Conditions and Treatments

Parkinson’s disease (PD) causes muscle stiffness, slowing of movement, tremors and balance problems. Other symptoms include loss of the sense of smell, sleep changes, difficulty with hand writing, decreased facial expression, soft voice and constipation. The diagnosis is based on findings in the neurological exam. PD is caused by gradual loss of brain cells that produce the chemical dopamine. PD now affects nearly 60 million people world-wide, including 1% of people over the age of 60. Due to continued loss of dopamine-producing cells with aging, PD becomes more frequent in the older population. Many treatment options are currently available to increase dopamine levels and improve the symptoms of PD. Physical activity is also a major factor in improving the quality of life. For more information and support, please visit the American Parkinson Disease Association, the National Parkinson Foundation and the Parkinson’s Disease Foundation which can direct you to a local patient support group. The National Institutes of Health (NIH) is another good source of information.

One of the most promising new treatments for PD is deep brain stimulation (DBS). A neurosurgeon places thin wire electrodes into specific areas of the brain, and these electrodes are connected to a neurostimulator that is implanted on the chest wall under the skin, just below the collarbone. The neurologist then programs the stimulator to deliver the right amount of current to the right place in the brain. You will also be able to turn the stimulator on or off and make simple changes yourself with a remote control. DBS can control many of the symptoms of PD, reducing tremor and improving mobility. DBS was first introduced in 1987 and has been FDA approved for essential tremor (ET), Parkinson’s disease (PD) and dystonia. The target area in the brain is different for each of these conditions. Electrodes are implanted in the subthalamic nucleus (STN) or globus pallidus interna (GPi) for Parkinson’s disease, in the thalamus (VIM) for tremors and in the GPi for dystonia. DBS has also been used for psychiatric conditions such as obsessive-compulsive disorder (OCD), tic disorders and severe depression when these problems do not respond to medications. The implanted pulse generator (IPG) has a battery life of over 5 years in most cases and can be replaced by your surgeon with a chest incision without additional brain surgery. You can find out more at the NIH's Deep Brain Stimulation for Parkinson's Disease Fact Sheet.

Huntington’s disease (HD) is a progressive neurodegenerative disease that causes loss of brain cells in a region called the basal ganglia, resulting in fidgety dance-like movements called chorea. It also causes personality changes and dementia. The disorder is hereditary and children of an affected parent have a 50% chance of inheriting the disease. While there are no treatments that affect the underlying course of the disease, there are medications that help reduce the excessive movements and other symptoms. UConn Health has a multidisciplinary Huntington’s Disease Clinic with participation by both Psychiatry and Neurology that can provide a variety of services for HD patients. You can find out more about Huntington’s Disease at the Huntington Disease Society of America and at the National Institutes of Health.

Tremor is the single most common involuntary movement. Some degree of tremor is normal, and it may worsen with too much caffeine, anxiety or certain medications. It can also be abnormal and disabling, either as an isolated symptom or as part of another movement disorder. Not all tremors are the same. A movement disorders specialist can determine what kind of tremor you have based on an examination and other tests. Most people think of Parkinson’s disease when they think of tremor, and the tremor of PD often involves one arm or hand and occurs at rest. Another type occurs with activity and is called essential tremor, or familial tremor when there is a positive family history. Systemic diseases, stress and medications can also cause tremors, which may improve with managing the underlying problem. A variety of other tremors can occur due to problems in specific areas of the brain. Treatment options include oral medications, injections of botulinum toxin type A (Botox®) and deep brain stimulation (DBS) surgery. Please call 1-84-GET-UCONN or request an appointment online at our clinic and learn more about your tremor. You can find out more about tremors on the NIH's Tremor Fact Sheet.

