neural pathways and reduce movement symptoms.
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Medications: Certain medications can help manage the symptoms of movement disorders by affecting neurotransmitters and neural pathways involved in motor control. Examples of medications used to treat movement disorders in children include:
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Dopamine Modulators: Medications that affect dopamine levels in the brain, such as levodopa or dopamine agonists, may be used for disorders like Parkinsonism or dopa-responsive dystonia.
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Anticholinergic Drugs: These drugs may help reduce muscle contractions and tremors in conditions like dystonia or Tourette syndrome.
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Benzodiazepines: These medications may be used to reduce muscle spasms and myoclonus.
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Botulinum Toxin Injections: Injections of botulinum toxin (Botox) can help manage dystonia, spasticity, and certain types of tremors by temporarily relaxing overactive muscles.
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Physical and Occupational Therapy: Therapists can work with children to improve muscle strength, coordination, balance, and motor skills. Therapy may include exercises, stretches, and techniques to optimize movement and functional abilities.
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Speech Therapy: For movement disorders affecting speech and vocalization, speech therapy can help improve communication skills and reduce vocal tics or other speech-related symptoms.
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Supportive Services: Psychological counseling, support groups, and educational interventions can help children and families cope with the challenges of living with a movement disorder.
