Presentation
The clinical presentation of Wilson disease (WD) is highly variable. We report an unusual presentation of Wilson's disease with de novo seizures and acute extrapyramidal features without hepatic manifestations. [neurologyindia.com]
It remains possible that the presentation of an extrapyramidal syndrome merely represents a chance association of a rare disorder with a more common one. [jnnp.bmj.com]
Dystonia is considered present when repeated, often asynchronous spasms of muscles are present. Most dystonias are idiopathic and the focal form of dystonia occurs 10 times more often than does the generalized systemic form. [pocketdentistry.com]
The condition can present with tremor or with rigidity. Rarely, it can primarily present with balance issues in the absence of other symptoms. These cases are particularly difficult to diagnose. [dartmouth.edu]
Presentation on theme: "Extrapyramidal disorder and movement disorder"— Presentation transcript: 1 Extrapyramidal disorder and movement disorder 2 the main cause behind the movement disorders is dysfunction of deep seated sub cortical gray matter called [slideplayer.com]
Entire Body System
- Fatigue
[…] reactions which occur in the extra pyramidal tract, these reactions are categorised under the term extrapyramidal effects. " Related Psychology Terms EXTRAPYRAMIDAL DYSKINESIA ATHETOSIS FACIAL MUSCLE EXTRAPYRAMIDAL SYMP MOTOR DISTURBANCE PYRAMIDAL TRACT FATIGUE [psychologydictionary.org]
Aggravating or precipitating factor- stress and anxiety worsen all movement disorder • Myoclonus may be triggered by specific stimuli- sudden loud noise or touch • Carbohydrate heavy meal, fatigue may precipitate paroxysmal dystonia Associated sensory [slideshare.net]
Dystonic spasms increase in intensity during stress, emotional upset, or fatigue. Pharmacologic treatment. Chemodenervation with botulinum toxin injections. Select use of neurosurgical treatment. [pocketdentistry.com]
This is more than fatigue and may be induced by fine motor activities other than writing. [medicalnewstoday.com]
They should be distinguished from fasciculations and from myokymia (such as that often occurs in eye muscles with fatigue). These disorders come in many varieties. [dartmouth.edu]
- Rigor
Contraindications Patients with dementia and symptoms of Parkinson's disease such as rigor, bradykinesia, and postural abnormalities Patients with dementia most probably caused by dementia with Lewy bodies Dose adjustment in renal impairment Begin with [amboss.com]
Eyes
- Blepharospasm
persistent abnormal posturing: Focal : spasmodic torticollis, blepharospasm. Generalized : primary torsion dystonia Secondary : drugs, vascular. [authorstream.com]
For the dystonias that affect a specific motor system (eg, blepharospasm or torticollis), it is necessary to assess that system thoroughly to ensure that no local infection or neoplastic or arthritic disease is present, to name only a few of the considerations [pocketdentistry.com]
Botulinum toxin has become the preferred treatment for patients with focal dystonia, particularly where involvement is limited to small muscle groups such as in blepharospasm, torticollis, and spasmodic dysphonia. Surgical therapy is an alternative [slideshare.net]
Eye symptoms Associated movement symptoms Blinking of both eyelids (blepharospasms) may be so severe that the patient is legally blind. The eyes may be rolled in any direction (oculogyric crisis). [medicalnewstoday.com]
Musculoskeletal
- Myalgia
Possible Saphris side effects in Reported by a consumer/non-health professional from United States on 2012-08-02 Patient: Reactions: Akathisia, Myalgia, Extrapyramidal Disorder, Tremor Drug(s) suspected as cause: Saphris Dosage: 10 mg, bid Indication: [druglib.com]
Face, Head & Neck
- Mask-like Facies
Some patients with tardive Parkinsonism lack facial expressions (mask-like facies) and they may drool. [medicalnewstoday.com]
Urogenital
- Incontinence
[…] vertical gaze, blinking on saccade, square-wave jerks, nystagmus, blepharospasm, and apraxia of eyelid opening or closure Pyramidal tract signs not explained by previous stroke or spinal cord lesions Autonomic symptoms such as postural hypotension and incontinence [slideshare.net]
[…] research criteria for neuroleptic malignant syndrome (NMS) include the development of severe muscle rigidity and elevated temperature associated with the use of neuroleptics along with two or more signs or symptoms of diaphoresis, dysphagia, tremor, incontinence [primarypsychiatry.com]
Neurologic
- Extrapyramidal Symptoms
