About Movement Disorders

Movement disorders are neurological conditions that cause involuntary or abnormal movement affecting the speed, quality, and ease of movement. Sometimes they cause additional movements that are unwanted or uncontrolled; sometimes a person's ability to move is reduced or slowed.

Movement disorders are neurological conditions that cause involuntary or abnormal movement affecting the speed, quality, and ease of movement. Sometimes they cause additional movements that are unwanted or uncontrolled; sometimes a person's ability to move is reduced or slowed.

The most common of these conditions treated in the Duke Movement Disorders Center are:

  • Parkinson’s disease
  • Huntington’s disease
  • Essential tremor
  • Dystonia

Other movement-related conditions that we treat include

  • ataxia
  • chorea
  • hemiballismus
  • hemifacial spasm
  • myoclonus
  • multiple system atrophy (MSA)
  • progressuive supranuclear palsy (PSP)
  • restless leg syndrome
  • corticobasal ganglionic degeneration (CBGD)
  • spinocerebellar ataxia (SCA)
  • tardive dyskinesia
  • Tourette syndrome

Parkinson's disease (PD) is movement disorder of the nervous system that gets worse over time. As nerve cells (neurons) in parts of the brain weaken, are damaged, or die, people may begin to notice problems with movement, tremor, stiffness in the limbs or the trunk of the body, or impaired balance. As symptoms progress, people may have difficulty walking, talking, or completing other simple tasks. Not everyone with one or more of these symptoms has PD, as the symptoms appear in other diseases as well.

There is no cure for PD, but research is ongoing and medications or surgery can often provide substantial improvement with motor symptoms.

The four primary symptoms of PD are:

  1. Tremor—Tremor (shaking) often begins in a hand, although sometimes a foot or the jaw is affected first. The tremor associated with PD has a characteristic rhythmic back-and-forth motion that may involve the thumb and forefinger and appear as a “pill rolling.” It is most obvious when the hand is at rest or when a person is under stress. This tremor usually disappears during sleep or improves with a purposeful, intended movement.
  2. Rigidity—Rigidity (muscle stiffness), or a resistance to movement, affects most people with PD. The muscles remain constantly tense and contracted so that the person aches or feels stiff. The rigidity becomes obvious when another person tries to move the individual's arm, which will move only in short, jerky movements known as “cogwheel” rigidity.
  3. Bradykinesia—This is a slowing down of spontaneous and automatic movement that can be particularly frustrating because it may make simple tasks difficult. Activities once performed quickly and easily—such as washing or dressing—may take much longer. There is often a decrease in facial expressions (also known as "masked face").
  4. Postural instability—Impaired balance and changes in posture can increase the risk of falls.

PD does not affect everyone the same way. The rate of progression and the particular symptoms differ among individuals. PD symptoms typically begin on one side of the body. However, the disease eventually affects both sides, although symptoms are often less severe on one side than on the other.

People with PD often develop a so-called parkinsonian gait that includes a tendency to lean forward, taking small quick steps as if hurrying (called festination), and reduced swinging in one or both arms. They may have trouble initiating movement (start hesitation), and they may stop suddenly as they walk (freezing).

Other problems may accompany PD, such as:

  • Depression
  • Emotional changes
  • Difficulty with swallowing and chewing
  • Speech changes
  • Urinary problems or constipation
  • Skin problems
  • Sleep problems
  • Dementia or other cognitive problems
  • Orthostatic hypotension
  • Muscle cramps and dystonia
  • Pain
  • Fatigue and loss of energy
  • Sexual dysfunction
  • Hallucinations, delusions, and other psychotic symptoms can be caused by the drugs prescribed for PD.

Source: National Institute of Neurological Disorders and Stroke (last checked November 2023)


Dystonia is a movement disorder that causes involuntary muscle contractions that create slow repetitive movements or abnormal, sometimes painful postures. Different forms of dystonia may affect only one muscle, groups of muscles, or muscles throughout the body. The affected areas and severity of symptoms varies from person to person.

Dystonia can occur on its own or be the result of another condition. Some forms of dystonia can be inherited from one's relatives. The disorder typically is not associated with problems thinking or understanding. Dystonia is not fatal, but problems related to conditions that may result from dystonia may be life-threatening.


