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Orofacial Dyskinesia


Presentation

  • CASE PRESENTATION: A 55-year-old Sri Lankan man with a recent visit to South Africa presented with an acute febrile illness, cough and worsening dyspnoea with alveolar-interstitial infiltrates on chest radiography.[ncbi.nlm.nih.gov]
  • We present the case of a patient with orofacial dyskinesia secondary to treatment with phenytoin monotherapy. Right-handed male aged 80 years with a personal history of hypertension and atrial fibrillation.[elsevier.es]
Down Syndrome
  • Abstract Of 54 patients aged 30-60 years with a diagnosis of Down's syndrome, 38 had evidence of orofacial dyskinesia, assessed using the AIMS.[ncbi.nlm.nih.gov]
Family History of Epilepsy
  • He was being treated with acenocoumarol and had been fitted with a pacemaker; there was no family history of epilepsy or movement disorders. The patient came to the emergency department with a subacute headache resistant to conventional analgesics.[elsevier.es]
Pneumonia
  • CONCLUSIONS: Plasmodium falciparum and Mycoplasma pneumoniae co-infection occurring in vivo manifests clinical features that are plausibly a result of the interaction between the two microorganisms.[ncbi.nlm.nih.gov]
  • Medical HX: Hypertension, Type II diabetes, Depression, Migraine headaches, Involuntary Masseter muscle movements, Irritable Bowel Syndrome (IBS), Diarrhea, abdominal pain, heart burn, nausea/vomiting, gastro-esophageal reflux disease (GERD), pneumonia[medcraveonline.com]
Asterixis
  • Although asterixis, dystonia, and tremor have been described with carbamazepine (Tegretol), there is no report of orofacial dyskinesia.[ncbi.nlm.nih.gov]
  • […] has been described in patients treated with lamotrigine, ethosuximide, carbamazepine, valproic acid, 2 gabapentin, 3 felbamate, 4 and phenobarbital. 5,6 DPH may cause different movement disorders, including orofacial and limb dyskinesias, trembling, asterixis[elsevier.es]
  • We will not discuss here reports about tremor, asterixis and myoclonus since these are less specific abnormalities seen in a wide range of metabolic and toxic disorders.[scielo.br]
Oral Ulcers
  • He also had oral ulcers due to involuntary biting. Blood smear showed 20% acanthocytes. Nerve conduction demonstrated sensory axonal neuropathy. MRI was negative for white matter changes and caudate atrophy.[neurology.org]
Tooth Loss
  • The patients collectively demonstrated uncontrolled movement that worsen over time, tooth loss due to periodontal disease and bruxism, xerostomia, tongue movement and lacerations, tongue protrusion and heavy calculus.[medcraveonline.com]
Facial Grimacing
  • On day 4 of treatment, she experienced involuntary, rhythmic facial grimacing accompanied by periodic cervical muscular contractures.[ncbi.nlm.nih.gov]
  • grimacing (commonly involving lower facial muscles) Finger movement (piano playing movements) Rocking or thrusting of the pelvis (duck-like gait) Jaw swinging Repetitive chewing Rapid eye blinking Tongue thrusting Restlessness When TD is diagnosed, the[medlineplus.gov]
  • Typical symptoms include facial grimacing, sticking out the tongue, sucking or fish-like movements of the mouth.[rarediseases.org]
  • Facial grimacing. Repetitive tongue protrusion. Puckering, smacking and licking of the lips. Side-to-side motion of the jaw. Withdrawal of neuroleptic medications or other offending agent. Pharmacologic treatment.[pocketdentistry.com]
Renal Insufficiency
  • Patients on fluoroquinolones of advanced age and with renal insufficiency should be monitored closely for such toxicities.[ncbi.nlm.nih.gov]
Dystonia
  • Oromandibular dystonia (OMD) is perhaps the most common of these and includes jaw opening, jaw closing, and jaw deviation dystonia.[link.springer.com]
  • Although asterixis, dystonia, and tremor have been described with carbamazepine (Tegretol), there is no report of orofacial dyskinesia.[ncbi.nlm.nih.gov]
  • Dystonia Dystonia is a movement disorder that causes involuntary contractions of your muscles. These contractions result in twisting and repetitive movements. Sometimes they are painful.[icdlist.com]
  • Orofacial dyskinesia (video on the Neurology Web site at www.neurology.org ), oral mutilation, and feeding dystonia are typical of chorea-acanthocytosis. 1 Generalized seizures and axonal sensory neuropathy are associated. 2 AUTHOR CONTRIBUTIONS All authors[neurology.org]
Tremor
  • Although asterixis, dystonia, and tremor have been described with carbamazepine (Tegretol), there is no report of orofacial dyskinesia.[ncbi.nlm.nih.gov]
  • Tremors are a type of dyskinesia. Nerve diseases cause many movement disorders, such as Parkinson's disease. Other causes include injuries, autoimmune diseases, infections and certain medicines.[icdlist.com]
  • Subtypes of tremors include tremors at rest, essential tremor, which is a postural tremor at either rest or activity and may be inherited, or tremor with movement (intention "kinetic" tremor).[encyclopedia.com]
  • The term "tardive dyskinesia" was first introduced in 1964 and is now commonly used to identify any tardive movement disorder, including stereotypy, akathisia , dystonia, myoclonus , tics, chorea, and tremor ( Faurbye et al 1964 ).[medlink.com]
Extrapyramidal Symptoms
  • The low prevalence of extrapyramidal symptoms associated with atypical antipsychotics has led to their widespread use during the past decade.[journalofpsychiatryreform.com]
  • symptoms Distinguishing TD from other Movement disorders: o Youtube video demonstrates the symptoms of Parkinson’s disease o Youtube video demonstrates various TD symptoms and how to score them o Using forms and scoring techniques, it is easier to document[slideshare.net]
  • Persistent emergent tardive dyskinesia was defined by the scores on the dyskinesia subscale of the Extrapyramidal Symptom Rating Scale. Among the 330 patients enrolled in the study, the mean age was 82.5 years.[aafp.org]
  • About two-thirds had no extrapyramidal symptoms. Approximately one-quarter had orofacial and generalized dyskinesia and 12% had orofacial and generalized dystonia, but half of patients showed a mixed presentation.[medpagetoday.com]
  • Antipsychotic-induced extrapyramidal symptoms and their management. Expert Opin Pharmacother. 2008;9:1451-1462. 19. Haddad PM, Dursun SM. Neurological complications of psychiatric drugs: clinical features and management.[uspharmacist.com]
Choreoathetoid Movements
  • movements of the extremities.[medical-dictionary.thefreedictionary.com]
  • Choreoathetoid movements of the fingers, hands, or upper or lower extremities also are common. Patients may experience axial symptoms affecting the neck, shoulders, spine, or pelvis.[mdedge.com]
  • Involuntary biting, clenching, chewing, mouth opening, and lateral movements of the jaw may also occur, along with protrusion, tremor, and choreoathetoid movements (ie, rolling, wormlike movement of the tongue without displacement from the mouth).[mdmag.com]
Tic Disorder
  • […] chorea Tardive dyskinesia Transient tic disorder [ Read More ][icdlist.com]
  • Tardive tourettism is a tic disorder featuring the same symptoms as Tourette syndrome. The two disorders are extremely close in nature and often can only be differentiated by the details of their respective onsets.[en.wikipedia.org]

