Page 1
ROBERT R.YOUNG, MDProfessor and Vice ChairmanDepartment of NeurologyMedical Director, Movement Disorders ProgramUniversity of California at IrvineIrvine, California
Edited byANTHONY B.JOSEPH, MDMedical DirectorThe Center for Neurobehavioral RehabilitationOlympus Specialty HospitalWaltham, MassachusettsConsultant NeuropsychiatristMcLean HospitalBelmont, MassachusettsAssociate Clinical Professor of PsychiatryHarvard Medical SchoolBoston, Massachusetts
SECOND EDITION
•InNeurology andNeuropsychiatry
Movement Disorders
BlackwellScience
b
Page 2
M~!A.I~AOUV:sn!S~U~SAap~:JnpuI-~n.Ia
::JIAO)JNV[Hd3:S0["ff3:TIIW09vaNIJ1l1
NOIJ.:)flOOlIJ.NI
l[l1S;;).!OS[CAemursruosuq:red0(9(;)rouran~Ul'poe'(SZ)CISll{lqc;;)Arpm'(V(;'£Z)snuopoxur;;J4Ipm'(ZZ-Ll'sT'n)ursmamoi;;)A~lCl'(vl-OT)e!3:!9:lskp;;JA~.lCl;;)pnpurcuJOSU.l10Jl;;)ljlOo(-eIS3'-P!sAP"Ao!OWIndOJ,,)SlU;)Ul;;)AOur
:Bll!){JOlJIAI;;)d10lJ!<lUL11lj3!.ITJnpmds;;)psl1mJlAI;;)dpoer-em
-WOpq~~UlosreAemCIS;;)uqsAa0(6)j3unpc;;J.lqlInJ
-91~p~plleASIOU!.ITj3U!lfl1S;;)olP;;JAIOAUlares;;)psnwlS;;)t[Jpuc
/4ir~cor4.dcrp;)t[l'SCIS;;)U~SAPA..lO~C.llds;;uUI0(8)alUl.tnJJO
OS[Cl;;);;)JpucSUl.1C'spueq'Sl;;)~u:g;;Jl[lJOS)U;;)UI;;)AOmJI;;J.l0l[:)
"GlJoSUOIlClS;;)Jm-ewpdZ~r20J;;)1lSOUl;;JIp;;J1C(;m2uo~;;)l[l
JOSlU;;)lliJAOW"2U~J~CJ-Ay,,'~uqJClliS'2Ul.lJVnd'2ttrA'l.JljJ
'"20J)S:jU;;JW;;)AOmAlO.CJIlSCUl[lm~UnOJJnqA..Tc~unToAul
°Slo.d;;JJ;;)lcururedop){JOlq.Cljl
s2nlpJI1JW;)llUCpoeJIl0l[JASdlloeJpnpm01P;)U;;)PCOlqsel[
p.!Oh\;;)IPJOosn::llfl,:S.l::lzrrmbuCll.lO[CW"JOSs-epCJlOU;)P
01(L).l;;)~;)GAqpJmoJsrM.,:UOlll.::lU;;)l[~SJ){Clt[J!l[A'I.
lCl[~"sueourAII'~I;)lITL[J!l[M]!ldiJ/oo/1'liJUlli'!J~::It[l°SJ~dJIO.!
