Lewis, Steven L. MD, FAAN
Guest Editor Alberto J. Espay, MD, MSc, FAAN, and his international team of authors have succeeded in skillfully providing the optimal amount of practical and up-to-date information for us to use to diagnose and manage our patients with hypokinetic or hyperkinetic movement disorders.
A CONTINUUM issue covering the entire neurologic subspecialty of movement disorders needs to maintain a healthy balance between covering too much and too little, in order to practically and efficiently inform us regarding the diagnosis and care of our patients whose movements are too much or too little. In this issue of CONTINUUM, Guest Editor Alberto J. Espay, MD, MSc, FAAN, and his international team of expert authors have succeeded in skillfully providing the optimal amount of practical and up-to-date information for us to use to diagnose and manage our patients with hypokinetic or hyperkinetic movement disorders, and to understand the most current thinking regarding the pathogenesis of these syndromes.
This issue begins with a discussion by Drs David R. Williams and Irene Litvan on Parkinson disease and the other parkinsonian syndromes. Their thorough review will assist us in the recognition, diagnosis, and management of these various parkinsonian syndromes that we all encounter in our neurologic practices. Next, Drs Mark J. Edwards and Guenther Deuschl present a very practical approach to the clinical recognition, classification, and treatment of tremor syndromes. Drs Francesca Morgante and Christine Klein discuss the classification, phenomenology, pathophysiology, and treatment of dystonia, including a thorough review of the most recent knowledge regarding the genetics ofthese syndromes. In the following article, DrRuth H. Walker thoroughly reviews her approach to the diagnosis and management of the many causes of chorea.
Next, Dr Espay and Dr Robert Chen review the clinical features, pathophysiology, and treatment of myoclonus, a movement disorder that can occur in the context of a number of cortical, subcortical (including spinal) disease processes. This is followed by the comprehensive review on the tic disorders by Drs Davide Martino and Jonathan W. Mink, including the most up-to-date information regarding their pathophysiology and diagnosis, and the role of an individualized approach to the non-pharmacologic and pharmacologic treatment of these syndromes. Next, Drs Massimo Pandolfo and Mario Manto review the classification, diagnosis, and management of the many disorders manifesting with ataxia, including those ataxic disorders that occur from cerebellar dysfunction and those that are due to abnormal afferent (ie, proprioceptive sensation) function. Drs Alfonso Fasano and Bastiaan R. Bloem next discuss the classification, clinical evaluation, pathophysiology, and treatment of disorders of gait-common and important causes of morbidity and mortality in patients with insults to the nervous system of many possible localizations and causes. In the final review article of the issue, Drs Morgante, Edwards, and Espay review the clinical features, diagnosis, and management of psychogenic movement disorders, including the newest insights into the pathophysiology of these symptoms; the authors also describe helpful characteristic clinical features and examination findings that can support this diagnosis rather than it being purely a diagnosis of exclusion.
In this issue’s Ethical Perspectives section, Drs James K. Fleming and David Charles discuss the ethical dilemma of responding to a patient’s request for off-label treatment with a medical device after trial involvement has ended, illustrating this with a hypothetical case of a request for deep brain stimulation for early-stage Parkinson disease. In the Practice section, Dr Andrew P. Duker reviews the practical issues that we all need to know with regard to video recording of our patients with movement (or other) disorders, given that videos have become an increasingly accessible and utilized tool for documenting our patients’ progress or for educational reasons. In fact, this issue is itself filled with excellent illustrative video examples of specific syndromes and case presentations, which are available as links on the online and tablet-based versions of the issue. Dr Allison Brashear and Ms Laura Bushong thoroughly outline the important issues involved in coding when using botulinum toxin for movement disorders.
As with each CONTINUUM issue, a number of opportunities exist for CME. Reading the material, answering the Multiple-Choice Questions crafted by Drs Joanne Lynn and Joseph Safdieh, and reviewing the subsequent discussions will assess and enhance your knowledge of the material, and you will be able to earn up to 10 AMA PRA Category 1 CME Credits™. An alternative opportunity allows you to obtain up to 12 AMA PRA Category 1 CME Credits specifically approved by the American Board of Psychiatry and Neurology (ABPN) for self-assessment by completing and submitting the Self-Assessment Pretest before reading the material and completing the postreading Multiple-Choice Questions. The Patient Management Problem, written by Dr Duker, describes the clinical diagnostic, genetic, and management issues in the case of a 37-year-old man presenting with a hyperkinetic movement disorder. By following his case and answering multiple-choice questions corresponding to important diagnostic, counseling, and therapeutic decision points along the course of his illness, you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits.
I thank Dr Espay and his authors for creating such a thorough and well-balanced CONTINUUM issue that will be of great benefit as we diagnose, counsel, and manage the many patients with disordered movement whom we encounter in our daily practices of clinical neurology.
-Steven L. Lewis, MD, FAAN