Movement Disorders

At the Boston Children’s Hospital Movement Disorders Program, we care for infants, children, and teens with movement disorders.

The neurologists and other specialists in our program are experienced in treating children with genetic and acquired movement disorders including dystonia, ataxia, chorea, myoclonus, tremor, parkinsonism, spasticity, and tic disorders.

Children with movement disorders have involuntary movements or trouble moving in the way they intend to. The term “movement disorders” is broad and includes a wide variety of conditions with a wide variety of causes. While children with paralysis also have difficulty moving, movement disorders are different in that the abnormal movements are “extra” or added on to movements children intend to make.

Movement disorders can affect single or multiple parts of the body, and may change in location and severity over time. The abnormal movements may happen on their own, or may occur only when the child is moving or trying to make a specific kind of movement. Sometimes the movements are more apparent at certain times of day or have specific triggers or situations that make them worse.

Types of movement disorders include:

Dystonia

In children with dystonia, faulty brain signals cause groups of muscles to contract abnormally. Rather than contracting in a coordinated way, muscles may contract in opposition to each other: both “push” and “pull” muscles are active at the same time, causing painful or uncomfortable twisting movements and awkward, contorting postures.

Dystonia is often triggered by specific actions, like writing or walking, but can also occur when the child is at rest. Symptoms often start in one part of the body, such as the hand, leg, or mouth, and then spread to other body areas.

Chorea

Children with chorea have irregular, flowing movements that are sometimes described as “dance-like.” Sometimes the movements are incorporated into motions the child intends to make. They can be slow and writhing, or more forceful. If chorea affects the legs, children may frequently stumble and have difficulty walking but rarely fall.

Tremor

Tremor is a rhythmic shaking or trembling of a limb. Tremor can occur at rest or during movement, and can occur alone or with other symptoms such as weakness of the limb and difficulty in fine-tuning movements.

Tremor sometimes runs in families. The most common inherited form is known as essential tremor.

Sometimes tremor is just a temporary part of a child’s motor development; in other cases, it may be long-lasting. Unlike most other movement disorders, children can sometimes consciously suppress tremors.

Myoclonus

Myoclonus is a movement disorder involving very quick, sudden, involuntary muscle jerks that the child cannot suppress. The jerks can be occasional or frequent, and may occur randomly or in a semi-rhythmic pattern. Myoclonus sometimes has triggers, like holding the body in a certain posture, being touched, or startled. In other cases, symptoms may seem to appear for no reason.

Myoclonus is often a benign condition with no long-term effect on a child’s health, but it is critical to be evaluated by a movement disorders specialist to identify the type of myoclonus and its cause.

Myoclonus may occur after a severe brain injury, or can result from a metabolic disorder or a neurodegenerative disease. It can also be part of a seizure disorder called myoclonic epilepsy, and for that reason, it’s often recommended that children with myoclonus be tested for epilepsy.

Parkinsonism

Children with parkinsonism have at least two symptoms of Parkinson disease: muscle rigidity, balance problems or frequent falls, slow movement, or tremor while at rest. By itself, parkinsonism is the least common movement disorder in children. Most often, the symptoms occur as a side effect of medications. Parkinsonism can also result from genetic conditions causing brain degeneration, such as Wilson disease, juvenile Huntington disease, and lysosomal disorders, and from various forms of brain injury.

Ataxia

Ataxia is a failure of motor coordination caused by injury or dysfunction of the cerebellum. Its symptoms are clumsiness, poor balance, irregularity of movements, and inability to perform fine-tuned or smooth movements.

Ataxia can have different patterns. Some cases begin abruptly, as a result of a stroke, inflammation, or infection, and typically get better as these causes are treated. Other types of ataxia repeatedly come and go, and are caused by epilepsy, genetic mutations, metabolic disorders, or atypical types of migraine.

Spasticity

Spasticity is an abnormal increase in muscle tone that results from disruption of the connections between nerve cells in the brain and spinal cord that control movements and muscle tone. It is also colloquially referred to as an unusual "tightness," stiffness, or "pull" of muscles. There are often other signs including strong muscle reflexes or a shaking movement upon passive stretch (called “clonus”). Spasticity of the legs can lead to an inability to walk and reliance on a wheelchair. While cerebral palsy is a common cause of spasticity, there are also a number of other acquired and genetic condition conditions that present with spasticity in childhood. Hereditary spastic paraplegia is a group of genetic conditions that present with progressive spasticity and, in many cases, other neurological symptoms including motor and speech delays.

Treatment of spasticity often requires an interdisciplinary approach and includes physical therapy, medications, and other procedures.

Tic disorders

Tics are sudden, involuntary movements or sounds that come and go over time. They are fairly common in children and usually can be treated by a general pediatrician. Muscle tics can involve any body part and may vary in severity — from very mild and hardly noticeable to very disruptive, frequent, and severe. Children are usually able to suppress tics, at least temporarily, but will feel a building sense of “wrongness” or “push” as they resist the tic.

If tics persist despite treatment, the child may need to see a specialist in movement disorders. About 10 to 15 percent of children will see their tics progress and become potentially disabling, but most tic disorders improve over time.

If a child has both vocal and motor tics that last longer than a year, they may have Tourette syndrome.

Functional neurological disorders

In addition to the above conditions, it is not uncommon for movement disorders in children to follow stressful life events. A condition known as functional neurological symptom disorder, sometimes called conversion disorder, can cause any of the movement disorders described above, even when no neurologic cause or condition can be identified.

Functional disorders also can occur in children with other neurological problems and make an existing movement disorder worse. The good news is most children recover from this type of movement disorder with retraining by physical therapists and continued supportive care from a neurologist. Children with functional neurological disorders benefit from joined care with a psychologist or psychiatrist.