Surgical management of movement disorders
Movement disorders are usually treated by neurologists, and appropriately so. The first-line management of all conditions that are grouped together as movement disorders (e.g. Parkinson’s disease, dystonia, essential tremor) is with medication and, in some, with rehabilitative strategies, such as occupational therapy, physiotherapy and even psychotherapy. In general, if these strategies fail or have undesirable consequences, surgery would become an option. Intramuscular injection of botulinum toxin is also very useful in the focal dystonias, such as writer’s cramp, and in the occupation-specific dystonias, such as musician’s dystonia or hairdresser’s dystonia. The limiting factor is the total safe dosage allowed. One cannot inject every muscle involved in all four limbs in a patient with generalised dystonia. This has led to surgery being offered as therapy in certain cases where there have previously not been any alternatives. Surgery does not offer curative procedures for movement disorders, but long-term control with medication is possible, often with significant reduction or complete cessation of symptoms.