Overview of movement abnormalities in palliative care
Patients with palliative care needs can experience a wide range of movement abnormalities including ataxia, tremor, tics and dystonia. These movements may involve impaired coordination, increased or reduced activity and be voluntary or involuntary. Potential causes of movement abnormalities include:
- neurological disorders (eg Parkinson disease, Huntington disease)
- cerebellar disease (eg alcohol-related)
- drug adverse effects
- cancer complications (eg tumours involving areas of the brain controlling movement, paraneoplastic syndromes, spinal cord compression)
- delirium
- generalised weakness and muscle atrophy
- metabolic disturbance
- cerebrovascular disease
- peripheral neuropathy.
Drugs are a common cause of movement abnormalities in patients with palliative care needs:
- Dopamine antagonists (eg haloperidol, prochlorperazine, metoclopramide) are particularly problematic because they can cause extrapyramidal adverse effects.
- Antipsychotics are a leading cause of neuroleptic malignant syndrome; for diagnosis and treatment, see the Toxicology and Toxinology guidelines.
- Serotonergic drugs (eg selective serotonin reuptake inhibitors [SSRIs], some opioids) can cause serotonergic toxidrome—for a list of drugs commonly associated with serotonergic toxidrome, diagnosis and treatment, see the Toxicology and Toxinology guidelines.
- Aminoglycosides and antiepileptics (eg phenytoin, carbamazepine, gabapentin) can cause ataxia.
For management of myoclonus, see Myoclonus in palliative care.
Manage movement abnormalities by addressing reversible contributing or causative factors. In some cases, treatment of the cause may not be available or effective, or may not be appropriate because of the patient’s overall condition. Follow the principles of symptom management when managing movement abnormalities in palliative care. The Neurology guidelines provide advice on management of different movement disorders.
Patients with ongoing movement abnormalities, particularly ataxia, are at risk of falls and functional decline—management by a multidisciplinary team to reduce these risks is recommended. Also consider seeking specialist advice. Ataxia due to solitary mass lesions in the cerebellum may benefit from surgical excision or radiotherapy.