What is Bradykinesia? Bradykinesia Meaning [8 causes]

After reading what your doctor has written, you may wonder: What is Bradykinesia?

The meaning of the medical term Bradykinesia is “slowness of movement”. A person with bradykinesia walks, talks, eats and even blinks slowly (see video below).

If a person does not move at all, it is called “Akinesia”.

The most common cause of Bradykinesia (meaning slowness of movement) & Akinesia is Parkinson’s disease.

Doctors test for bradykinesia by asking the patient to do various tasks. These tests include tapping fingers rapidly.

The treatment for bradykinesia depends on the cause. A medication called levodopa can reduce bradykinesia in Parkinson’s disease.

Let us know more:

What is Bradykinesia, Hypokinesia and Akinesia?

These words are from the Greek language.

Bradykinesia:

Brady means slow. Kinesia means movement. So Bradykinesia means “slow movements”.

Here is a video of  a bradykinetic patient, being examined by Dr. Niall Turbidy from the University of Dublin. Most importantly, notice how the lady’s is walking slower than usual. This is called Bradykinesia.

Hypokinesia:

Hypo means little or reduced. When a patient does not move much, he/she is said to have hypokinesia.

Akinesia:

A means absent. Akinesia means loss of some or all movements. For example, loss of blinking or normal arm swinging while walking.


Bradykinesia, Hypokinesia and Akinesia have slightly different meanings.

But since they are similar, many doctors use only one word in their note.

The most popular word is “Bradykinesia”.

So when doctors write the word Bradykinesia (meaning simply “slowness of movement”), they indicate that the patient has all 3 symptoms described above.

Some doctors may prefer to write “Akinesia” or “Akinetic syndrome” instead.

Reference / Extra reading:
1. Marsden’s textbook of Movement disorders
This is the “bible” of movement disorder specialists. Although possibly too complex for individual patients, Chapter 3 and Section 3 in the book beautifully describe the terms discussed here.

2. The terminology of Akinesia, Bradykinesia & Hypokinesia – Schidler 2017

This paper describes how the meaning and usage of these terms has evolved. A fascinating read, but very detailed.

Difference between bradykinesia and Dyskinesia
Even though they sound similar, bradykinesia and dyskinesia have very different meanings.

Dys means “bad”. Dyskinesia means excessive “bad” movements. Usually, these bad movements are jerky dance-like movements of the limbs.

Treatment with certain medications like levodopa can cause Dyskinesias of the limbs. Some psychiatric medications can cause excessive facial movements, called “Tardive dyskinesia”.

What does bradykinesia feel like?

You may have the following symptoms of Bradykinesia.

You may yourself notice these Bradykinesia symptoms. Sometimes, it is your friends who might bring your slowness of movement to your attention.

In the morning, when you are trying to stand up from the bed and walk, your feel might feel stuck to the ground. It may take longer to take a bath and get dressed.

Doing fine tasks like buttoning of shirts and writing may be difficult. Doing any movement may need you to make an extra mental effort.

You may get left behind when walking in a group. Your spouse may complain of you taking too long to get ready.

Patients with Parkinson’s disease can get “left behind” when walking in a group, because they walk slowly.

 

It is easy to attribute bradykinesia to ageing. This is a mistake.

Early evaluation by a doctor is critical. A doctor can confirm bradykinesia, and treat it in time.

How do doctors test for bradykinesia?

Tests for bradykinesia do not need special instruments.

The doctor will ask you to perform certain tasks. Some of these are:

Tests for Bradykinesia
  1. Tapping your fingers together as fast as you can
  2. Opening and closing your fist rapidly
  3. Turning your palm up and down – like flipping a pancake – as fast as you can
  4. Tapping your toes or heel on the floor – as fast as you can

During this time, the doctor notices:

  • How long it takes for you get started
  • How fast you are able to do the movement
  • Whether the movements become smaller after a few seconds….

and so on….

Here is an excellent video of Dr. Kathleen Poston from Stanford University demonstrating the tests done for bradykinesia.