-11;)USCUM0U:>fOS{C's'ilmpj3uqJOjqroidooarouturedopAqp;;JsnnereS.!;;)p10SrplU;;)Ul::lAOUlpaonput-Srup~soW
°SC~SJUl){SAPpconpur-Srupno
smoJTIlMM.::llA;;)lSll{J,°(9-(;)srcnplArpUlAP::lpT;;)sn0f111U::lpJ
U~se'ATsnOJUClt!Ods.ll1JJOOS[CLICJSlU::lWJAOUl{ClJCJOIO
::lAl~I:lJd;)1lnq'OJ.JOuorremcsaidTCJ!d,\.j~SOUlJl[lsrAd,\]
-OJIJlS{CDCJOlO0(1)SlU::llUJAOUlAlclUnIOAU!snoJUerrJJSlUl
poe'aotuan'snnopo/ur'SJIl'eJ.l0l[J'eruolSAPAqPJ1S;)JruCUl
JICs-erS;)UD[SAPpconput-SnrpoTJl[lO'auourasourIrgJsodmd
AI~lllU[;;)JS'PJlCU!P.lOO:J'::lA~~llJd;;).lCseP;)uYJp'AdA10J1JlS
JOill.IO]CU!111:JJOSCISJuqsAppconptn-SnrpasotnJ[!l[il\
°(al)V1SJU!~SAPamp.lV)urroa::llpJJUJl!'poddoisU;;)::lqSCl[
2l1.lp2u~u::l.D0;;)1l1IJlJ"EU;)A;)sistsrodWll1lUJUlJAOtll{CDrJ
-010Jrd,\]O;)l;;)lSpucJA11I:lJdJ.IPJJnpm-Bl11pJO1XJ~UOJ;)IP
U!p;)snATuomwoJSIll°A20T0[jJJOJAIlJ;;Jds;).l.l!'lUJW;)AOlU
AIClUnToAUl[CW.lOuqcAueSJqUJSJpv!SaU!~SApUl.lJl;;JL[l
rou"';".'n~"'P'"""ruaurasotn'''PAP){I{srl~p;)~u;mrmoplS.lYSl!M.'\d-e.l;;)ll~J~~d;){m
-nou]cy60rl-eJqdwoJeseSlU;)Ul;)AOUlr-e1U10uq-eJO;;)JU;)~
-rouratit'l;)A;;)A'l.OI['9S6~ul°SUOISSIWp-eruouedutJOu;)pmq
;;)ll~2!.ITu;)ss;)[';;)NISSod;;JWCJ;;)q;;)lCJruarredinodA[jJ;;J1H
°S~U;;J!lC<!./-t,n-elllJ,(sdJO;;)l-eJ;;Jll~Ul)U;;)Ul;;JAOldunJI~CUle1p
e'UJ.!e:l(S;;J~10l-elOqC'Il[JU;;)ldpm:;;JUf[)I'llllUlS~;;JU1Ze1Ol[l)
~rqJJOZS61UluOllJnpOIlu~;;Jl[lll~~il\
~Vg'IV:)ffiOJ.SIH
..: ;;Jl[lUlP;;)1I!\;;JIA;;J.l ;;)q[[IMSl;;JplOSrplU;)W;;JAOWp;;JJy{t'Il-~lUP
JOlU;)UllC;;J1)pucSl;)Pl0S~W;;JW;;JAOW~u!snCJ,9filpJ:gtJ;)ds
JOA2o[oJcur:rel[d=uo~Sl:gp;;)SsnJS~;;)qITT'I.'\.II'uoneztr
-o~;m:JlJ;;)llOJoilDlllJJsr1;;)P10SIPlU;JUl;JAom;)l[lJOA20
-joucmoucqdrueunuopord;;)l[lJOUQillU.BOJ;;).l;)l[~;)JUlS
0(££'01) // Adcl;;)l[lJlld;;)IOoll1;)UJOSl-e;;)Aoist{lUOlU.l;;)lJ-eruosardATI-ensn
cupuceruoisxp;)A~.lCl}t§;t£)lU;;)WW;;JllJ1ld;;)I0ltl;;)U
