Dr Susan H. Fox has brought together an outstanding group of experts in the field of movement disorders who provide their authoritative but flexible approaches to the diagnosis and management of each of the many disorders of movement we may encounter in clinical practice.
This issue of Continuum is devoted to the diagnosis and management of our patients with movement disorders. Dr Susan H. Fox, associate professor of neurology at the University of Toronto and associate director of the Movement Disorder Clinic at Toronto Western Hospital, has brought together an outstanding group of experts in the field of movement disorders who provide their authoritative but flexible approaches to the diagnosis and management of each of the many disorders of movement we may encounter in clinical practice.
The issue begins with the article by Drs Christopher W. Hess and Michael S. Okun who review the approach to the clinical diagnosis of Parkinson disease (PD), emphasizing how the neurologic history and examination, informed by knowledge of clinical diagnostic criteria, can help establish PD or suggest alternative diagnoses. Drs John C. Morgan and Susan H. Fox then discuss the various current pharmacologic and nonpharmacologic approaches to treating the motor symptoms of PD, using prototypical case examples to help inform us about how to optimize and tailor treatment strategies to the individual needs of our patients. Next, Dr Jennifer G. Goldman summarizes the diagnosis and current approaches to management of the neuropsychiatric issues that frequently occur in patients with PD, including disorders of mood, cognition, and behavior. Dr Janis M. Miyasaki then reviews the recognition and management of the many nonmotor symptoms that may occur in PD and related movement disorders, highlighting the importance of these symptoms as they affect the quality of life of our patients, especially as their diseases advance. Dr Miyasaki also stresses the importance of the neurologist being involved and engaged in symptom management and palliative approaches to our patients with advanced disease.
Moving on from the articles primarily about PD, Dr Nikolaus R. McFarland reviews the diagnosis and management of the atypical parkinsonian syndromes, including progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration, and addresses how their distinctive (although overlapping) clinical features can help distinguish them from PD. Dr Elan D. Louis next discusses the clinical approach to the categorization, diagnosis, and management of patients with any of the various tremor disorders who may present for our care.
Drs Manju A. Kurian and Russell C. Dale provide an overview of the diagnosis and management of the multitude of acquired and genetic movement disorders that may present in childhood. Turning back toward adults, Dr Tiago A. Mestre reviews the approach to the diagnosis and management of patients with disorders manifesting with chorea as a clinical sign, including Huntington disease and the many other genetic and acquired choreic syndromes. Drs Tetsuo Ashizawa and Guangbin Xia next discuss their approach to the clinical assessment, classification, diagnosis, and laboratory investigation of patients with ataxia. In the subsequent article, Drs Vicki Shanker and Susan B. Bressman review the clinical phenomenology, classification, and the diagnosis and treatment of patients with dystonia.
In the final review article of the issue, Dr Ronald F. Pfeiffer discusses the most current approaches to the diagnosis and treatment of Wilson disease, a disorder that is so important to keep in mind when seeing any patient with unexplained neurologic or psychiatric (or hepatic) dysfunction since it is treatable and reversible if caught early but progressive and irreversible if not.
In the Ethical Issues article, Dr Thomas I. Cochrane dissects the ethical considerations involved in the decision whether to order preclinical dopamine transporter imaging in the hypothetical case of a 52-year-old man with a family history of PD who is requesting such testing. Drs Allan D. Wu, Dawn Eliashiv, and Marc Nuwer present two cases to illustrate their discussion of the various considerations neurologists need to be aware of with regard to diagnostic coding for chemodenervation procedures.
As with every issue of Continuum, a number of opportunities exist for CME. By taking the Postreading Self-Assessment and CME Test, written by Drs James W. M. Owens Jr and Joseph E. Safdieh, after reading the issue, you may earn up to 12 AMA PRA Category 1 CreditsTM toward self-assessment and CME. The Patient Management Problem, written by Dr Fox, describes the case of a 70-year-old woman who presents with a 6-month history of abnormal mouth and truncal movements and vocalizations. By following her case and answering multiple-choice questions corresponding to diagnostic and management decision points along the course of her disorder, you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits.
I want to sincerely thank Dr Fox for her thoughtfulness, dedication, responsiveness, collegiality, and hard work beginning from the development and organization of this issue and culminating in its publication. Thanks also to each of the expert authors in this issue for providing the readers of Continuum with the benefit of their clinical experience and expertise so that we can use their insights to inform our own individualized approaches to the clinical diagnosis and treatment of our patients with movement disorders.
—Steven L. Lewis, MD, FAAN