SECOND EDITION SECOND EDITION SECOND EDITION A PRaCTICaL AppROaCH TO A PR A PRaCTICaL AppROaCH TO MOVEmENT a DISORdERS CTIC a Diagnosis and Management L A MOVEmENT Hubert H. Fernandez, MD • Andre G. Machado MD, PhD • Mayur Pandya, DO pp This is a quick-access, pocket-sized guide to the diagnosis and treatment of all RO major movement disorders. Written for busy practitioners who need an immediate a CH TO DISORdERS reference at the bedside, it presents medical, behavioral, surgical, and nonpharma- cological approaches in an expanded outline and bulleted format. The revised and expanded second edition is divided into four convenient sections. Diagnosis and Management The medical section provides a starting point for assessing and treating patients MOVE who present with a movement disorder and guides practitioners through the clinical presentation, diagnosis, and work up of all major disease categories. A new section on psychiatric issues delves into the behavioral features that typically manifest with m Parkinson’s disease, Huntington’s disease, Tourette syndrome, and also covers con- DISOR ENT version disorders with concomitant movement abnormalities. The surgical approach section has been completely updated to incorporate recent advances in functional neurosurgery including deep brain stimulation. The final section on nonpharmaco- logic therapies includes informative chapters on physical and occupational therapy, speech and swallowing evaluation and therapy, and nutrition. d The second edition also incorporates new information about sleep-related move- ERS ment disorders and covers treatment of Parkinson’s disease in greater depth. Loaded with tables, algorithms, and flow charts that illustrate key concepts, outline management of disorders, and highlight important information about diagnosis and treatment, this book is a highly useful addition to the pockets of all • Machado Pandya Fernandez clinicians who work with patients with movement disorders. Key Features: ■■ Completely revised and updated second edition of popular practical resource for busy clinicians ■■ Covers medical, psychiatric, surgical, and nonpharmacologic approaches to all types of movement disorders ■■ Written concisely in expanded outline, bullet-point format for quick access to information ■■ Emphasizes diagnosis, work up, and treatment Hubert H. Fernandez ■■ Packed with management algorithms, tables, and flow charts outlining drug dosing, side effects, and other therapeutic regimens Andre G. Machado Recommended Shelving Category: Neurology Mayur Pandya 11 West 42nd Street New York, NY 10036 www.demosmedical.com 9 781620 700341 A PRACTICAL APPROACH TO MOVEMENT DISORDERS A PRACTICAL APPROACH TO MOVEMENT DISORDERS Diagnosis and Management, Second Edition Editors HUBERT H. FERNANDEZ, MD Head, Section of Movement Disorders Center for Neurological Restoration Cleveland Clinic and Professor of Medicine (Neurology) Cleveland Clinic Lerner College of Medicine Case Western Reserve University ANDRE G. MACHADO, MD, PHD Director, Center for Neurological Restoration Staff, Department of Neurosurgery Associate Staff, Department of Biomedical Engineering Associate Staff, Department of Neurosciences Cleveland Clinic MAYUR PANDYA, DO Director, Comprehensive Huntington’s Disease Clinic Center for Neurological Restoration Cleveland Clinic and Assistant Professor of Medicine (Psychiatry) Cleveland Clinic Lerner College of Medicine Case Western Reserve University New York Visit our website at www.demosmedical.com ISBN: 9781620700341 e-book ISBN: 9781617051937 Acquisitions Editor: Beth Barry Compositor: Amnet Systems © 2015 Demos Medical Publishing, LLC. All rights reserved. This book is protected by copy- right. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Medicine is an ever-changing science. Research and clinical experience are continually expand- ing our knowledge, in particular our understanding of proper treatment and drug therapy. The authors, editors, and publisher have made every effort to ensure that all information in this book is in accordance with the state of knowledge at the time of production of the book. Nevertheless, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the contents of the publication. Every reader should exam- ine carefully the package inserts accompanying each drug and should carefully check whether the dosage schedules mentioned therein or the contraindications stated by the manufacturer differ from the statements made in this book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. LIBRARY OF CONGRESS CatalOGING-IN-PublicatiON Data Fernandez, Hubert H., author. A practical approach to movement disorders / Hubert H. Fernandez, Andre G. Machado, Mayur Pandya. — Second edition. p. ; cm. Preceded by A practical approach to movement disorders / Hubert H. Fernandez ... [et al.]