Accidental Falls in Patients with Hyperkinetic Movement Disorders: A Systematic Review

Abstract

Background:The significance of falls and their repercussions in Parkinson's disease has been extensively researched. However, despite potentially serious effects on health and quality of life and negative impact on the healthcare system, there is not a sufficient understanding of the role of falls in hyperkinetic movement disorders (HKMDs). This review aims to provide an overview of the prevalence of falls, injuries, and preventive measures in the most common HKMDs.Methods: Studies up to May 1, 2022 were searched in PubMed using Medical Subjects Headings of relatively prevalent HKMDs associated with the terms "accidental falls", "injuries", "fractures", and "accident prevention".Results: In our review of 37 studies out of 155, we found evidence that for several HKMDs, such as spinocerebellar ataxia, essential tremor, Huntington's disease, and dystonia, fall risk is increased. Falls were reported in up to 84% of spinocerebellar ataxia patients, 59% of essential tremor patients, and 79% of Huntington's patients, with 65% of the latter falling frequently. Injuries occurred in up to 73% in Huntington and 74% in ataxia patients. Most of the common diseases characterized by HKMDs were investigated for both fall causes and consequences, but prevention studies were limited to spinocerebellar ataxia and Huntington's disease. Discussion:The limited available data suggest that patients with several HKMDs can be considered to be at increased risk of falling and that the consequences can be serious. As a result, physicians should be advised to include fall exploration in their routine workup and provide advice for safer mobility. In general, more research into fall-related concerns in HKMDs is necessary. Highlights:In contrast to Parkinson's disease, the prevalence of accidental falls, their repercussions, and preventive strategies are under-investigated in hyperkinetic movement disorders (HKMDs). Several HKMDs such as essential tremor, ataxia, and Huntington's disease have reported fall rates of up to 84% and fall-related injury rates of up to 74%. Therefore, routine examinations of HKMD patients should include a fall exploration and provide advice on safe mobility.

Motor Output Variability in Movement Disorders: Insights From Essential Tremor

“…However, we found that although tDBS significantly reduced tremor in these patients, it had no effect on their inconsistency (Fig. 3C) (22).…”

“…Additionally, the presence of tremor in the head or trunk (axial tremor) may cause gait instability and increase the risk for falls (19)(20)(21). Indeed, individuals with ET fall twice as much as healthy counterparts (22). Thus, the functional repercussions of tremor are contingent upon its site and intensity, spanning the spectrum from marginal disruption to daily activities and social discomfort to severe outcomes such as occupational impairment or susceptibility to falls and grave injuries.…”

Potential Factors Associated with Healthcare Utilization for Balance Problems in Community-Dwelling Adults within the United States: A Narrative Review

“…Another review on balance and falls in Multiple Sclerosis patients by Cameron et al in the USA reported that 50-80% of these patients have balance and gait dysfunction and more than 50% fall at least once every year [32]. Individuals with neurological disorders have been reported to have more frequent and more severe falls [33].…”

Abnormal vestibular-evoked myogenic potentials as a risk factor for unpredicted falls in spinocerebellar ataxia: a preliminary study

“…[ 2 , 8 ] However, the ataxia score alone cannot fully represent the quality of life (QoL), especially unpredicted falls that significantly affect the QoL. [ 9 – 12 ]…”