JOuoueunrrJOSIPUOUl;);;)},l{lllll{lL'I.'I.suroadurxsJOl;)SUO;;)l{l
;;)ACt[(dla)tusruosuppedpeonput-SnrpI[lIM.sruarred;)l[lJOruoorad,\];;JUlWo(0£)poddorsS!~nlp~UlPU;).D0
;;Jl[l.l;;)lJcc!snpc:>fC;)Arp:tflsersrsradAcmlnqosnoudojornauJOsl[luom;);;).ll[l~MsiuosardU;)lJo'SS;;JUSS;;)[lS;;).l JO~U!I;;J;)J
e'CISIl{lCW0(£~£~)soudcjomauJOUOllCJlldlUOJauoueur-rsdeselS!SJ4puc.tnJJOtreoeruois/p;;)Mp:rellnq'AIsno;;)u
-eruodsS;;),)!"OS;)lAucnsnUOIlJC;;JlJlUOlSAp;;JlnJesll{l0(6Z);)msodxy2norp1;;)lJ"EAI;;Jlelp;;)UlUl!smoooU;;JlJo'lU;;)lU;)AOlU
j3ll!lsrM.:)p;)UlC~SnSe'eruolsAp;)In:lV°Sl;)PlOS~lU;;JW;;JAOm
JO/.64;;)~.l-eAeconpordtreos:Bl1.lpJ!ld;;JI0.ln;;JUlnq'Adel;;)l[l
JI:ld;;JIOln;;)UJOuoneoqduroop;;JZrrillOJ;;)l~SOlU;;)tpS!Gl
/0(8Z'a)lSlX;;)OJ
ueJSl;;Jp10SlplU;;)ur;;)AOlUJOs;;)d,\.jOM);;)ljlpue'S.l;)poIOSIP
lU;;)UI;;)AOWJI:l;;)uq.l;;)dAlj;;)l[l;;JsneJlCljls:Bl1.lp;;)Ules;;Jl[llUo.g
piSI"!'1
Page 3
8
.(8(;)e;)IT.1;)l[lOUC
UlUOT1;)[ddparrruredop01lU;)llb;)SUOJrecddeAemsuroadur/sueruostropeddTTllMGJ,SCpossardxo;)qACurer[BUeB[Cscq
;)l[lJOUOlB;)ldUO111i\.)IAUlSUdSl;)dns.roidcooroudeuxsiscd';:lrdmex;:l.10d·S;):)U;)l;:llJ1PICllO!B;)lJOSUT.l;)lU!pourejdxaU;:ldqscqII·;:lmurtdop01osuodsardA!SS;)::lX;)ueSlJ;)g;:ll0.1.
pueU011d[d;)pourursdopJOoouonbosuooCS!ursruostropuddl;:ll{M'sursttreqocur::l120To:)CUT.rcl[dcarsoddoJOUOTSS;).1dx;)
tredqoaSllT;);)SUTSUTOSUq.1cdpueOJ,JOd:)tI;)lSlX;)OJdlf.1.
.(8Z)(SIT;)ApS:ldSUOJO;)BCtlC;)UT);)UOICG.1.pcouotradxaOl[MSlU;)T1edosoqiUC1.[l(;)peJ;)pl.{ll[BT;)10l[lU;)A;)S)0.1.
JOl;)SUOJOd2cl;:lleTepel{GLl{lTM.p;)le!::lOSSeUTSmOSU!)[led
1.[llM.siuoned'S;)U;)SsupUI·(8Z)urstuosurxredlU;).1.ll1JUOJ
pel.{(%££)sr'G.1.l.{lTMsiuotred917]0Apnls.1;)IPOUCtil·(SZ)
UTS!lIOsuq1edpmGL~UdlSlX;:lOJpEl{(%P"L1)£Z'SlU;)I~Ed
JLneTl[JASdZ£lJOApn1seul·Uls!Uosuq.lcdBl11pnpm
'Sl;)Pl0SIPlU;:lUT;)AOLU.1dIpOLj~lM.P;)lITq1.UOJ;)qAemG.1.
