title: The wrong end of the telescope: neuromuscular mimics of movement disorders (and vice versa).
abstract: The rapid advances in modern neurology have led to increased specialisation in clinical practice. Being an expert in a neurology subspecialty offers advantages for diagnosing and managing specific disorders. However, specialisation also risks tunnel vision: interpreting symptoms and signs within one's own framework of reference, while ignoring differential diagnostic options from other subspecialties. This is particularly relevant when the patient's presentation potentially belongs to different neurological subspecialties. We illustrate this challenge by highlighting a series of clinical features that partially overlap between two common subspecialties: movement disorders and neuromuscular disorders. An overlap in clinical presentation is not rare, and includes, for example, involuntary eyelid closure (which could be active eye closure due to blepharospasm, or ptosis due to weakness). Other overlapping features include abnormal postures, involuntary movements and gait changes. We describe two of these overlapping features in more detail and emphasise the possible consequences of 'looking through the wrong end of the telescope' in such patients, as this may lead to a wrong differential diagnosis, unnecessary investigations and a delayed treatment start.
authors.affiliation: Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: B R
authors.initials: BR
authors.lastname: Bloem
authors.affiliation: Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: N C
authors.initials: NC
authors.lastname: Voermans
authors.affiliation: Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: M B
authors.initials: MB
authors.lastname: Aerts
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, UK.
authors.forename: K P
authors.initials: KP
authors.lastname: Bhatia
authors.affiliation: Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: B G M
authors.initials: BG
authors.lastname: van Engelen
authors.affiliation: Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: B P
authors.initials: BP
authors.lastname: van de Warrenburg
mesh_terms: D001764:Blepharospasm / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D009069:Movement Disorders / Q000175:diagnosis*; D009915:Orbit
keywords: MOVEMENT DISORDERS; NEUROMUSCULAR; differential diagnosis; specialisation