. c2007. Includes bibliographical references and index. ISBN 978-1-62070-034-1 (print : alk. paper) — ISBN 978-1-61705-193-7 (e-book) I. Machado, Andre G. (Neurosurgeon), author. II. Pandya, Mayur, author. III. Title. [DNLM: 1. Movement Disorders—Handbooks. WL 39] RC376.5 616.8′3—dc23 2014013970 Special discounts on bulk quantities of Demos Medical Publishing books are available to corporations, professional associations, pharmaceutical companies, health care organiza- tions, and other qualifying groups. For details, please contact: Special Sales Department Demos Medical Publishing, LLC 11 West 42nd Street, 15th Floor New York, NY 10036 Phone: 800-532-8663 or 212-683-0072 Fax: 212-941-7842 E-mail: [email protected] Printed in the United States of America by Gasch Printing. 14 15 16 17 / 5 4 3 2 1 This book is warmly dedicated to our wives, Cecilia, Sandra, and Laura, and to our children, Annella Marie, Gabriella, Julia, Sameer, and Sara, for uncondi- tionally supporting us in good times and bad; for providing us the strength to overcome all challenges, big and small; and most of all, for inspiring us to strive to become better men, with pride and with humility. H. H. F. A. G. M. M. P. CoNtENtS Contributors ix Preface xiii Acknowledgments xv Share A Practical Approach to M o ve ment Dis o r d ers I Getting Started 1 The Body Language of Movement Disorders 3 II Neurological Approach to Movement Disorders 2 Tremors 27 3 Parkinsonism 45 4 Parkinson’s Disease 67 5 Dystonia 123 6 Chorea 149 7 Myoclonus 165 8 Ataxia 199 9 Tics 217 10 Sleep-Related Movement Disorders 229 III Psychiatric Approach to Movement Disorders 11 The Psychiatric Assessment 245 12 Psychiatric Issues in Parkinson’s Disease 259 13 Psychiatric Issues in Huntington’s Disease 271 14 Psychiatric Issues in Tourette Syndrome 279 15 Approach to Conversion Disorder 289 viii CONTENTS IV Surgical Approach to Movement Disorders 16 Surgical Approach to Movement Disorders 303 V Nonpharmacologic Approach to Movement Disorders 17 Physical and Occupational Therapy 321 18 Speech and Swallowing Therapy 337 19 Nutritional Considerations 369 Index 393 CONTRIBUTORS Anwar Ahmed, MD Staff, Center for Neurological Restoration Fellowship Program Director, Section of Movement Disorders Neurological Institute Cleveland Clinic Cleveland, Ohio Neurological Approach to Tremors Kristin Appleby, MD Staff, Center for Neurological Restoration Neurological Institute Cleveland Clinic Cleveland, Ohio Neurological Approach to Tics Joseph Austerman, DO Staff, Center for Behavioral Health Neurological Institute Cleveland Clinic Cleveland, Ohio Psychiatric Issues in Tourette Syndrome Jawad Bajwa, MD Assistant Professor of Neurology King Saud bin Abdulaziz University for Health Sciences Riyadh, Saudi Arabia; Program Director, Adult Movement Disorders and ­Neurorestoration Clerkship Director, Neuroscience Department of Neurology x CONTRIBUTORS National Neuroscience Institute King Fahd Medical City Riyadh, Saudi Arabia; Adjunct Assistant Professor of Neurology University of Florida Gainesville, Florida Neurological Approach to Ataxia Amy Chan, PT, NCS Clinical Specialist Mellen Center for Multiple Sclerosis Neurological Institute Cleveland Clinic Cleveland, Ohio Physical and Occupational Therapy Margo Funk, MD, MA Staff, Center for Behavioral Health Neurological Institute Cleveland Clinic Cleveland, Ohio Approach to Conversion Disorder Gencer Genc, MD Fellow, Center for Neurological Restoration Neurological Institute Cleveland Clinic Cleveland, Ohio; Neurologist, Gumussuyu Military Hospital Istanbul, Turkey Nutritional Considerations Justin Havemann, MD Staff, Center for Behavioral Health Neurological Institute Cleveland Clinic Cleveland, Ohio Psychiatric Issues in Parkinson’s Disease Ilia Itin, MD Staff, Center for Behavioral Health Neurological Institute Cleveland Clinic Cleveland, Ohio Neurological Approach to Dystonia CONTRIBUTORS xi Thien Thien Lim, MD, MRCP (UK) Fellow, Center for Neurological Restoration Neurological Institute Cleveland Clinic Cleveland, Ohio; Consultant, Island Hospital Penang, Malaysia Neurological Approach to Parkinsonism Neurological Approach to Parkinson’s Disease Andre G. Machado, MD, PhD Director, Center for Neurological Restoration Neurological Institute Cleveland Clinic Cleveland, Ohio Surgical