Early symptoms can be very mild and may be noticeable only after prolonged exertion, stress, or fatigue. Over time, the symptoms may become more noticeable or widespread; sometimes, however, there is little or no progression. Symptoms may include:

  • A foot cramp or a tendency for one foot to turn or drag—either occurring occasionally or in irregular patterns or after running or walking some distance
  • A worsening in handwriting after writing several lines
  • An involuntary turning of the neck, especially when the person is tired or under stress
  • Rapid and uncontrollable blinking of both eyes; other times, spasms will cause the eyes to close
  • Tremor
  • Difficulty speaking

Dystonia often progresses through various stages. Initially, the movements may be intermittent and appear only during voluntary movements or stress. Later, the dystonic postures and movements can be seen while walking and ultimately even when the person is relaxed. Dystonia can be associated with fixed postures and shortening of tendons.


Currently, there are no medications to prevent dystonia or slow its progression. There are, however, several treatment options that can ease some of the symptoms of dystonia, so physicians can select a therapeutic approach based on each individual's symptoms. 

Source: National Institute of Neurological Disorders and Stroke. (Last checked November 2023)

Read more about dystonia here.

Huntington's disease (HD) is an inherited disorder that causes nerve cells (neurons) in parts of the brain to gradually break down and die. The disease attacks areas of the brain that help to control voluntary (intentional) movement, as well as other areas. People living with HD develop uncontrollable dance-like movements (chorea) and abnormal body postures, as well as problems with behavior, emotion, thinking, and personality.

For example, uncontrolled movements in the person's fingers, feet, face, or torso. These movements are signs of chorea. They can get more intense when the person is nervous or distracted; as HD progresses, the person's movements can become more extreme and obvious.

Symptoms of HD typically appear in middle-aged people (adult HD). They can also appear in children (juvenile HD), but this is rare. The disease gets worse over time.

Early signs of HD can vary, but often include mild clumsiness or problems with balance or movement, cognitive or psychiatric symptoms (problems with thinking or emotion), and changes in behavior.

For some people, chorea can make it harder to walk, which increases the chances of falling. Some people with HD do not develop chorea; instead, they may become rigid (stiff) and move very little or not at all. This condition is called akinesia. Other people may start out with chorea but become rigid as the disease progresses.

In addition to chorea, some individuals have unusual fixed (unchanging) postures, which is known as dystonia. The two movement disorders (akinesia and dystonia) can blend or alternate.

Other symptoms may include tremor (unintentional back-and-forth movement in the person's muscles) and unusual eye movements. The eye movements can happen early in the disease.

Physical changes may include slurred speech and problems with swallowing, eating, speaking, and especially walking. People with HD may lose weight because of problems with feeding, swallowing, choking, and chest infections. Other symptoms may include insomnia (having trouble sleeping), loss of energy, fatigue, and seizures. Eventually the person will need to stay in bed or in a wheelchair.

Changes in thinking (cognitive changes) may include problems with attention or judgment and having difficulty solving problems or making decisions.

Other changes may include trouble with driving, prioritizing (deciding which things are more important to do and which are less important), and difficulty organizing, learning new things, remembering a fact, putting thoughts into words, or answering a question.

These cognitive changes get worse as the disease progresses, until people with HD are not able to work, drive, or care for themselves.

When the cognitive problems are severe enough that the person cannot function in daily life, the condition is described as dementia. But many people with HD stay aware of their environment and can express their emotions.

Changes in behavior may include mood swings; feeling irritable (cranky); not being active; or feeling apathetic (uninterested), depressed, or angry. These symptoms may decrease as the disease progresses. But in some people, the symptoms can continue and may include angry outbursts, thoughts of suicide, deep depression, and psychosis (losing touch with reality). People with HD may withdrawal from social activities.


There is no treatment that can stop or reverse HD, but some of the symptoms can be treated:

  • The drugs tetrabenazine and deuterabenazine can treat chorea associated with HD
  • Antipsychotic drugs may ease chorea and help to control hallucinations, delusions, and violent outbursts
  • Drugs may be prescribed to treat depression and anxiety

Side effects of drugs used to treat the symptoms of HD may include fatigue, sedation, decreased concentration, restlessness, or hyperexcitability. These drugs should be only used when HD symptoms create problems for the person living with HD.

Source: National Institute of Neurological Diseases and Stroke (last checked November 2023