Movement Disorders Associated With Radiotherapy and Surgical Procedures

Abstract

Occasionally, movement disorders can occur following interventional procedures including but not limited to radiotherapy, dental procedures, and cardiac, cerebral and spinal surgeries. The majority of these disorders tend to be unexpected sequelae with variable phenomenology and latency, and they can often be far more disabling than the primary disease for which the procedure was performed. Owing to poor knowledge and awareness of the problem, delays in diagnosing the condition are common, as are misdiagnoses as functional movement disorders. This narrative review discusses the phenomenology, pathophysiology, and potential treatments of various movement disorders caused by interventional procedures such as radiotherapy and neurological and non-neurological surgeries and procedures.

Keywords: Cardiac surgery; Dystonia; Myoclonus; Parkinsonism; Radiation; Tremor.

Figure 1.

Classification based on phenomenology. A variety of phenomenologies can be seen in movement disorders which are associated with radiotherapy and surgical procedures. With the exception of ataxia which is reported only post radiotherapy, all others are phenomenologies are seen with multiple causes. VP, ventriculoperitoneal.

Figure 2.

Classification based on latency. There is high variability observed in the latency of onset, even with the same underlying procedure and phenomenology.

Figure 3.

Classification based on underlying mechanism. The underlying mechanisms can be broadly classified as direct injury to the brain/spinal cord to the specific region or via diffuse hypoxic/ischemic injurt, or due to brain changes induced by peripheral injury. PKD, paroxysmal kinesigenic dyskinesia; VP, ventriculoperitoneal.