Extrapyramidal Disorder Symptoms and Signs The extrapyramidal symptoms are a collection of side-effects that commonly occur with certain use of medications. [healthfoxx.com]
Extrapyramidal symptoms caused by these agents are indistinguishable from neuroleptic-induced extrapyramidal symptoms. [ncbi.nlm.nih.gov]
Extrapyramidal symptoms ( EPS ), also known as extrapyramidal side effects ( EPSE ), are drug-induced movement disorders that include acute and tardive symptoms. [en.wikipedia.org]
What Are Extrapyramidal Symptoms? Extrapyramidal symptoms (also known as EPS) are a set of side effects that are common with antipsychotic medications, as well as with a few other types of medications. [schizophrenia.emedtv.com]
The Extrapyramidal Symptoms Rating Scale. [eprovide.mapi-trust.org]
- Chorea
chorea Inherited AD, adulthood chorea & dementia. [authorstream.com]
Causes: Hereditary: as in Huntington’s chorea, benign hereditary chorea, Wilson’s disease, familial chorea with acanthocytosis. [slideplayer.com]
The model for choreiform disorders is Huntington's chorea. [dartmouth.edu]
Athetosis has features of dystonia and chorea and often occurs with chorea as choreoathetosis. [merckmanuals.com]
Inherited disorder: Huntington disease, wilson disease, benign hereditry chorea, neuroacanthocytosis Infectious causes: Rheumatic chorea (sydenham chorea), HIV disease Structural lesion of the basal ganglia- infarct, neoplasm, trauma Chorea [slideshare.net]
- Resting Tremor
[…] movement Rest : -Rest or ‘Parkinsonian’ tremor -Coarse & slow 4-5/s. [authorstream.com]
Intention Rest Tremor: is maximum at rest & becomes less prominent with activity eg: parkinson disease, Postural Tremor: is maximum while limb posture is actively maintained against gravity (arm outstretched) eg: Essential tremor, enhanced physiologic [slideshare.net]
Affectation of which may result in bradykinesia or slow movements, lead-pipe rigidity, postural instability, mask like face, shuffling gait and resting tremor that are similar to true Parkinson’s disease. Tardive Dyskinesia. [healthfoxx.com]
General inspection Look for: Walking aids Hypomimia (reduced facial expression) Stooped posture (in PD) Resting tremor. This is often described as "pill-rolling" and is frequently exacerbated by high emotions. [fastbleep.com]
The tremor has been erroneously considered a tremor at rest, but actually it is a tremor of postural or resting muscle tension. [dartmouth.edu]
- Hyperactivity
These drugs reduce acetylcholine hyperactivity and raise dopamine levels. Besides, they decrease dopamine hyperactivity in the mesolimbic system. [omicsonline.org]
Drug-induced dystonic-type extrapyramidal reactions There are patients who have developed a medication-induced oral motor hyperactivity that does not fit into the dyskinesia category. [pocketdentistry.com]
EPS and TD can mimic disorders such as Parkinson's Disease, Tourette's Syndrome, Huntington's Chorea, tics, cerebral palsy, stroke and hyperactivity. They are often mistaken for psychiatric disturbances and patients may be shunned. [medicalnewstoday.com]
Dopamine normally inhibits acetylcholine, but with dopamine blocked in this pathway, acetylcholine becomes hyperactive and can lead to effects such as EPS. 9 Although all SSRIs have the class effect of potentiating serotonin release, and thus indirectly [ptcommunity.com]
[…] or other socially disruptive behavior in children, adolescents, or adults associated with below-average mental abilities or retardation and destructive behavior, e.g., aggression, impulsivity, and self-harm Autism spectrum disorders characterized by hyperactivity [amboss.com]
- Hyperreflexia
[…] deafness, flattened T waves on ECG, seizures, sensory polyneuropathy, dysarthria, various craniofacial abnormalities (high forehead, flat occiput, triangular face, prominent nasal root, hypertelorism, and down-slanting palpebral fissures), scoliosis, hyperreflexia [orpha.net]
On exam there is a combined deficit of vibration and proprioception with pyramidal signs (plantar extension and hyperreflexia). [forums.studentdoctor.net]
Treatment
Treatments include: Medications Medications are the primary treatment of extrapyramidal symptoms. [healthfoxx.com]
Vitamin E in the treatment of tardive dyskinesia. Am J Psychiatry 1990;147:505–6. PubMed Google Scholar 13. Egan MF, Hyde TM, Alberts GW, Elkashef A, Alexander RC, Reeve A, et al. Treatment of tardive dyskinesia with vitamin E. [link.springer.com]
Treatment varies by disorder. Medicine can cure some disorders. Others get better when an underlying disease is treated. Often, however, there is no cure. In that case, the goal of treatment is to improve symptoms and relieve pain. [icdlist.com]
