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Approach to History Taking and Examination of the Movement Disorder Patient 

Approach to History Taking and Examination of the Movement Disorder Patient
Chapter:
Approach to History Taking and Examination of the Movement Disorder Patient
Author(s):

David J. Burn

DOI:
10.1093/med/9780199609536.003.0002
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date: 26 February 2020

Movement disorders can be classified into akinetic–rigid and hyperkinetic categories. The value of a systematic approach to history taking and examination cannot be overstated. For example, taking a detailed family and drug history, or paying close attention to the saccadic eye movements, often produces important information. Cognitive and neuropsychiatric features commonly accompany movement disorders, are often not spontaneously volunteered, and therefore should always be screened for. Sadly, there appears to be an increasing over-reliance on ordering tests indiscriminately in the diagnostic quest, often at the expense of a thorough clinical evaluation. Such an approach is likely to have a low yield, to be potentially misleading, and also to be costly. The key to accurate diagnosis lies in identifying the phenomenology of the movement disorder, set in the context of the historical information obtained (e.g. rate of onset, progression, use of offending drugs), and whether there are additional physical signs to be elicited from the general medical or neurological examination that further narrow down the differential (e.g. organomegaly, eye movement disorder, reflex changes). For intermittent, situational, or task-specific movement disorders, asking the patient to make a video recording on their mobile phone or other device can be invaluable. Alternatively, bringing the relevant piece of equipment to the consulting room (such as a golf club, guitar, etc.) can be illuminating. The implications for other family members should always be borne in mind when undertaking genetic testing. Management should be incremental, engaging the patient in therapeutic decisions wherever possible.

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