Tics, stereotypies, akathisia, and restless legs fall at different places on the spectrum of discrete, unwanted and potentially disabling motor routines. Unlike tremor, chorea, myoclonus, or dystonia, this subgroup of abnormal movements is characterized by the subject's variable ability to inhibit or release undesired motor patterns on demand. Though it may be sometimes clinically challenging, it is crucial to distinguish these “unvoluntary” motor behaviors because secondary causes and management approaches differ substantially. To this end, physicians must consider the degree of repetitiveness of the movements, the existence of volitional control, and the association with sensory symptoms, or cognitive-ideational antecedent. This review aims to summarize the current existing knowledge on phenomenology, diagnosis, and treatment of tics, stereotypies, akathisia, and restless leg syndrome.

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Freezing of gait (FOG) is a common symptom in Parkinson's disease (PD) and is a significant cause of falls, disability, and reduced quality of life. 1 Unfortunately, FOG is poorly understood pathophysiologically and remains difficult to treat. Beyond optimizing dopaminergic medications and considering surgical therapy, rehabilitation strategies are a mainstay of management. Behavioral strategies, such as using sensory cues or shifting weight to initiate gait, help reduce FOG. In addition, patients often develop their own compensatory strategies. 2 An 81-year-old right-hand-dominant male was assessed in clinic for PD. His symptoms began 7 years ago with the development of right-sided rest tremor in the hand, right-sided bradykinesia and rigidity, micrographia, and a slow, shuffling gait. Treatment with levodopa substantially improved his parkinsonism. 3 years after symptom onset, he developed FOG during gait initiation and turning. This was not dopamine responsive and progressed with increasing frequency and duration. Additional triggers included narrow spaces, doorways, navigating obstacles and crowds, and ambulating under time constraints. Physiotherapy strategies helped him avoid falls. However, to maintain safety during walking, he began using a 4-wheel walker at home and for short distances, which was not associated with improvement in FOG, and an electric scooter for long distances. His other motor symptoms continued to be well-managed with levodopa and non-motor symptoms were non-contributory.At 81 years of age, he created his own strategy to address FOG while performing upper extremity exercises with resistance bands. He decided to secure resistance bands (TheraBand, Akron, OH) under the soles of his feet individually or simultaneously and hold them at the level of the handles of his 4-wheel walker, such that the bands were mildly stretched superiorly and anteriorly (Video 1 and Video 2). He did not actively pull on the bands and passive elasticity helped facilitate gait initiation and maintenance. With the use of

Background: Fluctuation-related pain (worse in OFF periods) is a frequent and disabling symptom in Parkinson’s disease (PD). As evidence-based treatments to treat pain in PD are limited, exploring alternatives to treat it are imperative. Apomorphine is the only antiparkinsonian agent compatible with levodopa in improving PD motor symptoms and is usually well tolerated. We explored the effects of apomorphine in PD fluctuation-related pain. Methods: Small pilot double-blind, placebo controlled, randomized crossover study evaluating the safety and efficacy of subcutaneous apomorphine vs. placebo on fluctuation-related PD pain including participants experiencing pain during OFF periods. Primary outcomes: changes in a Visual Analogue Scale for pain and MDS-UPRDS III from baseline to 30 and 60 minutes after injections (two doses, separated by 60 min) and adverse events. Domperidone was used as premedication to avoid nausea/vomiting. Results: 16 patients were screened and 11 completed the study. All participants tolerated both treatments without significant side effects. Efficacy results remain blinded until the end of February 2023 and will be shown at the conference. Conclusions: Apomorphine, recently approved by Health Canada as an adjunctive therapy in PD patients and experiencing “off” periods, has shown to be safe when used to treat fluctuation-related PD pain. Efficacy outcomes will be soon available.