TREATMENT Treatment of movement side effects that appear early during treatment (EPS) is generally accomplished by slowly withdrawing the drug or lowering the dose. [medicalnewstoday.com]
Prognosis
It is treated usually experts and prognosis is usually poor. Following video shows tardive dyskinesia. First posted in [mentalhealthdoc.blogspot.com]
Conclusions The expected improvement in EPS profiles for participants randomised to second-generation drugs was not found; the prognosis over 1 year of those in the first-generation arm was no worse in these terms. [bjp.rcpsych.org]
[…] can add a significant burden, reducing patients’ quality of life and contributing to noncompliance. 1 Effective management of these unwanted effects of antipsychotics has the potential to improve patients’ compliance, quality of life, and possibly the prognosis [primarypsychiatry.com]
Etiology
Etiology Woodhouse-Sakati syndrome is associated with mutations in the DCAF17 gene (2q31.1), encoding a nucleolar protein of unknown function. Genetic counseling The disease is transmitted in an autosomal recessive manner. [orpha.net]
[…] syndrome Neurology A condition characterized by a range of findings–eg, rigidity, tremors, drooling, shuffling gait–parkinsonism, akathisia–restlessness, dystonia–odd involuntary postures, akinesia–motor inactivity, and other neurologic disturbances Etiology [medical-dictionary.thefreedictionary.com]
The role of environmental toxins in the etiology of Parkinson's disease. Trends Neurosci 1989;12:49–54. PubMed CrossRef Google Scholar 18. Fahn S. [link.springer.com]
Epidemiology
This volume discusses the extensive clinical boundaries of acute dystonias, drug-induced parkinsonism, akathisia and tardive dyskinesia, providing demographic and epidemiological context while illustrating how prescribing choices impact powerfully on [books.google.com]
Summary Epidemiology Approximately 30 patients from consanguineous Middle Eastern families, together with one Caucasian woman and three sibs from an Indian family, have been reported so far. Clinical description The onset is usually in adolescence. [orpha.net]
Basic description Originally developed in 1979 for epidemiological studies of tardive dyskinesia in schizophrenic outpatients on long-term classical anti-D2 antipsychotic medications Authors Chouinard G Copyright Extrapyramidal symptom rating scale (ESRS [eprovide.mapi-trust.org]
Tardive dyskinesia: Epidemiology. Journal of the Neurological Sciences, Vol. 389, Issue., p. 17. [bjp.rcpsych.org]
No adequate epidemiologic data exist regarding whether any particular psychiatric diagnosis constitutes a risk factor for the development of tardive reactions to medications; however, the duration of exposure to antipsychotics that is required to cause [pocketdentistry.com]
Pathophysiology
Akathisia Not a lot is known about the pathophysiology of akathisia. It is described as a “feeling of inner restlessness.” [learn.pharmacy.unc.edu]
However, the acute features in our case with normal liver functions are difficult to explain at present on the basis of existing literature and warrant further studies regarding pathophysiology of brain damage in WD. » References 1. [neurologyindia.com]
MPTP a neurotoxin relevant to the pathophysiology of Parkinson's disease. Neurology 1986;36:250–8. PubMed CrossRef Google Scholar 29. Koller W, Vetere-Overfield B, Gray C, Alexander C, Chin T, Dolezal J, et al. [link.springer.com]
The pathophysiology of bruxism is unknown. The most cogent theory describes bruxism as a neuromotor dysregulation disorder. This theory proposes that bruxism occurs because of the failure to inhibit jaw motor activity during a sleep state arousal. [pocketdentistry.com]
Pathophysiology : Inhibition of the nigrostriatal dopaminergic pathways results in EPS. [amboss.com]
Prevention
For tardive dystonia, prevention is the most important treatment since few pharmacologic treatments have proven efficacy. Prevention also is the key to managing akathisia. [the-hospitalist.org]
Collaborative Meta-Analysis of Randomised Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients. [books.google.es]
Standardized titration to avoid excessive dosage escalation and the use of atypical antipsychotics are successful measures of prevention. [uspharmacist.com]
Preliminary studies concerning Parkinson's disease suggested that vitamin E (2,000 IU/day) probably cannot prevent the development of the disease. It was suggested that vitamin E is able to slow the progression of the illness. [link.springer.com]
They are unable to make the appropriate kinetic-postural adjustment necessary to prevent them from falling. [dartmouth.edu]