Movement Disorders: Integrating Innovation Into Practice

Innovations in diagnostic testing and treatments for movement disorders continue to optimize the quality of life for patients living with these conditions. This issue of Practical Neurology includes an overview of some of these advances and offers neurologists a succinct, practical overview of how they can integrate these innovations into the evaluation, management, and counseling of their patients.

Drs. Hu, Lee, and Mason open this issue with an article on Advances in Neuromodulation for Essential Tremor, which provides a summary of approved and investigational procedural therapies for medication-refractory essential tremor. As deep brain stimulation and magnetic resonance-guided focused ultrasound (MRgFUS) become more popular, it is increasingly important to identify their key similarities and differences as detailed in this work.

Although Parkinson disease (PD) remains a clinical diagnosis, several ancillary tests can help support a clinician’s diagnosis of PD. In their article, Updates in Diagnostic Testing in Parkinson Disease, Drs. Thordarson and Fu highlight the strengths, limitations, and practical uses of the growing arsenal of diagnostic tests for PD, including cerebrospinal fluid testing, skin biopsies, and genetic testing, in addition to the long-standing use of DaTscans. An understanding of the clinical applicability of these tests is especially important given the recent debates in the field regarding adapting a biologic definition of PD for research purposes.

Next, Drs. Furr Stimming, Zadegan, and Patino review a Clinical Approach to the Diagnostic Evaluation of Chorea. They begin by defining the phenomenology of chorea and differentiating it from other hyperkinetic movement disorders before embarking on a discussion of possible etiologies, both acquired and hereditary, and the corresponding diagnostic work-up.

Drs. Zuchowski and Santini then discuss treatment options for chorea in their article, A Choreographed Approach to the Treatment of Chorea. They begin with a critical discussion of when chorea warrants treatment and then provide a treatment approach and overview of available pharmacologic therapies.

The issue then transitions to the diagnosis and treatment of dystonia. Drs. Lin, Mulligan, and Coughlin highlight the approach to evaluating a patient with dystonia in Clinical Diagnostic Evaluation of Dystonia. They discuss key elements of obtaining a robust patient history and conducting a thorough physical examination and provide strategies for how to accurately differentiate dystonia from mimics, such as pseudodystonia, which is critical for patient evaluation and management.

Drs. Martinez-Nunez and Mahajan then discuss treatment options for dystonia in their article, Dystonia Treatment: Current Approach and Future Directions. They review pharmacologic therapies, such as the recently approved DaxibotulinumtoxinA for cervical dystonia, neuromodulation, and rehabilitation therapies, all of which remain important options when considering how best to maximize function and improve quality of life for people with dystonia.

This issue concludes with Clinic-Based Assessment and Treatment Strategies for Functional Neurologic Disorders (FND), which is written by a team of physical therapists, Drs. Cicio, Hershberg, and Richardson, and psychologist, Dr. Pugh. Many neurologists are aware that the mainstay of treatment in FND includes a multidisciplinary team of physical therapists, occupational and/or speech therapists, and psychologists; however, access to rehabilitation specialists or therapists with expertise in FND management may be limited. This article aims to empower neurologists to begin implementing tailored, individualized care for patients with FND, particularly when assembling a multidisciplinary team may not be immediately feasible.

Thank you to the authors for sharing their expertise. We are excited to share these practical articles which are aimed at helping neurologists integrate recent innovations into their clinical care of patients with movement disorders.