Movement disorders (MD) represent an area of neurological dysfunction based on clinical phenomenology rather than on an anatomical location. The term was coined in 1968 by Stanley Fahn and was quickly adopted by the neurological community.

Movement disorders could be defined as neurological syndromes in which there is either an excess of movement or a paucity of voluntary and automatic movements , unrelated to weakness or spasticity. The former are commonly referred to as hyperkinesia (excessive movements ), dyskinesia (unnatural movements ), and abnormal involuntary movements. The paucity of movement group is referred to as hypokinesia (decreased amplitude of movement), bradykinesia (slowness of movement) and akinesia (loss of movement) [1].

The key factor for the modern classification of MD is the phenomenology of the movements. The conditions are therefore grouped into two major groups: hyperkinesia (ataxia, athetosis, ballism, chorea, dyskinesia, dystonia, hemifacial spasm, hyperekplexia, myoclonus, tics, tremor, restless legs), and hypokinesia (bradykinesia/parkinsonism, freezing, catatonia).

The list of the diseases is constantly expanding, as does MD as a subspecialty of neurology. A survey conducted by the American Academy of Neurology in 2008 reported that 9 % of the residents going into a fellowship chose MD. Moreover, general internists, family physicians, and neurologists were questioned about three neurological conditions: transient cerebrovascular events, dementia and Parkinson’s disease (PD) . For the issue of the transient event, over 50 % of internists felt that the primary care physicians should manage the condition alone; for dementia over 70 % felt the same. Only for PD was there a majority recommending referral to a MD specialist [2].

Shih et al. [3] surveyed the approximate percentage of diagnoses and conditions seen in movement disorders clinics in North America and the frequency was: PD 51.9 %, dystonia 15.1 %, tremor 13.7 %, ataxia 7.5 %, and others MD 10.7 %. There is a high frequency of PD in MD clinics worldwide as it is the second most common neurodegenerative disorder after Alzheimer’s disease . Because of the combination of the aging process and a chronic condition, it represents an economic burden for the patient and for payers.

According to Kowal et al. [4], the population with PD in the USA incurred medical expenses of approximately $14 billion in 2010. Nursing home care is a major contributor to the medical cost burden, whereas reduced employment is a major indirect cost of PD.

Another study conducted by Johnson et al. [5], demonstrated that slowing disease progression by any disease modification treatment would reduce the symptom burden and be cost-effective. A scenario where PD progressed 20 % slower than a hypothetical base case resulted in net monetary benefits of a 25 % reduction in excess costs spread over a longer expected survival period.

The burden of chronic conditions such as PD is projected to grow substantially over the next few decades as the size of the elderly population grows. Such projections give impetus to the need for innovative new treatments to prevent, delay onset, or alleviate symptoms of PD and other similar diseases, Kowal et al. [4] concluded.

However, preventing, delaying or alleviating any chronic debilitating condition, which is the case in most MDs, by reducing the cost burden should not be the only goal of any treatment; the quality of life of patients and caregivers should also be improved.

Quality of life (QoL) is defined as “individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept acted in a complex way by the persons’ physical health, psychological state, level of independence, social relationships and their relationship to salient features of their environment” [6].