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  1. I Bone,
  2. G N Fuller
  1. Correspondence to:
 Professor Ian Bone, Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TS, UK;

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Movement disorders are common. In the majority of patients the diagnosis will be straightforward—for example, idiopathic Parkinson's disease or essential tremor—and in these patients the main issues relate to management. In others difficulties in diagnosis as well as management arise; difficulties in distinguishing the common conditions from their mimics and correctly labelling more unusual movement disorders. In many of these the classifications are evolving as genetic and other findings redefine syndromes and diseases.

This supplement aims to help with the diagnosis and management of both the common and more unusual movement disorders. Peter Bain reviews the diagnosis and management of tremor. David Brooks considers the diagnosis of Parkinson's disease and focuses on the atypical parkinsonian syndromes and their diagnosis and management. Andrew Lees discusses odd and unusual movement disorders. Carl Clarke writes about the medical management of Parkinson's disease. The neuropsychiatric aspects of movement disorders, including those related to treatment, are covered by Belinda and Graham Lennox. Ralph Gregory evaluates surgical treatments for Parkinson's disease, and other movement disorders. David Nicholl tells us where to look on the web for the best sites.

There are two limitations that run through this supplement. Firstly, movement disorders is a difficult subject to approach on paper as much is inevitably lost in the written description of abnormal movements. This cannot be remedied here, but sources of useful teaching video material are provided below. Secondly, many of the current practices within movement disorders are not based on extensive trials but on smaller case series or expert advice. The Cochrane Collaboration is drawing together such trial evidence as exists.



  • Movement disorders in clinical practice (with CD-ROM). Sawle G, ed. Oxford: Isis Medical Media Ltd, 1999.

Movement disorders need to be seen, and this CD makes it possible.

  • Movement Disorders, 3 volumes. Marsden CD, Fahn S, eds. Oxford: Butterworth-Heinemann, 1984,1987,1994.

Diagnosis and classification

  • Consensus statement of the Movement Disorder Society on tremor. Deuschl G, Bain PG, Brin M, and an Ad Hoc Scientific Committee. Movement Disorders 1998;13(suppl 3):2–23.

  • Accuracy of the clinical diagnosis of corticobasal degeneration: a clinicopathological study. Litvan I, Agid Y, Goetz C, et al. Neurology 1997;48:119–25.

  • Diagnosis and management of progressive supranuclear palsy. Litvan I. Semin Neurol 2001;21:41–8.

  • Consensus statement on the diagnosis of multiple system atrophy. Gilman S, Low PA, Quinn N, et al. J Neurol Sci 1999;163:94–8.

Valuable publications that provide expert opinion on the diagnostic criteria of these difficult and infrequently encountered disorders.


  • A prevalence study of primary dystonia in eight European countries. The Epidemiological Study of Dystonia in Europe (ESDE) Collaborative Group. J Neurol 2000;247:787–92.

  • Epidemiology of Parkinson's disease and akinetic syndromes. Tanner CM, Aston DA. Curr Opin Neurol 2000;13:427–30.

  • Cross sectional prevalence survey of idiopathic Parkinson's disease and parkinsonism in London. Schrag A, Ben-Shlomo Y, Quinn NP. BMJ 2000;321:21–2.

  • Prevalence of progressive supranuclear palsy and multiple system atrophy. Schrag A, Ben-Shlomo Y, Quinn NP. Lancet 1999;354:1771–5.

These papers address the methodological difficulties in obtaining data and provide information that will help plan provision of specialist services

Treatments and useful reviews

  • Pharmacological and surgical options for the treatment of cervical dystonia. Adler CH, Kumar R. Neurology 2000;55(12 suppl 5):S9–14.

This is a recent review of the role of botulinum toxin in dystonia and other movement disorders, which has not been discussed in this supplement.

  • Recent advances in atypical parkinsonian disorders. Litvan I. Curr Opin Neurol 1999;12:441–6.

  • Clinical Lewy body syndromes. McKeith I G. Ann NY Acad Sci 2000;920:1–8.

These recent overviews will update the trainee on difficult and advancing areas of knowledge.

Measuring movement disorders

  • How does Parkinson's disease affect quality of life? A comparison with quality of life in the general population. Schrag A, Jahanshahi M, Quinn NP. Movement Disorders 2000;15:1112–8.

Gives useful insights to what we do not usually assess or are uncertain how to measure in our clinics.

  • Parkinsonism, onset, progression and mortality. Hoehn MM, Yahr DM. Neurology 1967;17:427–42.

Seminal study that introduces us to the rating scale that bears their names.

  • Rating scales in Parkinson's disease. Martinez-Martin P, Bermejo-Pareja F. In: Jankovic J, Tolosa E, eds. Parkinson's disease and movement disorders, Munich: Urban & Schwarzenberg, 1988:235–42.

Despite difficulties in accessing, this remains a definitive account of rating scales such as the Webster rating scale and the widely used unified Parkinson's disease rating scale (UPDRS).


  • Guidelines for the management of Parkinson's disease. Bhatia K, Brooks D, Burn D, et al. Hospital Medicine 1998;59:469–80.

  • An algorithm (decision tree) for the management of Parkinson's disease (2001): treatment guidelines. Olanow C, Watts R, Koller W. Neurology 2001;56(suppl 5):S1–88.

Cochrane corner

  • Parkinson's disease. Moore AP, Clarke C. Clinical Evidence 2001;5:906–15.

This summarises the evidence derived from systematic reviews and randomised controlled trials relating to the treatment of Parkinson's disease.


  • Genetics of parkinsonism: a review. Vaughan JR, Davis MB, Wood NW. Ann Human Genet 2001;65:111–26.

An up to the moment account of an ever increasing and exciting area.

The best source of information on the genetics of Parkinson's disease and related conditions can be found at the Online Mendelian Inheritance in Man at


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