• Parkinsonian syndromes (e.g., Parkinson's disease)
• Tremor (Trembling)
• Dystonia
• Chorea
• Tics
• Myoclonus

The most important factor is the correct diagnosis of the underlying disease which will guide the therapeutic approach, as the etiology, the prognosis and the treatment of movement disorders might vary. 

This is a neurodegenerative disease that primarily affects mobility and other functions. In patients, there is a lack of a neurotransmitter, dopamine. Parkinson's disease is the second most common neurodegenerative disease after Alzheimer's disease. This is a chronic progressive disease with a slow progression.

Parkinson's disease is caused by the degeneration of the nerve cells responsible for producing dopamine in part of the brain called the substantia nigra. Essentially, dopamine depots and dopaminergic neurons are degenerating. Degeneration is the result of the accumulation of a pathological protein, α-synuclein.

In the industrialized countries, 0.3% of the general population and 1% of the people over 60s suffer from Parkinson's disease As a rule, the disease starts between 40 and 70 years, with an average starting age in the seventh decade.

 

In the majority of cases, the disease is sporadic and multifactorial, resulting in hereditary predisposition, combined with environmental factors. Only in 5-10% of cases the disease can be hereditary and due to one of the many genes that have been discovered so far. In these cases, mainly hereditary illness, the onset age may be smaller.

Before the onset of the disease, a precursor period of several years may precede. Patients may experience symptoms such as olfactory disorder, sleep disturbance (with intense movements during sleep), pain mainly one shoulder, change of writing mode, where the patient writes in smaller letters, etc. It is often that depression precedes the motor symptoms of the disease.

 

Parkinson's disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain. Non-motor symptoms include constipation, urinary disorders, orthostatic hypotension, etc.

 

The motor symptoms include the following:

• Rest Tremor: Tremor (trembling) occurs usually asymmetrically, that is, in one hand, or in one leg, especially when the limb is at rest (that is, when it does not move). When the patient moves the extremity, e.g. when eating tremor disappears or diminishes in contrast to other forms of tremor such as idiopathic, where the movement increases the tremor. Tremor is a more intense symptom, but rarely disturbs the everyday life of a patient with Parkinson's disease.
• Stiffness: Described as a grip, snapping, usually occurs on one side of the body and later affects the other as well as the trunk.
• Bradykinesia: It refers to the slowness in movements as well as the inability to perform repetitive movements due to upcoming fatigue. It first occurs with difficulty in fine movements such as button buckle or writing.
• Loss of postural reflexes: It leads to instability when walking, with the risk of falling.

The diagnosis of Parkinson's disease is clinical, while laboratory and imaging examinations are required to rule out diseases that mimic the disease. In the differential diagnosis of the disease there is a large number of diseases. Of these, hereditary parkinsonism, pharmaceutical causes of parkinsonism, degenerative diseases, vascular parkinsonism, toxic and infectious causes are the main ones, without being able to ignore normal aging and idiopathic tremor.

The treatment is symptomatic. This means that there is currently no treatment that affects or stops the progression of the condition. However, a range of treatments is available to help relieve the symptoms effectively.

The most important step in the treatment of Parkinson's disease occurred in 1967, when Kotzia introduced levodopa to treat the disease, which has been considered one of the greatest successes in modern medicine and remains the most effective treatment available to date relief of symptoms. 

 

However, complications of chronic therapy such as dyskinesia and motor fluctuations are major obstacles to its use.
Dopamine agonists, COMT inhibitors, MAO-B inhibitors, etc. have significantly increased the therapeutic benefit of Parkinson's patients but the substance is focused on the fact that each Parkinsonian patient is different from each other, therefore it is considered necessary to personalize the individual treatment.

Treatment of advanced Parkinson's disease includes surgical treatment (deep brain stimulation, DBS) as well as the use of apomorphine and Duodopa® pumps.

These are syndromes with a predominant feature of Parkinsonism but differentiate from Parkinson's in clinical, imaging and pathologically. These include Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP), Corticobasal Degeneration (CBD), and others. Grouped according to the term "atypical parkinsonism" or "parkinson-plus syndromes" do not respond as well as Parkinson's in therapies, and their prognosis differs compared to typical Parkinson's disease.

 

Differential diagnosis with Parkinson's is of great prognostic and therapeutic importance and requires a specialized neurologist.

Tremor (trembling) is the most common movement disorder and is defined as an inadvertent and rhythmic oscillation of a body part. Tremor can be of varying etiology and intensity. Very often it can be the result of anxiety, taking a large amount of caffeine or nicotine, and so on. It can also often be due to taking certain medicines e or due to thyroid gland disorders.

 

The most common type of hereditary tremor is the essntial (idiopathic) tremor. However, depending on its phenomenology and accompanying symptoms, the tremor may be caused by multiple underlying diseases such as Parkinson's disease, dystonia or other metabolic or neurodegenerative diseases. Therefore, it is very important when a patient first shows tremor to consult a neurologist, so as to investigate the underlying cause that will determine the prognosis and the treatment.

Essential (Idiopathic) tremor is the most common tremor syndrome. There is usually a family history where more than one person within the family has it. It is mainly observed in voluntary movements, especially of the upper limbs, such as writing, holding mainly light objects, such as a glass or a fork, and may extend to the head and the voice.

Patients often complain that they cannot bring food to their mouth, drink water, or write well because of the tremor. It occurs when the person tries to perform a movement, as opposed to the tremor of Parkinson's disease, which typically occurs in calmness. It often becomes more intense in situations of emotional charging, such as in joy or sadness and is often reduced by mild alcohol consumption. It might occur in almost all ages, though somewhat more often in the elderly. Since idiopathic tremor does not always restrict the patient's functionality and the quality of life, treatment is not always necessary and depends mostly on the needs of each patient. The treatment is to take appropriate medicines from a specialist neurologist.

• blepharospasm
• spasmodic dysphonia
• oromandibular dystonia
• cervical dystonia or torticollis.

Chorea is characterized by arrhythmic, unpredictable, short, steep movements, spreading continuously from one part of the body to another. Often, the patient is not aware of these movements and the caregiver is the one that describes them and is seeking advice for the patient. Very important in examining a patient with chorea is the family medical history, since it can denote Huntington's disease or related diseases.