Movement disorders can be divided into hypokinetic disorders, manifested by paucity or slowness (bradykinesia) of movement, hyperkinetic disorders, dominated by excessive, abnormal involuntary movements, hypertonic disorders, such as spasticity and stiff person syndrome, and ataxia dominated by incoordination of movement (see Table 26.1). While in most patients the movement disorder is dominated by either parkinsonism, usually caused by Parkinson’s disease (PD), or some involuntary movement such as tremor, dystonia, chorea, tics, myoclonus, or stereotypy (Jankovic 2009a), non-motor, autonomic, or systemic features may accompany the primary motor disorder. In this chapter we will focus on respiratory problems encountered by patients with movement disorders and provide a guide to the clinical diagnosis, classification, and treatment.
Hypokinetic movement disorders
Hypokinetic movement disorders are divided into classical PD and atypical parkinsonism (also referred to as parkinsonism plus syndromes). Compared to PD patients, patientswith atypical parkinsonism usually lack the typical rest tremor, and tend to have a poor response to levodopa and a more rapid progression, as well as additional (“plus”) features, such as ophthalmoparesis in progressive supranuclear palsy (PSP) and dysautonomia in multiple system atrophy (MSA) (Fahn et al. 2011).