Curriculum standards
Knowledge guides
LG23: Movement disorders
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations – hyperkinetic
- Athetosis
- Ballism
- Chorea
- Dystonia
- Fasciculations
- Myoclonus
- Myokymia
- Myorhythmia
- Stereotypies
- Tics
- Tremor
Presentations – hypokinetic
- Bradykinesia
- Catatonia
- Freezing
- Parkinsonism
- Postural instability
- Rigidity
Conditions – psychological
- Conversion disorder
- Malingering
Conditions – specific hyperkinetic disorders
- Adult-onset focal dystonia
- Blepharospasm
- Cervical dystonia
- Episodic ataxia
- Facial dystonia
- Functional movement disorder
- Generalised dystonia
- Hemifacial spasm
- Huntington disease
- Myoclonus dystonia
- Tourette syndrome
- Tremors:
- drug-induced
- dystonic
- essential
- essential tremor plus
- functional
- palatal
- systemic / metabolic causes
- Wilson disease
- Writer’s cramp
Conditions – specific hypokinetic conditions
- Corticobasal syndromes
- Dementia with Lewy bodies
- Drug-induced Parkinsonism
- Functional neurological disorder
- Multiple system atrophy
- Normal pressure hydrocephalus
- Parkinson disease
- Progressive supranuclear palsy
- Stiff person syndrome
- Vascular parkinsonism
Conditions – other
- Functional neurological disorder
- Prion disease
- Stiff person syndrome
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Hereditary ataxia syndromes, including:
- spinocerebellar ataxias
- Metabolic causes of movement disorders
- Paroxysmal dyskinesias:
- exercise-induced
- kinesogenic
- non-kinesogenic
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Acute, chronic, common, and rare diseases that cause disorders of movement
- Neuroanatomy, neuropharmacology, and neurophysiology of the motor pathways
Cerebrospinal fluid (CSF) procedures and investigations
- Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
- cell count
- cytology
- cytometry
- immunological tests
- microbiological tests
- protein level
- sugar level
- opening pressure
- special tests:
- 14-3-3 protein
- real-time quaking induced conversion (RT-QuIC)
- basic CSF analysis:
Neurogenetic investigations
- Genetic testing, including, but not limited to:
- chromosomal testing, such as:
- karyotype
- microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
- chromosomal testing, such as:
- Referral to a neurogeneticist
Neuroimaging investigations
- CT, including:
- CT angiography
- perfusion
- venography
- Dopamine uptake transporter (DAT)
- MRI, including:
- functional (fMRI)
- magnetic resonance:
- angiography (MRA)
- spectroscopy (MRS)
- venogram (MRV)
- with contrast
- Myelography
- PET
- Single photon emission computed tomography (SPECT)
- Vascular imaging:
- catheter angiography
- Doppler ultrasound
Neuroimmmunology investigations
- Autoantibody measurement:
- antinuclear antibodies (ANA)
- anti-amphiphysin, anti-GAD, and anti-glycine antibodies
- anti-phospholipid antibody testing
- double-stranded DNA (dsDNA)
- extractable nuclear antigens (ENA) antibody testing
- Referral to a neuroimmunologist
Neuropathology investigations
- Brain biopsy
Neuropsychological investigations
- Cognitive screening:
- Mini-Mental State Examination
- Montreal Cognitive Assessment
- Referral to a neuropsychologist
Other investigations
- Other laboratory tests:
- acanthocytes
- B12 level
- copper
- fasting lipid profile
- iron studies
- serum angiotensin converting enzyme
- thrombophilia screen
- urinary porphyrins
- Polysomnography
- Overlap with other allied health and medical specialties, such as geriatrics, medical genetics, physiotherapy, and rehabilitation medicine, and when it is appropriate to refer
- Prognosis and implications of these disorders