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Infantile Dystonia - Parkinsonism

IPD


Presentation

  • Special emphasis is placed on acutely presenting disorders and emergency situations. The rationale of the approaches presented in this book are based on extensive, collective clinical experience.[books.google.com]
  • […] excess in the synaptic cleft, it likely also causes depletion of presynaptic dopamine stores and possibly downregulation of postsynaptic dopamine receptor function, resulting in impairments in dopaminergic neurotransmission consistent with the clinical presentation[ncbi.nlm.nih.gov]
  • Additional symptoms that may be present include abnormal eye movements, reduced facial expressions, irritability, sleeping problems, digestive problems (such as reflux or constipation), and recurrent pneumonia which can be life-threatening. [2] [3] Classic[rarediseases.info.nih.gov]
Feeding Difficulties
  • Infants typically manifest nonspecific findings (irritability, feeding difficulties, axial hypotonia, and/or delayed motor development) followed by a hyperkinetic movement disorder (with features of chorea, dystonia, ballismus, orolingual dyskinesia).[ncbi.nlm.nih.gov]
Impaired Balance
  • Parkinsonism develops as the disorder progresses and is characterized by tremor (shaking), slowed movements (bradykinesia), rigidity (stiffness), and impaired balance and coordination.[rarediseases.info.nih.gov]
Feeding Difficulties
  • Infants typically manifest nonspecific findings (irritability, feeding difficulties, axial hypotonia, and/or delayed motor development) followed by a hyperkinetic movement disorder (with features of chorea, dystonia, ballismus, orolingual dyskinesia).[ncbi.nlm.nih.gov]
Hyperactivity
  • Variations in solute carrier family 6A, member 3 (SLC6A3/DAT1), the human gene encoding DAT, have been implicated in attention deficit hyperactivity and bipolar disorders, and DAT is a prominent site of action for drugs such as amphetamines and cocaine[ncbi.nlm.nih.gov]
  • In mice however, mutations to the DAT gene produces prominent hyperactivity rather than Parkinsonian symptoms.[birmingham.ac.uk]
  • Population frequency for the p.G399S substitution were generated from Norwegian attention deficit hyperactivity disorder patients ( n 589) and healthy controls ( n 640).[pnas.org]
  • On neurological examination, the ankle clonus and Babinski sign were no longer present, but the deep tendon reflexes of the legs were hyperactive.[bmcneurol.biomedcentral.com]
Ocular Flutter
  • This syndrome is usually caused by endogenous dopamine deficiency but in these patients was associated with elevated dopamine metabolites in CSF and an unusual eye movement disorder: ocular flutter together with saccade initiation failure.[ncbi.nlm.nih.gov]
Ocular Flutter
  • This syndrome is usually caused by endogenous dopamine deficiency but in these patients was associated with elevated dopamine metabolites in CSF and an unusual eye movement disorder: ocular flutter together with saccade initiation failure.[ncbi.nlm.nih.gov]
Akinesia
  • Over time, affected individuals develop parkinsonism-dystonia characterized by bradykinesia (progressing to akinesia), dystonic posturing, distal tremor, rigidity, and reduced facial expression.[ncbi.nlm.nih.gov]
Spastic Gait
  • She developed a mildly spastic gait at 10 years, which progressively worsened by age 13. At that time she became stiff, developed bradykinesia, and her cognitive function became noticeably worse.[ashg.org]

Workup

White Matter Lesions
  • An MRI of the brain revealed mild diffuse cerebral volume loss, periventricular white matter lesions and thinning of the anterior corpus callosum. Array-CGH, metabolic studies and CSF neurotransmitter analysis were normal.[ashg.org]

Treatment

  • There is no effective treatment.[diseaseinfosearch.org]
  • Dystonia provides a practical review of the disorder that emphasizes cost-effective evaluation and treatment and advice on how to apply the current knowledge in clinical practice.[books.google.com]
  • Treatment may include medicines to control involuntary movements (such as tetrabenazine and benzodiazepines), medicines to control dystonia (such as pramipexole and ropinirole ), and physical therapy to reduce the risk of contractures from muscle rigidity[rarediseases.info.nih.gov]

