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Semin Neurol 2023; 43(01): 002-003
DOI: 10.1055/s-0043-1762913
Preface

Introduction to Diagnostic Challenges in Movement Disorders

Abhimanyu Mahajan
1   Rush Parkinson's Disease and Movement Disorders Program, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
,
Ludy C. Shih
2   Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
3   Boston Medical Center, Boston, Massachusetts
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Abhimanyu Mahajan, MD, MHS
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Ludy C. Shih, MD, MMSc, FAAN, FANA

In recent history, the demise of the clinical neurologist was first predicted in the early 1970s with the advent of the computed tomography scan.[1] Answers to localization and presence of structural abnormalities including ischemic stroke and hemorrhage could be answered by direct visualization of the brain, thereby rendering the clinician's input ancillary, at best. Instead, clinicians incorporated available modalities into their repertoire and enabled major treatment advances. A stellar example would be in stroke care, where such an approach led to eventual use of thrombolysis to minimize disability in the mid-90s and eventually, incorporation of endovascular treatments to reverse deficit in the last few years.[2]

The clinical diagnostician is as pertinent in the field of movement disorders as any, where clinical diagnosis is regarded as the gold standard to appropriate clinical care.[3] [4] With an aging population and projected increase in neurological disorders, and fewer than 5 neurologists per 100,000 people in the United States and even fewer elsewhere,[5] [6] [7] [8] it is critical that diagnostic skills be correctly taught, discussed, and shared to provide care to patients perhaps seeing us in clinic on the worst day of their lives. It is therefore important that our skills in diagnosis not only be celebrated and passed on from one generation to the next, but also constantly revisited and perfected. The field of movement disorders, like others in medicine, is ripe with silos, gaps, and overlap between disorders. Accurate diagnosis, when delivered the correct way, can be therapeutic in its own right. It can lead to symptomatic treatment, prognostication, and better informed counseling. Clinical diagnosis in movement disorders can inform the development of validated scales and personalized symptomatic therapies. In addition, recent developments in imaging methods, neurophysiology, and genetics offer the chance for the clinician to incorporate the latest advances in biomedical research.

Throughout this issue, we bring together a wonderful collection of movement disorder experts to discuss diagnostic challenges in various movement disorders. We present diagnostic approaches to movement disorders, including but not limited to ataxia, chorea, tremor, and functional neurological disorders. We discuss the use of investigational modalities such as neuroimaging in parkinsonism. We further discuss current gaps, approaches to address them in the clinic, and attempt to foresee what the near future might bring. We highlight contemporary clinical issues such as the ethics of diagnosing prodromal movement disorders and the appropriate application of genetic testing in clinical care. Finally, we briefly discuss the current and imagined utility of investigational methods including wearables and genetics in the diagnostic process and, through collaboration, the possibility of a new future in movement disorders and health care.

The clinician–patient relationship remains at the core of medicine and health care. The evolved clinician must aim for the diagnostic prowess of Charcot, the humanistic principles of Osler, and embrace credible new investigational methods to continue to be at the vanguard of clinical care of their patients.[9] [10]



Publication History

Article published online:
17 February 2023

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