This issue of Continuum is devoted to the diagnosis and management of our patients with movement disorders, whether hypokinetic (eg, Parkinson disease and other parkinsonian disorders) or hyperkinetic (eg, chorea, tremors, and myoclonus). My sincere thanks go to Dr Elan D. Louis for so graciously accepting my invitation to be the guest editor for this issue, and especially since he interrupted his academic-year sabbatical to devote the immense amount of time and effort required to edit a successful Continuum issue.
The issue begins with articles on the primarily hypokinetic movement disorders, starting with one by Dr Theresa A. Zesiewicz, who informs us about the most current approach to the diagnosis and optimal management of our patients with idiopathic Parkinson disease. Next, Dr Paul Greene discusses the pathologic underpinnings, clinical features, and diagnosis of progressive supranuclear palsy, corticobasal degeneration, and multiple system atrophy. Although these three neurodegenerative disorders have been historically—and still occasionally—referred to as Parkinson plus syndromes (a term that seems to have devolved from the somewhat more apt term parkinsonism plus1), this arguably archaic moniker has been “subtracted” from Continuum since these (not uncommon) disorders are not related to Parkinson disease and are distinct diseases that are diagnosable by their classic and unique clinical and pathologic features.
The issue then turns to the hyperkinetic movement disorders, starting with the article by Dr Harvey S. Singer, who reviews the diagnosis and management of patients with tics and Tourette syndrome. This is followed by the article by Dr Louis, who discusses the diagnosis and management of our patients with tremor, whether predominantly action or resting. Dr H. A. Jinnah then reviews the diagnosis and management of the many disorders characterized by the presence of dystonia.
Dr Pichet Termsarasab next reviews the disorders that present with chorea, including Huntington disease and various other choreic disorders, including those that may resemble Huntington disease. Dr Sheng-Han Kuo then provides us with a practical approach to the diagnosis and management of the ataxias. In the article that follows, Dr John N. Caviness provides us with an approach to the categorization, diagnosis, and management of the various forms of myoclonus we can encounter in our practices.
Dr Joseph H. Friedman then reviews the diagnosis and current approaches to management of the tardive syndromes, potentially debilitating syndromes that unfortunately remain a significant public health problem due to exposure to any of the currently available dopamine receptor–blocking agents. Drs Toni S. Pearson and Roser Pons next provide a thorough review of the diagnosis and management of the many movement disorders that may occur in childhood. In the final review article of the issue, Drs Mary Ann Thenganatt and Joseph Jankovic share their expertise in the diagnosis and management of functional (ie, psychogenic) movement disorders, including identification of those positive clinical features that should suggest the diagnosis.
In this issue’s Medicolegal Issues article, Dr Joseph S. Kass and Ms Rachel V. Rose present a hypothetical case of a new patient requesting a refill for a long-standing prescription for metoclopramide as a springboard for a discussion about ways to mitigate a physician’s liability when prescribing medications with potentially serious long-lasting side effects such as tardive dyskinesia.
After reading the issue and taking the Postreading Self-Assessment and CME Test written by Drs Adam G. Kelly and Allison L. Weathers, you may earn up to 20 AMA PRA Category 1 CreditsTM toward self-assessment and CME or, for Canadian participants, a maximum of 20 hours toward the Self-Assessment Program (Section 3) of the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. Additional credit can be obtained by listening to Continuum Audio interviews associated with this and other Continuum issues, available to all subscribers, and completing tests on the Continuum Audio web platform or mobile app. Continuum Audio is also accredited by the Royal College of Physicians and Surgeons of Canada.
My deepest appreciation to Dr Louis for his expert guest editorship of this wonderful issue from its inception. I would also like to thank him for his remarkable attentiveness to the details required in such an issue and for enlisting such internationally expert authors in the field of movement disorders to assist us in the diagnosis and management of the many patients with any of the wide and sometimes perplexing variety of movement disorders who present to us.
—STEVEN L. LEWIS, MD, FAAN