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The wrong end of the telescope: neuromuscular mimics of movement disorders (and vice versa)
  1. B R Bloem1,
  2. N C Voermans1,
  3. M B Aerts1,
  4. K P Bhatia2,
  5. B G M van Engelen1,
  6. B P van de Warrenburg1
  1. 1Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
  2. 2Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, UK
  1. Correspondence to Professor B R Bloem, Department of Neurology (935), Radboud University Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands; Bas.bloem{at}radboudumc.nl

Abstract

The rapid advances in modern neurology have led to increased specialisation in clinical practice. Being an expert in a neurology subspecialty offers advantages for diagnosing and managing specific disorders. However, specialisation also risks tunnel vision: interpreting symptoms and signs within one's own framework of reference, while ignoring differential diagnostic options from other subspecialties. This is particularly relevant when the patient's presentation potentially belongs to different neurological subspecialties. We illustrate this challenge by highlighting a series of clinical features that partially overlap between two common subspecialties: movement disorders and neuromuscular disorders. An overlap in clinical presentation is not rare, and includes, for example, involuntary eyelid closure (which could be active eye closure due to blepharospasm, or ptosis due to weakness). Other overlapping features include abnormal postures, involuntary movements and gait changes. We describe two of these overlapping features in more detail and emphasise the possible consequences of ‘looking through the wrong end of the telescope’ in such patients, as this may lead to a wrong differential diagnosis, unnecessary investigations and a delayed treatment start.

  • MOVEMENT DISORDERS
  • NEUROMUSCULAR
  • differential diagnosis
  • specialisation

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    Phil E M Smith Geraint N Fuller