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]

• Asymptomatic

  Heterozygotes (carriers) are asymptomatic and are not at risk of developing the disorder. [ncbi.nlm.nih.gov]

  Olanzapine also causes an asymptomatic increase of liver enzymes. [amboss.com]

  It appears to be much less common with other SGAs, but has been reported with the use of olanzapine and ziprasidone (Geodon) at high dosages. 6 Hyperprolactinemia can be asymptomatic, but may cause gynecomastia, galactorrhea, oligo- or amenorrhea, sexual [aafp.org]

• Congestive Heart Failure

  heart failure, prostatic outlet obstruction, confusion, hallucinations, insomnia Anticholinergics Benztropine (Cogentin) 0.5 mg per day Up to 4 mg per day Tremor reduction, less effect on other features, drug induced parkinsonism Atropinic effects: dry [slideshare.net]

• Pneumonia

  Many patients eventually develop retrocollis (a dystonic extension of the neck) and they often develop severe swallowing troubles (that can lead to pneumonia). [dartmouth.edu]

• Xerostomia

   Augment the effect of dopamine  Weak and play an adjuvant role  They are the same in efficacy but with some inter- individual variation in response Side effects:  Mood changes  Xerostomia, blurred vision, constipation, urinary retention  Hallucination [slideshare.net]

• Hypertension

  The alpha-2 blocking drug clonidine may suppress symptoms as well, however this is a powerful anti-hypertensive agent. [dartmouth.edu]

  Hypertension may be managed by antihypertensive agents, preferably angiotensin-converting enzyme inhibitors as they may reduce the progression of diabetes, decrease coronary vascular disease, and delay the progression of microalbuminuria. [primarypsychiatry.com]

• Jaundice

   Age- age of disease onset is very important tourette syndrome, typically begins in the first decade, parkinsons disease usually occurs in late age  Past history –About infection (rheumatic fever), jaundice(wilsons disease) • Medical history & Toxin [slideshare.net]

  […] epilepsy Alcohol-related psychosis, psychosis caused by intoxication or medication, or comatose states Circulatory collapse and/or CNS depression Severe renal or cardiac impairment Myocarditis Acute liver disease associated with nausea, anorexia or jaundice [amboss.com]

  […] or addition of an antiepileptic, usually allowing continuation of therapy. 63 Hepatic Adverse Events Mild, benign, and transient increase of liver enzymes infrequently occurs with both FGAs and SGAs, usually during the first 3 months of treatment. 64 Jaundice [primarypsychiatry.com]

• Torticollis

  […] irregular ,sinusoidal in character (piano playing) ,when it sustained leading to abnormal posture we call it dystonia ,which can be generalized or localized in one or 2 limbs segmental) .if it affect group of muscle called focal dystonia as writers cram or torticollis [slideplayer.com]

  Acute dystonic reaction involves muscular spasm of the neck known as torticollis. The patient experiences severe pain on the neck when trying to move it. The eyes may also be affected leading to oculogyric crisis. [healthfoxx.com]

  Torticollis is the medical term for a tilted head that occurs because on one side of the neck, when the muscles contract abnormally. [livestrong.com]

  Dystonias can affect all voluntary muscles in the body, including the neck (called torticollis), the eye muscles (called an oculogyric crisis), the tongue, jaw, and even the respiratory muscles, which can make it difficult to breathe. [psychvisit.com]

  persistent abnormal posturing: Focal : spasmodic torticollis, blepharospasm. Generalized : primary torsion dystonia Secondary : drugs, vascular. [authorstream.com]

• Fracture

  There is growing evidence that chronic hyperprolactinemia from antipsychotics can cause osteoporosis and an increased risk of hip fracture. [aafp.org]

  There are many articles that describe the clinical presentation and consequences of bruxism; most agree that the single most effective way to protect the teeth from progressive attrition, fracture, or clenching-induced pulpitis is to fabricate an occlusal [pocketdentistry.com]

  Elderly patients are particularly sensitive to this side effect and syncopal episodes can lead to falls and hip fractures. [primarypsychiatry.com]

• Delusion

  D2 receptors 5 Mu-opioid receptor partial agonist M2 Select Answer to see Preferred Response PREFERRED RESPONSE 4 (M2.PY.49) A 35-year-old woman is diagnosed with schizophrenia after nine months of experiencing auditory hallucinations and persecutory delusions [medbullets.com]

  Clinical science Summary Antipsychotics are a heterogeneous group of substances used primarily to treat schizophrenia, psychosis, mania, delusions, and states of agitation. [amboss.com]

  These patients are very sensitive to the older antipsychotic medications which are often administered in an attempt to quell the hallucinations, that are often accompanied by paranoid delusions. [dartmouth.edu]

• Tremor

  Physiologic Tremor: In normal individual 8-12Hz, mainly young adults Cerebellar tremor: intention tremor, coarse & irregular Thyrotoxic tremor: fine & rapid but may be complicated by choreiform involuntary movement Red nuclear tremor: the severe, [slideshare.net]

