Movement Disorders Clinical Practice

"My legs shake when I stand." Are you sure it's tremor?

Key message: if the history is "shaky legs + unsteadiness on standing", don't assume orthostatic tremor. It could be Orthostatic Myoclonus! Surface EMG is essential to accurate diagnosis.

In this cohort:
-79% had an underlying neurological disorder
-26% had parkinsonism
-Nearly all had gait instability
loom.ly/WpnNiBk

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. …mentdisorders.onlinelibrary.wiley.com/doi/10.1002/md…

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