Movement Disorders

Movement Disorders

St. Luke's Movement Disorders Center

Nancy L. Diaz, MD is the Medical Director of the St. Luke's Movement Disorders Center. She diagnoses and treats Parkinson's Disease, tremors, Huntington's Disease, restless leg syndrome, dystonia and other movement disorders. Dr. Diaz works closely with Steven Falowski, MD, Functional Neurosurgeon, to develop treatment plans for patients with these disorders.

Dr. Nancy Diaz

Parkinson's Disease

PD STEPS Program

The Support To Empower
Parkinson's Strategies
(PD STEPS) Program is a
free monthly community
education program for
patients living with
Parkinson's Disease.

Register by calling InfoLink
at 866-STLUKES (785-8537).

Parkinson's Disease is a brain disorder that occurs when certain nerve cells in the part of the brain that controls muscles and movement are damaged or die. Normally, these cells produce a chemical (dopamine) that lets the body's muscles move smoothly. According to the National Parkinson Foundation (NPF), the symptoms of Parkinson’s disease appear when about 80 percent of these cells are damaged.

Symptoms

  • Tremors or shaking
  • Slow movements
  • Stiffness
  • Balance problems
  • Loss of facial expressions
  • Shuffling walking
  • Speech changes
  • Nervousness
  • Depression 

Although Parkinson’s disease usually appears after the age of 65, 15 percent of people with the disease are younger than 50. It affects men and women at almost the same rate. While there is no test that can diagnose the disease, tests are done to rule out other conditions with similar symptoms.

Treatment

Medications can be used to ease or control the symptoms of Parkinson’s disease. Since most of the symptoms of the disease are caused by a lack of dopamine in the body, the most commonly used medications replace or imitate dopamine. Doctors may suggest:

  • Physical, occupational or speech therapy
  • Surgery, which can ease the symptoms of Parkinson disease, but is not a cure. Deep brain stimulation is a surgical procedure used to treat tremors, rigidity, stiffness, slowed movement, and walking problems. A surgically implanted, battery-operated medical device called a neurostimulator delivers electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and other symptoms. This is used for patients whose symptoms cannot be adequately controlled with medications.  

Prevention

There are no known ways to prevent Parkinson’s disease.

Tremor

Symptoms

Occurring most often in the hands, tremor is an unintentional, rhythmic, muscle movement involving to-and-fro movements. The tremor also may affect the chin, lips, legs, and trunk. Excessive alcohol consumption or alcohol withdrawal can kill certain nerve cells, resulting in tremor, especially in the hand. Other causes include an overactive thyroid and the use of certain drugs.

Although tremor is not life-threatening, it can cause embarassment and make it harder to perform daily tasks.

Complete the Tremor Questionnaire.

Treatment

There is no cure for most tremors. The appropriate treatment depends on accurate diagnosis of the cause.

  • Some medications may provide relief of symptoms.
  • Eliminating tremor "triggers" such as caffeine and other stimulants from the diet often is recommended.
  • Physical therapy may help to reduce tremor and improve coordination and muscle control for some patients.
  • Surgical intervention, such as thalamotomy and deep brain stimulation, are usually performed only when the tremor is severe and does not respond to drugs.

Prevention

Although the most common form occurs in otherwise healthy people, some forms of tremor run in families, while others have no known cause. Tremor may occur at any age but is most common in middle-aged and older persons.

Huntington's Disease

Huntington's Disease is distinguished by uncontrolled movements, loss of intellectual faculties and emotional disturbance. It is caused by genetically programmed degeneration of brain cells (neurons) in certain areas of the brain. A child has a 50 percent chance of inheriting the mutated gene. If a child does not inherit the HD gene, he or she will not develop the disease and cannot pass it to subsequent generations. A person who inherits the HD gene will sooner or later develop the disease.

Symptoms

Early symptoms include mood swings, depression, irritability or trouble driving, learning new things, remembering a fact, or making a decision.

Later symptoms include increasing difficulty with intellectual tasks, feeding and swallowing.

A genetic test along with a complete medical history, neurological tests and laboratory tests will help physicians diagnose Huntington's Disease.

Treatment

A number of medications are available to help control emotional and movement problems associated with Huntington's Disease. Most of these medications have side effects including fatigue, restlessness or hyperexcitability.

It is recommended that people with Huntington's Disease maintain physical fitness. There is evidence that individuals who exercise and keep active tend to do better than those who do not.

Prevention

At this time, there is no way to stop or reverse the course of Huntington's Disease. Now that the gene has been located, investigators are continuing to conduct research to better understand how it causes disease in the human body.

Restless Leg Syndrome

Symptoms

Restless legs syndrome is a common neurological disorder distinguished by unpleasant sensations in the legs and an uncontrollable urge to move them for relief. These sensations can range from uncomfortable to irritating to painful.

Treatment

Lifestyle changes can help those experiencing mild to moderate symptoms.

  • Decreased use of caffeine, alcohol, and tobacco may provide some relief.
  • Some dietary supplements may correct in iron, folate and magnesium deficiencies.
  • Taking a hot bath, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients.
  • Some medications also may those experiencing moderate to severe symptoms.

Prevention

There is no cure for Restless Leg Syndrome. Symptoms gradually may get worse with age. Current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep.

Some individuals have experience remissions in symptoms, which may decrease or disappear for short or long periods. However, symptoms eventually reappear.

Dystonia

Dystonias are characterized by sustained muscle contractions that cause twisting and repetitive movements or abnormal postures. These involuntary and sometimes painful movements, may affect a single muscle, a group of muscles or the entire body.

Symptoms

Dystonia can affect many different parts of the body.

  • Early symptoms may include a deterioration in handwriting after writing several lines, foot cramps, and/or a tendency of one foot to pull up or drag; this may occur "out of the blue" or may occur after running or walking some distance. The neck may turn or pull involuntarily, especially when the patient is tired or stressed. Sometimes both eyes will blink rapidly and uncontrollably, rendering a person functionally blind. Other possible symptoms are tremor and voice or speech difficulties. The initial symptoms can be very mild and may be noticeable only after prolonged exertion, stress, or fatigue.
  • Over a period of time, the symptoms may become more noticeable and widespread and be unrelenting; sometimes, however, there is little or no progression.

Treatments

There is no single treatment for dystonias. Physicians recommend a number of therapies to reduce or eliminate muscle spasms and pain including:

  • Medications - an individualized drug therapy plan based on the patient's unique condition.
  • Botulinum toxin - Minute amounts of this familiar toxin can be injected into affected muscles to provide temporary relief of focal dystonias. The toxin stops muscle spasms for up to several months.
  • Surgery and other treatments - Surgery may be recommended for some patients when medication is unsuccessful or the side effects are too severe. Physical therapy, splinting, stress management, speech-language therapy and biofeedback may also help individuals with certain forms of dystonias.

Prevention

There is no current evidence to suggest that dystonias can be prevented.