"O.1.JouO!lnlos;).1[ElOlBUlJU;)
-u;)dx;)(8=u)%9·6Zl[1lM.%OSuel.{~;)lOUtAqP;)AOldUTT
SlU;)lled;)l{lJOi\.)uorcur;)If.1.·(LS)O.1.JoSlSOUB01dW.1;)l-BUOr
;:ll.{llJdlftAW!lUelsqnsprnOJ;:lSOpJ!ld;:lIOllldU;:ll[l2UllW
-!lLT![;).10BUT1snfpc]I;:lUl1Ul;)l;)P01pOU;:ldlC;)A-;)A-Yel;:lAO
AW~.1;)Sp;:llpms;)l;)A'\SlU;)TltdJu~e~tpAsdU;)A;)S-i\.)U;)A'IJ,·(n)(6L-£S:;:lBUC1)Sle;)A<::9St:M1dSUO1e;)Be;)Be.1dAEs,dnOJB
;:ll{J,.(Slt;)A9·1:dn-MOrrOJue;)UT)dn-MOrrOJBr.n.mpP;)l
-~lUT;).l(%8·£S)JICl[.1;)AO'OL!.[lTMSlu;)!ledJUlerrpAsd£1JO
ApmsCuI·(ZP)SlU;)lledl;)PTOl.{llM.pd.ledmoJseBU1.AO.TdUT~
·P;)l;:lP!SllO::l;)qprnoqsroman;)Alp.lCl
JOsrsouiierp;)l[l'UTSlpTOlA1.[l.l;)dAqSCl.{J11S'rouran.10]S;)IB
-OTOIl;).1;:ll.{lOJO;)JU;:lsqtdl[lvr·.1OUT;).1lueruosurxred=s= -JCX;)oip;)lJ;)dx;);:lqprnOM;)llTzW;)qe.lld~'~SC.llUO:)UI·(9(;)
UOIlC.1lsTU!llIPedUlzcu;)qe.1~;)~JOsomurtn09orO£llll!l~M
S;)AOldUT[ratperlllq;)St;)srpS,UOSU!)[led1010UT;).1lIC!lU;)SS;)
.10Jp;)snAUCU01lU;)AUO:)AdC.1:ll[~01PUOdS;:l.llOUS;:lOP.ronran;:lAlp.1tL·SuB~Streruosrropedl;:ll[lOAqP;)!lICdUTOJJCA[!.rCSS;)J:lU
lOUSTITputJTl;)uqpucIC.1msodAPUtUlUTOP;)ldST11lel.{~
Ul;:lStdSlpS,lTosuqledIp1A\siustredlITP;:lA.1;)SqO.rouraumO:1}
Sl;)lflprouran;)i\lpl1':.1.·Adi\.)o;)l;)lS;:lArplClU!IT;);)S~UdUT;:lAOm
[l~:psod.rndA[BU!UT;);)S'p;)leU!p.100:)UEq~.1;)tPC.llU;)UT;:lAOLU
MOltWJSOtreJOSlSISUOJ~TleqlLT!AdAlO;)J;:llSUOUlUTOJ
;).10UTdqlUT0.y;)rqCl{S~llBlT!lSlpsrlU;:lUT;)AOUTJ!llIl{lAl{.T
srqJ..(90)OJ.JOUT.lOJ;).It.1AldA!lepleS1rotnan;)ArpleL
pSUOuro.ySl1':;;)A17·<::UrtpTMP;;)lJn:):lOsrqJ,·ApATl::l;;)ds;o)1
'eruors/p;;)A1Pl1':lJOUO~SSTlU;;)lsnocueauodspoouctrcdxc(%S·L)L9JO;)AYpuesiuouedZpJO(%z1);)AY'scrprus1;)l[1Oul·(n)P;)·l;)lUno:)U;);;).1;)MSUO~SS~;)lsnoouemodsou'(SIC;)A
8oisqiuour17:;)~ml)511':;)AS·ZJOporteddn-A-\0uoJP;)~1':
-1;)ACtreJOJP;)UTU!t:X;)C~OlSAP;)Alp.Wll[llM.siuoued::lqlcrq::l
-AsdctrruJOApmsCuI·(<::1)lU;;)lSTS1;)darour;)qACur'OL::llSSCPtlE1:.p2UT[qcslparourApu;)nb;)JJ'errroiszp;)AlpJCL
·(09)1;)P10Slp
lU;)U!;)AOUTS!l[l10JSlOPCJ)[SUseP;)Y1lU;;)PT;)l;)MAdeJ;)l[l
;)ATS[l1AUO:)OIP;)[;)pmuouepreiarIC1U;)W·(19)e!UOl5AP
