Introduction: Movement Disorders: Merck Manual Home Edition


	Section		Brain, Spinal Cord, and Nerve Disorders

	Subject		Movement Disorders

Introduction

Every body movement, from raising a hand to smiling, involves a complex interaction between the central nervous system (brain and spinal cord), nerves, and muscles. Damage to or malfunction of any of these components may result in a movement disorder.

Different types of movement disorders can develop, depending on the nature and location of the damage or malfunction, as in the following:

Damage to the parts of the brain that control voluntary movement or the connections between the brain and spinal cord: Weakness or paralysis of the muscles involved in voluntary movements and exaggerated reflexes
Damage to the basal ganglia (collections of nerve cells located at the base of the cerebrum, deep within the brain): Involuntary or decreased movements, but not weakness or changes in reflexes
Damage to the cerebellum: Loss of coordination

Some movement disorders, such as hiccups, are temporary, usually causing little inconvenience. Others, such as Parkinson's disease, are serious and progressive, impairing the ability to speak, use the hands, walk, and maintain balance when standing.

Hiccups: Spasms of the Diaphragm

Almost everyone has had hiccups, so hiccups are hardly thought of as a movement disorder. But they are. They occur when there are spasms of the diaphragm, followed by quick, noisy closings of the glottis. (The diaphragm is the muscle that separates the chest from the abdomen and that is responsible for each breath. The glottis is the opening between the vocal cords, which closes to stop the flow of air to the lungs.) Hiccups are more likely to occur when carbon dioxide levels in the blood decrease. Such a decrease can occur when people hyperventilate.

Most bouts of hiccups have no obvious cause. They usually start in a social situation, perhaps triggered by some combination of laughing, talking, eating, and drinking. Sometimes hot or irritating food or liquids are the cause. Some less common causes of hiccups are more serious. For example, the diaphragm may become irritated because of pneumonia, chest or stomach surgery, or waste products that accumulate in the blood when the kidneys malfunction. Rarely, hiccups develop when a brain tumor or stroke interferes with the breathing center in the brain.

Hiccups usually begin suddenly and stop after several seconds or minutes, but occasionally, they persist for some time, even in healthy people. When the cause is serious, hiccups tend to persist until the cause is corrected. Hiccups due to a brain tumor or stroke may be very hard to stop and may become exhausting.

Many home remedies have been used to cure hiccups. Most involve ways to raise the level of carbon dioxide in the blood, such as the following:

Holding the breath
Breathing into a paper (not plastic) bag

Stimulating the vagus nerve, which runs from the brain to the stomach, may stop the hiccups. The following can stimulate this nerve:

Drinking water quickly
Swallowing dry bread or crushed ice
Gently pulling on the tongue
Gently rubbing the eyeballs

For most people with hiccups, any of these remedies work.

For persistent hiccups, treatment is needed, particularly when the cause cannot be easily corrected. Several drugs have been used with varying success. They include scopolamine, prochlorperazine, chlorpromazine, baclofen, metoclopramide, and valproate.

Last full review/revision August 2007 by David Eidelberg, MD; Michael Pourfar, MD