Prognosis

  • […] abnormal eye movements, reduced facial expressions, irritability, sleeping problems, digestive problems (such as reflux or constipation), and recurrent pneumonia which can be life-threatening. [2] [3] Classic DTDS is associated with a poor outlook ( prognosis[rarediseases.info.nih.gov]
  • The prognosis is thus poor. Treatment - Infantile neuroaxonal dystrophy Resources - Infantile neuroaxonal dystrophy Not supplied.[checkorphan.org]
  • The invitro functional analysis further confirm previous data that all classical infantile onset DTDS missense mutations studied to date retain dopamine uptake of below 5% and may help predict phenotypic disease severity and prognosis.[mdsabstracts.org]
  • Clinical presentation varies widely in age of onset, localization, temporal pattern and presence of specific features or associated conditions, and careful diagnosis and then classification is important for prognosis and treatment selection 5,6 .[centogene.com]
  • A confirmed genetic diagnosis may help predict disease prognosis and progression, facilitate early detection and treatment of symptoms, inform family planning and carrier screening, or promote enrollment in clinical trials.[invitae.com]

Etiology

  • A study by McClelland et al indicated that there are significant differences in the rate and pattern of pallidal firing according to the etiology and phenotype of dystonia.[emedicine.medscape.com]
  • Of these, eight were drug-induced, highlighting the importance of this etiology.[e-jmd.org]
  • The presence of associated findings, however, may suggest a specific etiology.[blepharospasm.org]
  • This group has proposed to classify dystonia based on two axes: clinical features and etiology. Classifying dystonia by clinical features includes age of onset, body distribution, temporal pattern, and associated features.[rarediseases.org]
  • These historical reports usually attributed the etiology of the motor abnormalities to overuse.[en.wikipedia.org]

Epidemiology

  • There is a lack of high quality epidemiological data on the disorders, and underdiagnosis is likely ( 6 , 12 , 13 ). A prevalence in the general population of 0.5 per million is often reported in the literature ( 12 , 13 ).[tidsskriftet.no]
  • To date, epidemiological data related to RDP is limited and fewer than 75 RDP cases have been reported worldwide [ 2 ].[bmcneurol.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • Finally, there has been increasing recognition of both the extramotor phenotype in dystonia and the part played by the cerebellum in its pathophysiology.[journals.lww.com]
  • Both respond to similar subcortical targets in deep brain stimulation (DBS), suggesting a pathophysiological overlap.[neurologyadvisor.com]
  • Genetics and pathophysiology of neurodegeneration with brain iron accumulation. Curr Neuropharmacol 2013 ; 11 : 59 –79. 6. S. A. Schneider, K. P. Bhatia.[cambridge.org]
  • The presumed pathophysiologic mechanism of hemifacial spasm involves the generation of ortho- and antidromic impulses by a damaged area of the facial nerve.[blepharospasm.org]
  • From the 1990s onwards, studies have been conducted to characterise the underlying genetic causes and associated biochemical deficiencies and pathophysiology.[tidsskriftet.no]

Prevention

  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.com]
  • To prevent secondary complications: Start physical therapy early and orthopedic management to help prevent contractures as the disease progresses. Genetics PLAN is inherited in an autosomal recessive manner.[nbiadisorders.org]
  • Symptoms - Infantile neuroaxonal dystrophy Causes - Infantile neuroaxonal dystrophy Prevention - Infantile neuroaxonal dystrophy Not supplied.[checkorphan.org]
  • […] and/or stool softener treatment for constipation Control of secretions and excess drooling with transdermal scopolamine patch or other treatments (as needed) Early physical therapy and orthopedic management to prevent contractures Periodic testing of[nbiacure.org]
  • In most patients, discontinuation of the drugs requires tapering to prevent withdrawal symptoms.[emedicine.medscape.com]

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