;:lAlp.lelpel{Arq!::lt:J::lUlC!l{::lASdUOTlCJ1srumrpvsuel;)PACtIT
siuonedS<::lJO%1<::'Apms.l;)IpOUElIT'.1;)A;)MOH·(09)IClrdsol[
::l11lt:rq::lASdCmpszqendsoqsnronedJO(1££JOS)ssstlIT
P;)lOUU;);)qsel[C~OlSAP;)AlplCJ,.(£1)(<::·Z;)[qcJ,)"p;)::lnpr.n
-Bn.IP"P;)J;)PTSUO::l;)qlOUprno:)IIU;)1.{l'.l;)P10SlplU;)U1;)AOlU
;)l[lJOPSUO;)Ip01zoudSl[lUOlUXISlSe;)[re10J;)STToudojor-nouJOAl01srqOU51;)l;)l[l]I1CIP;)A;)T];)qS;)llUOl[lnB150UT
'lU;)tu;);).lBC[eS.T;)Aml1ouS1;)1;)l[1l[BI10l[lIV·(6S'8S)amsodxs::l!ld;)IOlll;)UJOAl0lsrqOUST;)1;)q1l[BnOlpU;)A;)'em01SAp
;)ATp.telseP;)SOuBClpSTTUA[lu;)nb;).y51(;)UIQ1PUASS,;)Bl;)W)
eru01sAprejnqrpuetnoro-ursedsoreqdajqlI1lM.eruois/ponped-Olp1'cmOlSAp;)AlpJClpmdAl01;)::lucrqm;)s;).[JO;)SnB::l;)g
.(£1)C!lIOlSAP;:lAlplClIpIMsiuouedL9JO(%lZ)
pl~U;);)Sse",\OLlU;)lSlX;)O:)"GLJOSlU;)W;)AOUTBU!)[J;)[
prder::l!di\.)O;)l;)lSuopesodurrrcdns;)qACUTSlU;)m;)AOUT
::lTUOlSAP;)1.[.1..(£1)onbnsruofienre;)ls;)210S)[::lUlMOSU;)S
se01P;)l1dP.t'S.1;)AIl;)UCUT;)[!1::lC1AqP;)A;)~PlU;):gOorepuc
d;);)[sBuunp;)prsqnsAwnsnSlU;)lU;)AOUT::lm01SAPdl.{.1..(£.<::
;).mBld)S~O::lO.1l;)lp;)Ac[dslplU;)1.U;)ATOAUI)[J;)lll.{11Msruoued;)IpJO]TCl[A[l1':;)N.(£1)=vmJOi\.)11;)A;)$umunxeurJO;)UT!l
;)1:.1'1Cp;)A[OAmApu;)nb;).-ylSOUToSTe;).TCpucl;)SUO1CSU01B;).l
P;)l:);)lJl!APU;)11b;).ylSOUT;)tp;)JC)[J;)Upm;)JCJ;)l[.1..(£1)(Z·Z
;).111B!d)Ad1':.l;)I[lJrld;)[O.1l1;:lUJOS1.[lUOUtSA\OUO]11AnenS11lnq
'lU;)Ut1e;)11:)[lOtPASd11ueJOSACP;);).1l.{1AraO.l;):gt:JIlJJOAcm
eru01SAP;)A!p.1e1'squll[JO')[Un.11'V;)U';):)eJ;)tPBUIATOAtIT
SlU;)Ul;)AOUtBU11S~prdc.110MO[S'p;)Ul:med'P;)ll1ClSTTS
AqP;)ZU;)lJelel[:)·(Zl)e~OlSAp.10JAJOlsrqAT=J;)AUCB;)U
Cpue'cruOlSAPA.lCPUO:);)SJOS;)S11eJUMOU)[JOUOtS11PX;)
';)SI1JT1d;)[0.1l1;)1llU;)l.1l1JUOJ.10loud'cruolSAPJm~.ll[JJO
;)Ju;)s;)Jd;)ql;:lpnpUIS[SOUBClpS11.10JeU;)lTl:)·(£1-01)UOT1
-JC;)lJTU01SAP1U;)~SUC.1l;)l11::ltm0.ySJ;)lflpl!dlOJdl;)l[lpue
.l;)Pl0STPlU;:lUT;)AOUTJIUOlSAPlU;)lSTS1;)dCSTC!llOlSAP;:lAlp.tcL
·(llJ6!J)UOfSUdJXd/O>/UnJJJfUOJOlJJSfdopuo(Jjdt)PUOlJ)OUOfXdJjJfUOJSAPbupnpoid
OfUOJSAPdltfpJOJpdzf/oJaua6lJJfMUOWOMJfUdJdOZflJJS6unoAVZ•Z~IIn9IJ