  The tremor has been erroneously considered a tremor at rest, but actually it is a tremor of postural or resting muscle tension. [dartmouth.edu]

  […] movement Rest : -Rest or ‘Parkinsonian’ tremor -Coarse & slow 4-5/s. [authorstream.com]

  However, in some cases, a tremor, though rhythmic, is irregular, as occurs when tremor is associated with dystonic disorders. [merckmanuals.com]

• 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]

• Akinesia

  The clinical manifestations include changes in the muscle tone, dyskinesia, and akinesia. Causes include vascular disorders, degenerative disorders, and antipsychotic drugs. [sideeffects.embl.de]

  […] motor pathways other than the pyramidal tract. extrapyramidal 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 [medical-dictionary.thefreedictionary.com]

  The extrapyramidal symptoms include acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome. [ncbi.nlm.nih.gov]

  The main features, akinesia, a mild dyspraxia Parkinsonism of movements of the arms and of gait, and primitive reflexes, were found in the majority of patients. Amyotrophy of the small hand muscles was found in six subjects. [karger.com]

  A general slowness or even absence of movement, called bradykinesia (ie. slow movement) or akinesia (absence of movement). [psychvisit.com]

• Insomnia

  Dystonia, Extrapyramidal Disorder Drug(s) suspected as cause: Saphris Possible Saphris side effects in female Reported by a physician from United States on 2011-12-13 Patient: female Reactions: Inappropriate Schedule of Drug Administration, Sedation, Insomnia [druglib.com]

  SUSTENNA ® were observed 1 Percentage of patients who discontinued due to AEs was 11.9% in the INVEGA SUSTENNA ® group and 7.8% in the oral antipsychotic group 2 The 5 most common AEs in the INVEGA SUSTENNA ® group were injection-site pain (18.6%), insomnia [invegasustennahcp.com]

  […] on other features, drug induced parkinsonism Atropinic effects: dry mouth, urinary outlet obstruction, confusion and psychosisTrihexyphenidyl (Artane) 0.5 mg bid Up to 2 mg tid MAO-B inhibitor selegiline, 5mg/day bd Neuroprotection, adjuntive therapy Insomnia [slideshare.net]

  The symptoms had begun 1 month prior to the referral to our hospital, and included: depressive mood, insomnia, early morning waking, loss of appetite and psychomotor retardation. [annals-general-psychiatry.biomedcentral.com]

  Restlessness may manifest as insomnia. It may be perceived as an uncomfortable inner vibration. Patients may call akathisia anxiety. Chorea/choreic Dance-like movements of any body part or the whole body. [medicalnewstoday.com]

• Somnolence

  Reference: Wikipedia Finnish tasapaino, uneliaisuus, sekavuus, huimaus, muistin heikkeneminen, keskittymisvaikeudet, dysfasia, neurologinen häiriö (ei määritelty), neuropatia, perifeerinen neuropatia, tuntohäiriö, puhehäiriö, vapina English impaired, somnolence [mymemory.translated.net]

  Somnolence can be managed by decreasing the total daily dose, changing the dosing schedule to a single bedtime dose, or changing to a less sedating antipsychotic. [primarypsychiatry.com]

  Schizophrenia Bipolar disorder Acute psychosis Postpartum psychosis MDD with psychotic features OCD (concomitant medication) Tourette syndrome Huntington disease Metabolic effects (usually weight gain, hyperglycemia, dyslipidemia ) most prominent Sedation, somnolence [amboss.com]

  Low-potency FGAs and clozapine are the most sedating, with some effect from olanzapine (Zyprexa) and quetiapine (Seroquel). 6 Somnolence can be alleviated by lowering the dosage, changing to a single bedtime dose, or switching to a less sedating medication [aafp.org]

• Hyperprolactinemia

  A 4, 5, 9 FGAs and the SGA risperidone (Risperdal) commonly cause hyperprolactinemia. Physicians should be vigilant for signs and symptoms of hyperprolactinemia in patients taking these medications. [aafp.org]

  Significantly fewer motor side effects ( EPS ) due to reduced D 2 receptor antagonism; greater affinity for 5HT 2A receptors and interaction with other receptors Hyperprolactinemia Elevated prolactin levels : Dopamine inhibits the release of prolactin [amboss.com]

  Atypical Antipsychotics Overview Atypical Antipsychotics Medication Unique features and side effects Risperidone • High potency • Usually first line • Hyperprolactinemia • Weight gain Olanzapine • Severe weight gain • Very sedating Ziprasidone • Minimal [medbullets.com]

  Symptoms of hyperprolactinemia include breast enlargement and tenderness, lactation, menstrual irregularities in women, and sexual dysfunction. [primarypsychiatry.com]

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]

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 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]

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]

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]

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]