Dystonia is a condition causing sustained muscle contractions resulting in stiffness, abnormal movements or postures. For example, in cervical dystonia or torticollis, the head is turned to one side with neck muscle stiffness. Other common examples are writer’s cramp, blepharospasm (forced blinking) and hemifacial spasm (pulling of one side of the face), oromandibular dystonia which interferes with eating and talking, and spasmodic dysphonia which causes harsh or strained speech. Dystonias can be caused by brain injuries, genetic mutations such as the DYT gene, or as a side effect of certain medications that block dopamine receptors such as antipsychotic and anti-nausea drugs. Dystonia can also be seen as symptom of diseases such as Wilson’s disease or Huntington’s disease. Dystonia can be focal (occurring at a specific body part) or generalized. It can be task-specific (as with writer’s cramp) or constant. Treatments include oral medications such as anticholinergics and muscle relaxants. Botulinum toxin injections are often the best option for focal dystonias due to their effectiveness and safety. You can find out more about dystonia at the NIH's Dystonias Fact Sheet.

Deep Brain Stimulation (DBS) surgery has shown good results for dystonia with DYT1 gene mutation and for Tardive Dystonia. If you have dystonia, please call 1-84-GET-UCONN or request an appointment online to visit our Movement Disorders clinic.

Ataxia is the loss of coordination of movement. It can affect your ability to walk and result in falling. Ataxia can occur after injury to areas of the brain involved in motor control such as the cerebellum, as well as sensory systems that detect the position of your body parts and vestibular (balance) sensation that detects where your body is in space. There are many possible causes of ataxia including hereditary (genetic) causes, toxic and metabolic problems such as alcohol, medications and vitamin or mineral deficiencies, as well as infections, inflammatory conditions or structural lesions in the brain. The spinocerebellar ataxias (SCA) are a group of genetic diseases causing ataxia and other neurological findings. While there is no specific treatment for these disorders, advances in genetic testing can now identify different forms of SCA and improve genetic counseling for patients and families. Treatment often focuses on physical therapy and rehabilitation to improve physical activity, gait training and fall prevention. A variety of medications are under investigation for the treatment of ataxias. Check clinicaltrials.gov for more information. You can find out more about the causes and treatments for ataxia on the NIH's Ataxia Fact Sheet.

Tics are brief, fast, semi-voluntary abnormal movements. They are usually preceded by an urge to move or sense of tension that is released when the tic occurs, and tics can be controlled to some extent. Tics can be motor (stereotyped movements) or phonic (vocal). They can be simple or complex (with multiple components) and can affect different areas of the body. The best known tic disorder is Tourette’s syndrome (TS), named for Dr. Gilles de la Tourette who was the first to describe patients with tics in the 19th century. TS is common among school age children with both motor and vocal tics. About 1 to 4% of school age children may have tics. While the cause of TS is still unknown, the prognosis is usually good. Medications are effective and tics tend to improve spontaneously before adulthood. Emotional support and therapy are the first line of treatment and are highly effective. In most cases, reassurance that this is a benign condition may be sufficient. TS has been associated with other neuropsychiatric conditions such as attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD), which should be monitored and treated as needed. Patients younger than 16 are usually followed by pediatric neurologists at the Connecticut Children’s Medical Center. Adults with TS or other tic disorders may call 1-84-GET-UCONN or request an appointment online to visit our Movement Disorders center. You can find out more about Tourette Syndrome and other tic disorders at the NIH.

Myoclonus is a sudden, brief, involuntary twitch-like movement. Myoclonic twitches can be present in normal persons, as with the sudden jerk that may happen just before falling asleep, but can also be a symptom of a neurological condition. Medications, stress and anxiety are also associated with myoclonic jerks. Myoclonus is seen with many neurological conditions including multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, muscle dystrophies, Creutzfeldt-Jakob disease, Wilson’s disease, Huntington’s disease and epilepsy, among others. Your neurologist will review your history and medications and order tests to rule out structural lesions, seizures and other neurologic conditions. Good control can be achieved with symptomatic treatment, often using anti-epileptic drugs. You can find out more about myoclonus on NIH's Myoclonus Fact Sheet.

Call 1-84-GET-UCONN or request an appointment online with one of our specialists.