Hyperkinetic
Tremor
Involuntary, rhythmic movements of the hands, head, voice, or other body parts. The most common is essential tremor, treated pharmacologically, or with HIFU or DBS when refractory.
Neurology and functional neurosurgery
Movement disorders
Assessment, diagnosis, and treatment of neurological diseases that alter the form, speed, or control of movement. From Parkinson's disease and essential tremor to less common conditions such as Huntington's disease, Tourette syndrome, and the ataxias.
What are they?
When movement no longer responds as it should
We use the term movement disorders to describe a broad group of neurological diseases that produce an alteration in the quantity, speed, or control of bodily movements. They can manifest as tremor, rigidity, slowness, involuntary movements, abnormal postures, or loss of balance.
Moving a hand, smiling, or walking requires a precise choreography between the brain, the spinal cord, the peripheral nerves, and the muscles. When any part of that circuit fails, movement disorders emerge, with an impact that can range from the everyday (writing, eating, dressing) to the most fundamental (autonomy and quality of life).
How they are classified
- Hypokinetic, the amount of movement decreases or becomes slower. The main example is Parkinson's disease.
- Hyperkinetic, involuntary movements appear in excess. This includes tremor, dystonia, tics, chorea, and many others.
Symptoms
Symptoms of movement disorders
Each disorder has its own clinical pattern. These are the most characteristic symptoms of the conditions we most frequently manage.
Parkinson's disease
- Resting tremor, usually asymmetric and starting in one hand
- Slowness of movement (bradykinesia) and "cogwheel" rigidity
- Short-stepped gait, reduced arm swing, and postural instability
- Loss of smell, constipation, and REM sleep behaviour disorder as early signs
Essential tremor
- Action and postural tremor (when holding objects or writing), not resting tremor
- Frequently affects both hands, the head, or the voice
- Worsens with stress and caffeine; often improves temporarily with alcohol
- Family history present in many cases
Dystonia
- Sustained involuntary muscle contractions causing abnormal or twisted postures
- Focal forms: cervical dystonia (torticollis), blepharospasm, or writer's cramp
- Repetitive movements triggered by specific activities
- "Sensory trick" (geste antagoniste) that temporarily relieves the posture
Other hyperkinetic disorders
- Chorea: brief, irregular, and fluctuating involuntary movements
- Myoclonus: sudden, brief, shock-like muscle jerks
- Tics (Tourette): repeated movements or vocalisations, preceded by a premonitory urge
- Ataxia: lack of coordination, unsteady gait, and difficulty with speech
When to seek advice: with any tremor, rigidity, slowness, involuntary movement, or loss of balance that interferes with daily activities. An accurate and early diagnosis is key, as the course and treatment differ greatly between disorders.
Our unit
A specialised multidisciplinary team
Managing movement disorders requires coordinating several specialities. At Brain & Spine Barcelona our dedicated team integrates neurology, functional neurosurgery, neuropsychology, neuroradiology, and rehabilitation, supported by specialist nursing staff who accompany the patient throughout the process.
Precision diagnosis
3T MRI, functional neuroimaging (DaTSCAN, PET when indicated), neurophysiology, and cognitive assessment. The goal is to reach an exact diagnosis before planning any treatment.
Personalised treatment
Pharmacological adjustment, botulinum toxin injections, apomorphine therapy, or continuous infusion pumps, depending on the case. Non-surgical options are always first-line.
Advanced functional surgery
When medication is no longer sufficient, we offer deep brain stimulation (DBS) and HIFU treatment. Both techniques are performed by Dr. Pedro Roldán.
Conditions we treat
Movement disorders we see
From the most common to rare diseases, we evaluate and treat the full spectrum of movement disorders. For each we define a personalised therapeutic plan.
Hyperkinetic
Dystonia
Involuntary, sustained muscle contractions causing abnormal postures or twisting movements. Can be focal (affecting one area) or generalised. Treated with botulinum toxin and, in selected cases, DBS.
Hypokinetic
Parkinson's disease
Slowly progressive neurodegenerative disorder characterised by resting tremor, rigidity, slowness (bradykinesia), and balance problems. See full page →
Hypokinetic
Parkinsonism syndromes
A group of diseases that produce symptoms similar to Parkinson's disease but with different underlying causes. Differential diagnosis is crucial because the course and treatment differ significantly.
Hyperkinetic
Ataxia
Lack of coordination and clumsiness in balance, speech, or limb movements. Originates in the cerebellum or its connections. May be hereditary, sporadic, or secondary to other diseases.
Hyperkinetic
Myoclonus
Sudden, brief, shock-like muscle jerks. May be physiological (on falling asleep) or pathological, linked to epilepsy, metabolic disorders, or other causes.
Hyperkinetic
Restless legs syndrome
An uncomfortable sensation in the legs, especially when relaxing or lying down, that improves with movement. Seriously affects rest and quality of life. Mainly pharmacological treatment.
