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Cranial movement disorders: clinical features, pathophysiology, differential diagnosis and treatment

Nature Clinical Practice Neurology volume 5, pages 93–105 (2009)Cite this article

Abstract

Cranial movement disorders are a common neurological problem. These disorders can be limited to the cranial muscles alone or manifest as part of a more generalized movement disorder. Cranial movement disorders can originate from the highest (motor cortex) to the lowest (cranial nerve and muscle) levels of the motor system. Owing to the lack of diagnostic tests and biomarkers for these disorders, their differential diagnosis can be difficult even for the experienced neurologist. Advances have, however, been made in the identification and treatment of these conditions, and most can be managed effectively with appropriate knowledge of the diagnostic signs and effective treatments. Here, we review the clinical features, pathophysiologies and therapies of the main movement disorders that affect the face, jaw, tongue and palate.

Key Points

  • Cranial movement disorders can be specific to the facial muscles or part of a generalized movement disorder

  • Cranial movement disorders can be generated by peripheral or central mechanisms

  • Neurophysiological and neuroimaging studies provide important insight into the pathophysiology of these disorders

  • The differential diagnosis of cranial movement disorders is made mainly on the basis of clinical characteristics, although neurophysiological and neuroimaging studies can also be of help

  • Treatment of the underlying disorder is mandatory when cranial movement disorders are part of a generalized disease

  • Botulinum neurotoxin is an effective symptomatic treatment in most focal cranial movement disorders

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Figure 1: Images of a patient affected by blepharospasm.

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Acknowledgements

All authors contributed equally to the finished article.

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Authors and Affiliations

  1. G Fabbrini and C Colosimo run the Movement Disorders Clinic at the Department of Neurosciences and Neuromed Institute, “Sapienza” University of Rome, Rome,

    Giovanni Fabbrini & Carlo Colosimo

  2. G Defazio is Associate Professor of Neurology at the University of Bari, Bari, Italy.,

    Giovanni Defazio

  3. PD Thompson is full Professor of Neurology in the University Department of Medicine, Australia and President-Elect of the Movement Disorders Society. A Berardelli is full Professor of Neurology in the Department of Neurological Sciences and Neuromed Institute, Royal Adelaide Hospital, Adelaide, “Sapienza” University of Rome, Rome, Italy and Chairman of the European Section of the Movement Disorders Society.,

    Philip D Thompson & Alfredo Berardelli

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  1. Giovanni Fabbrini
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  2. Giovanni Defazio
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  3. Carlo Colosimo
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  4. Philip D Thompson
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  5. Alfredo Berardelli
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Correspondence to Alfredo Berardelli.

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Fabbrini, G., Defazio, G., Colosimo, C. et al. Cranial movement disorders: clinical features, pathophysiology, differential diagnosis and treatment. Nat Rev Neurol 5, 93–105 (2009). https://doi.org/10.1038/ncpneuro1006

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