If you take a long time to start moving, the doctor may suspect Akinesia. If you have slow movements, the doctor may suspect bradykinesia….

As noted before, your doctor may write a single phrase (for example “akinetic syndrome”) to describe all these symptoms.

Reference / Extra reading:
1. Neupsykey – Approach to the hypokinetic patient.
A detailed description of what doctors check in a hypokinetic/bradykinetic patient.

I think, now we know the answer to the question: What is Bradykinesia?

Let us look to an even more important question: What causes Bradykinesia?

What are the 8 causes of bradykinesia?

Parkinson’s disease is the most common cause of Bradykinesia.

Bradykinesia meaning simply, slowness of movement, may also be due to other causes.

Some patients who walk slowly may not have “true”-bradykinesia at all! They may be walking slowly because they are afraid of falling down. This “cautious gait” is due to a problem in the balance system of the body.

Thus, it is very important for the doctor to confirm that you have “true”-bradykinesia.

Even if you do have truly slow movements, you may not have Parkinson’s disease.

There are 4 main features of Parkinson’s disease. Most patients with Parkinson’s disease will have two or more of these symptoms:

4 Cardinal signs of Parkinson’s disease
  1. Slowness (Bradykinesia, Hypokinesia or Akinesia)
  2. Uncontrolled shaking (tremor)
  3. Stiffness (rigidity)
  4. Unsteadiness

Other than these 4 symptoms, patents with Parkinson’s disease have other symptoms too.

There are many problems with movement in Parkinson’s disease.

If your only symptom is slowing of movements, you may have another disease.

Here are the 8 causes of Bradykinesia

8 Causes of Bradykinesia (meaning slow movements)
  1. Parkinson’s disease and Parkinson’s Mimics
  2. Hypothyroidism
  3. Severe depression
  4. Damage to the front of your brain, such as a stroke
  5. Problems with your spinal cord, such as Primary Lateral Sclerosis
  6. Overactive nerves e.g. “Stiff man syndrome”
  7. Very stiff muscles e.g. “Neuromyotonia” or muscle fibrosis
  8. Stiff joints e.g. Arthritis

Even amongst these conditions, only the first 3 conditions can truly be called “Bradykinesia”. This topic is discussed in greater detail here: [Diagnosing Non-Parkinson’s causes of Bradykinesia]

How is bradykinesia treated?

Bradykinesia decreases when the underlying disease is treated.

Patients with Parkinson’s disease are deficient in Dopamine. A medication called levodopa increases dopamine inside the brain. Levodopa can cause dramatic relief of bradykinesia in these patients.

Other diseases causing slow movements are treated differently. For example, the following therapies are effective:

 

 

DiseaseTreatment
1. HypothyroidismThyroid hormone tablets
2. Severe depressionAntidepressants & counselling
4. StrokePhysiotherapy & prevention
5. Overactive nerves (Stiff Man Syndrome)Muscle relaxants such as Baclofen. Some of these diseases now have gene therapies.
6. Very stiff muscles (Neuromyotonia)Some of these diseases are due to an immune system losing its regulation.

Medications to modulate the immune system (for example IVIG) may be useful in some cases.

Baclofen and other muscle relaxants are also useful.

6. Stiff joints (Arthritis)Medications to reduce pain and inflammation. Physiotherapy.

If needed, joint replacement is very effective.

 

In summary:

I hope this clarifies the question “What is Bradykinesia?” comprehensively.

Do not ignore Bradykinesia. Do not be scared by it.

Go to a doctor and get evaluated. Do not deprive yourself of effective treatments.


Caution:
This information is for educational purposes. It is not a substitute for professional medical diagnosis & treatment. Do not change your medications, supplements or other treatments without your doctor's permission.

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Dr. Siddharth Kharkar

Dr. Siddharth Kharkar is a board certified (American Board of Psychiatry & Neurology certified) Neurologist. He is a Epilepsy specialist & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

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