Investigators gathering historical information from a clinical evaluation of movement disorders should gather data pertaining to age of onset, symptom progression, type of involuntary movement, aggravating factors, and relieving factors (e.g., anxiety, stress, sleep, alcohol, food, and medications). Almost all involuntary movements, except for segmental myoclonus, tics, and hemifacial spasm, disappear during sleep. In addition past medical history, recent travel history, family history, toxins/chemical exposure, and information regarding medications are important. Dopamine receptor-blocking drugs, such as traditional antipsychotic and antiemetic medications, are associated with Parkinsonism and tardive dyskinesia; other agents such as cortico-steroids and medications for obstructive pulmonary disease are known to produce tremor.
Neurological examination should include assessment of language, memory, and other higher cortical functions. Frontal release signs such as Myerson's sign are seen commonly in Parkinson disease. Cranial nerve examination with special attention to extraocular movements (vertical saccades) is important, especially when differentiating Parkinson disease from progressive supranuclear palsy, or when searching for early signs of Huntington disease. Facial expression and speech pattern should be noted. Motor examination including muscle tone and power, sensory testing, and assessment of deep tendon and plantar reflexes is also important. Testing for rapid alternating movement, posture, and gait is necessary. In addition, emphasis on postures or movements that increase patient symptoms is helpful in defining particular syndromes (Stacy and Jankovic 1997).
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