Bradykinesia causes (including 3 Non-Parkinson’s causes)

Parkinson’s disease is the most common Bradykinesia cause.

But, there are many non-Parkinson’s causes of Bradykinesia.

It is important to know non-Parkinson’s diseases which can also cause Bradykinesia. The treatment of each disease is different.

Let us discuss this topic in a systematic fashion.

Is it really Bradykinesia?

The literal definition of Bradykinesia would include all kinds of slow movements.

But, doctors think of bradykinesia differently.

Most doctors use that word for involuntary slowness caused by problems in the brain.

So, slow movements due to the following reasons is not Bradykinesia.

Slow movements that are not Bradykinesia
  1. Voluntarily slow movements due to pain
  2. Voluntarily slow-walking due to fear of falling over
  3. Stiff joints causing slowness
  4. Stiff Muscles causing slowness
  5. Overactive nerves causing stiff muscles

Let us look at these problems in detail.

The examples may appear complicated. Don’t worry. Understanding the concepts is more important.

1. Voluntarily slow movements due to pain:

A person in pain moves that body part slowly and carefully. If that body part is in the legs (for example – knees) the person may walk slowly to avoid pain. This is not bradykinesia.

Examples: Painful hip arthritis, knee arthritis, ligament tears, infections of the legs…

Knee pain or stiffness can make your walking slow. This is NOT bradykinesia.

2. Voluntarily slow walking due to fear of falling over:

Some people have a problem with balance. The balance system includes sensory nerves in the legs, spinal cord and the little brain (cerebellum).

For obvious reasons, these people walk carefully. The walk with their feet wide apart. They make sure each step they are taking is safe. They are especially slow and deliberate when walking on uneven ground.

This is not bradykinesia. It is a conscious, purposeful, voluntary decision. This type of slow gait is a “Cautious gait”.

Examples: Diabetic neuropathy, Vitamin B12 deficiency, HIV, compression of the spinal cord…

People who are unsteady, walk slowly and carefully. This is NOT bradykinesia.

3. Stiff joints causing slowness:

Joints may become stiff because of immobility. This may happen after casting for fractures.

Joints can also become stiff because of inflammation. Diseases like Rheumatoid arthritis & Ankylosing Spondylitis can lead to joint swelling and stiffness.

People with stiff joints are unable to make big movements. Their steps may be small, and they may walk slowly. This is not bradykinesia.

Examples: Frozen shoulder, knee osteoarthritis, Rheumatoid arthritis, Ankylosing Spondylitis…

4. Stiff muscles causing slowness:

This is relatively uncommon. Some conditions can cause painful swelling and fibrosis of muscles. Others conditions can cause them to be in a state of perpetual contraction.

Surely, if the muscles are inflamed, painful and stiff, movements will become slow.

Examples: Neuromyotonia, Fibrosis secondary to Emery-Dreifuss, dermatomyositis…

Stiff muscles or joints can make movements slow.

Note that there is some subtlety here. Stiff muscles can also be a symptom of Parkinson’s. If the slowness is due to stiff muscles, it is not bradykinesia.

On the other hand, if both the slowness and stiffness are due to a brain problem, then it is bradykinesia. Differentiating one from the other requires care, and medical expertise.

5. Overactive nerves causing stiff muscles:

This is the rarest reason.

Most doctors will see only 1-2 cases like this in their life-time.

Examples: Stiff-man syndrome due to GAD-65 antibodies

Are other symptoms of Parkinson’s present?

As noted before, Parkinson’s disease is the most common of all the bradykinesia causes.

Parkinson’s disease has many symptoms other than Bradykinesia.

Not all these symptoms need to be present. But at least some of these symptoms need to be present to make a diagnosis of Parkinsonism.

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, patients with Parkinson’s disease have other symptoms too.

The 16 most important symptoms of Parkinson’s are described in another article. [16 early symptoms of Parkinson’s disease].

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

What if you don’t have any of these symptoms? Then, we need to carefully look for non-Parkinson’s cause of Bradykinesia.

3 Non-Parkinson’s causes of Bradykinesia

These are conditions of the Brain which cause involuntary slowness.

These conditions are limited in number.

Simple tests such as an MRI of the brain, blood tests and talking can help to rule out these problems.

DiseaseTreatment
1. Damage to the front of the brain

Examples:

– Tumors

– Strokes

– Hydrocephalus (too much water)

etc…

The person forgets how to do something. For example, the patient may forget how to take the next step.

In the purest sense, even this is not bradykinesia. It is called “frontal Apraxia”.

Treatment is varied. e.g. Hydrocephalus is treated by a shunt.

2. HypothyroidismPossibly: Donepezil, brain stimulants and other medications
3. Severe depressionsame as Alzheimer’s
Hydrocephalus is a condition in which there is too much water inside the brain. Treatment is a shunt surgery. A thin pipe is inserted, just below the skin. This pipe drains excess water from the head into the stomach.

The importance of being careful

Sometime, patients may be mis-diagnosed to have Parkinson’s disease.

This is uncommon, but not difficult.

Look at the person below. He has a kind of hydrocephalus called Normal Pressure Hydrocephalus (NPH). NPH is one of the non-Parkinson’s causes of Bradykinesia.

Look at how he is truly slow with his movements, especially walking. Sometimes, he appears “stuck” to the ground.

Imagine how easy it is to diagnose Parkinson’s disease here. But, this person does not have Parkinson’s disease.

This patient with NPH will improve after a small surgery called shunting. But, if this patient is mis-diagnosed and gets Parkinson’s medications instead, there will be no improvement.

Bottom-line

First, the doctor verifies if you really have bradykinesia.

Parkinson’s disease is the most common of all the bradykinesia causes.

But it is important to remember other bradykinesia causes. They may have a different treatment (for example, a shunt).


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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