Movement Disorders Clinical Practice

Physical/speech therapy and transcranial direct current stimulation (tDCS) are the most effective nonpharmacological interventions for degenerative cerebellar ataxia, based on evidence appraised by the @movedisorder Ataxia Study Group. movementdisorders.onlinelibr…

Fragility fracture in Parkinson’s? Treat the bone, not just the fall. In this large UK study, only 38% of patients with parkinsonism received bone-protective medication within 16 weeks of a fragility fracture, and just 53% by 48 weeks. Men and patients with rib fractures were particularly likely to miss treatment. Bone health belongs in the movement disorders clinic! loom.ly/CN43aPU

BoNT works for cervical dystonia. The problem? It may not last until the next injection. Could rTMS bridge the gap? In the D-TWIST pilot, accelerated rTMS was safe, feasible and well tolerated, with an encouraging but preliminary signal for symptom improvement. A fascinating adjunctive strategy, now needing a properly powered trial. loom.ly/auZpT0U

Handwriting in Parkinson’s is about much more than size. Digital analysis showed that de novo PD was characterised by slower writing, reduced acceleration and more in-air time, while acute inhaled levodopa shortened both in-air and on-surface writing time. The pen may provide an objective window into bradykinesia, treatment response and disease progression. loom.ly/UU3ViUc

Could essential tremor become a wearable-treated disorder? An AI-driven wristband delivering peripheral nerve stimulation was associated with sustained functional improvement over 1 year, with mADL benefit increasing from 6.9 points at 90 days to 9.7 at 1 year. Encouraging non-invasive neuromodulation data, but the open-label extension and attrition warrant caution. loom.ly/0JB22xY

“Cerebral palsy” that is getting worse? Think again. Early-onset hereditary spastic paraplegia (HSP) is an under-recognised mimic of CP, particularly when there is: -Progressive spastic gait -Loss of previously acquired motor skills -True weakness -Knee recurvatum -Dystonia or parkinsonism No family history does not exclude HSP. Early genetic testing can be key, especially as mechanism-targeted therapies begin to emerge. loom.ly/akigKf0

Want to learn DBS microelectrode recording? Start listening. This superb educational resource teaches the characteristic MER recordings encountered along Vim, STN and GPi trajectories, combining narrated audiovisual examples with Anki flashcards for self-testing. loom.ly/AkhczPM

Shortening the MDS-UPDRS Part III rating scale risks hindering its prognostic reliability, per findings from a longitudinal item response theory model analyzed by @movedisorder #COA Program. movementdisorders.onlinelibr…

Not every request for rescue levodopa represents motor OFF. In refractory DDS, severe anxiety accompanied self-perceived OFF states and drove escalating dopaminergic use. Pregabalin was followed by resolution of rescue levodopa use and a substantial reduction in LEDD. Before escalating dopamine, distinguish objective motor OFF from affective distress and medication craving. movementdisorders.onlinelibr…

Is adaptive DBS really better than conventional DBS? Not yet, at least with this beta-guided dual-threshold approach. In a blinded randomized crossover pilot, aDBS and cDBS had comparable clinical efficacy, with substantial patient-to-patient variability. The future of aDBS may lie in personalization, not simply adaptation. loom.ly/giug0fw

Expertise exists. Access doesn’t always follow. Across Latin America, children with movement disorders face highly variable access to genetic testing, imaging, DBS, medications and emerging targeted therapies. This viewpoint proposes a powerful solution: regional networks + shared education + collaborative research + locally adapted care pathways. loom.ly/U9xicg0

Same UPDRS improvement. Different motor physiology? Both L-dopa and STN-DBS improved finger-tapping scores in PD, but kinematics told a more interesting story: -L-dopa → fewer hesitations -STN-DBS → fewer interruptions -Sequence effect → improved by neither Bradykinesia is a complex, not a single deficit. loom.ly/1dl5nk8

Your patient is motorically ON. But are they neuropsychiatrically ON? This excellent review reframes neuropsychiatric fluctuations in PD as dynamic, dopamine-linked phenomena that may precede, exceed or occur independently of motor fluctuations. -OFF: anxiety, apathy, low mood, fatigue, cognitive slowing -ON: increased drive, impulsivity, disinhibition, hyperactivity Don’t just ask “When do you wear OFF?” Ask how mood, thinking and behaviour change around each levodopa dose. loom.ly/Ow7EwZI

Which bedside gait tests are most informative when assessing possible iNPH for shunting? In this cohort, greater baseline impairment and a larger CSF drainage response on TUG and 10-m walk were independently associated with greater post-shunt gait improvement. Interestingly, stationary balance and functional endurance measures did not show the same association with surgical outcomes. 📌 For falls: assess multiple domains. 📌 For shunt response: dynamic gait speed may matter most. loom.ly/0V3_wh4

Have we been dismissing groaning in PSP as a curiosity instead of a symptom? This large cohort study suggests groaning is associated with: ⚠️ More severe disease ⚠️ Worse cognitive-behavioural dysfunction ⚠️ Greater functional dependence ⚠️ Higher caregiver burden Maybe groaning is a clinical marker of advancing PSP rather than an incidental feature. loom.ly/_4frBmY

A post-void residual may tell you more than another scan. This practical review reframes lower urinary tract symptoms as diagnostic clues in parkinsonism: ✅ Storage symptoms → usually PD ⚠️ Early retention or PVR >100 mL → think MSA ⚠️ Urge incontinence + magnetic gait → think NPH The bladder deserves a place in the neurological examination. loom.ly/4xeEseE

New MDCP Clinical Pearl: High Prevalence and Clinical Impact of Fibromyalgia in Functional Motor Disorder doi.org/10.1002/mdc3.70674

"I'm not sleeping because I'm up 4 times every night." For many patients with advanced PD, nocturia can be as disabling as motor fluctuations. This real-world study found that overnight foslevodopa/foscarbidopa infusion improved nocturia, urinary symptoms and quality of life after 3 months of treatment. Don't just ask about OFF periods. Ask about nights. loom.ly/KsbAdOk

We measure tremor. We score bradykinesia. We quantify rigidity. But what about the symptoms that often determine whether a patient can safely eat, communicate with family, or avoid aspiration pneumonia? This review makes a compelling case that "Breathe, Eat, Talk" should become a routine part of every movement disorders assessment. loom.ly/_2L4COE