Hyperkinetic
Dyskinesia
Repetitive, involuntary movements (grimacing, blinking, limb movements) usually associated with prolonged use of dopaminergic (Parkinson's disease) or neuroleptic medication.
Hyperkinetic
Gilles de la Tourette syndrome
A neurological disorder beginning in childhood or adolescence characterised by repeated motor and vocal tics. In refractory cases, DBS has shown utility in selected patients.
Hyperkinetic
Chorea
Brief, irregular, and unpredictable involuntary movements that flow from one body part to another. Can occur in Huntington's disease, Sydenham's chorea, or other causes.
Hyperkinetic
Athetosis
A continuous flow of slow, fluid, writhing movements, generally in the hands and feet. Often associated with chorea (choreoathetosis) and can appear in cerebral palsy or basal ganglia lesions.
Hyperkinetic
Hemiballismus
An intense variant of chorea with violent, large-amplitude movements of one arm and/or leg on one side of the body. Usually associated with subthalamic nucleus lesions (typically stroke).
Neurodegenerative
Huntington's disease
A progressive hereditary disease with chorea, cognitive decline, and psychiatric symptoms. Requires a multidisciplinary approach and family genetic counselling.
Atypical parkinsonism
Multiple system atrophy (MSA)
Progressive atypical parkinsonism with autonomic dysfunction (blood pressure, bladder function) and, in some cases, cerebellar signs. An important differential diagnosis with respect to idiopathic Parkinson's disease.
Atypical parkinsonism
Progressive supranuclear palsy (PSP)
An uncommon neurodegenerative disorder that primarily affects balance, gait, and vertical eye movements, with a poorer response to levodopa than idiopathic Parkinson's disease.
Hereditary
Wilson's disease
A hereditary disease caused by abnormal copper accumulation that can cause neurological and hepatic symptoms. Early diagnosis is essential because medical treatment is effective when started promptly.
Functional
Functional movement disorder
Symptoms similar to other movement disorders but without detectable structural neurological disease. Requires careful diagnosis and a specific therapeutic approach combining neurology, psychology, and rehabilitation.
Treatments
Therapeutic options we offer
The therapeutic plan is decided in committee after assessment. From the first pharmacological line to the most advanced functional neurosurgery techniques.
Pharmacological treatment
Levodopa, dopamine agonists, antiparkinsonian drugs, anticholinergics, antiepileptics, and other options depending on the clinical picture. Medication is adjusted on an individual basis at each visit.
Botulinum toxin
Outpatient injections for focal dystonias (cervical, blepharospasm, writer's cramp), spasticity, and focal tremor. Effect progresses over 3-4 months, with periodic repeat injections.
Apomorphine and infusion pumps
Subcutaneous therapies for advanced Parkinson's disease with complex motor fluctuations not controlled by oral medication.
Deep brain stimulation (DBS)
Implantation of brain electrodes connected to a subcutaneous pulse generator. Reversible, adjustable, and bilateral. Indicated for Parkinson's disease, tremor, dystonia, and other selected cases. See DBS technique →
HIFU (focused ultrasound)
Non-incisional brain surgery for essential tremor and tremor-dominant Parkinson's disease. A single session, no general anaesthesia, and same-day discharge. See HIFU technique →
Rehabilitation and physiotherapy
An indispensable complementary programme. Neurological physiotherapy, speech therapy, occupational therapy, and, when appropriate, psychological support for the patient and family.
Is your condition no longer responding to medication as it used to?
We can assess whether a surgical technique such as DBS or HIFU could help. We provide initial feedback within 24-48 hours of reviewing your medical history.
Team
Functional neurosurgery and movement disorder neurology
The management of Parkinson's disease, tremor and movement disorders combines functional surgery (HIFU, DBS) with specialist movement disorder neurology assessment, both before and after the procedure.
Dr. Pedro Roldán Ramos
Neurosurgeon · Functional surgery, DBS and HIFU · Professor at the UB
View profile
Dr. Gabriel Salazar Tortolero
Neurologist · Parkinson's disease, tremor and movement disorders
View profile
Locations
Where we treat movement disorders
Surgical procedures are carried out in operating theatres equipped with the technology required for movement disorders. Your first consultation and follow-up can take place at any of our centres in Barcelona.
Operating theatre
★ Operating theatre
Hospital El Pilar
★ Operating theatre
Barnaclínic+
Consultation and follow-up
Consultation
Centro Médico Aribau
Consultation
Clínica Olivé Gumà
Patient reviews
What our patients say
High-grade glioma
"I arrived with a glioma I had been told was inoperable. Here they reviewed it at the tumour board and offered me a plan. The surgery was a success. Four years on, I am well."
Cervical disc herniation
"For years I had a cervical disc herniation, operated on by another team with no improvement. Minimally invasive surgery gave me back my mobility and took the pain away."
International patient
"I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique."
Request information
Assessment of your movement disorder case
Send us your medical reports and, if available, imaging studies (3T MRI, DaTSCAN). We will respond within 24-48 hours with initial feedback on the therapeutic options we can propose.