Case Studies in Movement Disorders

Virgilio Gerald H. Evidente, MD; John N. Caviness, MD; Charles H. Adler, MD, PhD


Semin Neurol. 2003;23(3) 

In This Article


Six cases representing the most commonly encountered movement disorders—restless legs syndrome with periodic limb movements, tics, myoclonus, chorea, essential tremor, and cervical dystonia—are presented. Discussion of each case focuses on a practical approach to recognizing the important clinical features of each movement disorder as well as the current therapeutic options. A detailed discussion of botulinum toxin follows the case on cervical dystonia, focusing on its mechanism of action, clinical indications, side effects, and dosing.

Objectives: Upon completion of this article, the reader will recognize the important clinical features of restless legs syndrome, Tourette's syndrome, myoclonus, Huntington's disease, and essential tremor as well as the current therapeutic options for these and the rationale and therapeutic uses of botulinum toxins.
Accreditation: The Indiana University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit: The Indiana University School of Medicine designates this educational activity for a maximum of 1 Category 1 credit toward the AMA Physicians Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.
Disclosure: Statements have been obtained regarding the author's relationships with financial supporters of this activity. There is no apparent conflict of interest related to the context of participation of Drs. Evidente and Caviness. Dr. Adler is a consultant for GSK, Pharmacia, and Elan, and has received research support from GSK, Pharmacia, Teva, Elan, and Allergan. The authors acknowledge the discussion of unlabeled use of the following products in this article: for restless legs syndrome, off-label treatment with dopamine agonists, gabapentin, benzodiazepines, amantadine, and zolpidem; for Tourette's syndrome, off-label treatment with clonidine, benzodiazepines, neuroleptics, dopamine agonists, reserpine, tetrabenazine, and botulinum toxin; for myoclonus, off-label treatment with clonazepam, primidone, and trihexyphenyl; for chorea, off-label treatment with clonazepam, dopamine agonists, and dopamine-depleting agents.