Workup

Plasmodium Falciparum
  • CONCLUSIONS: Plasmodium falciparum and Mycoplasma pneumoniae co-infection occurring in vivo manifests clinical features that are plausibly a result of the interaction between the two microorganisms.[ncbi.nlm.nih.gov]

Treatment

  • In most cases, they occur in older psychotic patients who are in institutions and in whom long-term treatment with antipsychotic drugs of the phenothiazine and butyrophenone groups is being carried out.[ncbi.nlm.nih.gov]

Prognosis

  • […] anti-psychotic medications, and some specific gastrointestinal drugs Please find comprehensive information on Tardive Dyskinesia (TD) regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis[dovemed.com]
  • This action on dopamine-related events provides a basis for a possible therapeutic action o... more The long-term prognosis of tardive dyskinesia (TD) has been insufficiently studied.[scinapse.io]
  • Symptoms - Tardive dyskinesia Causes - Tardive dyskinesia Prevention - Tardive dyskinesia Diagnosis - Tardive dyskinesia Prognosis - Tardive dyskinesia If diagnosed early, the condition may be reversed by stopping the drug that caused the symptoms.[checkorphan.org]
  • Typically, patients receive antiepileptic medications, and improvement of symptoms is usually associated with a good prognosis. If symptoms do not improve with antiepileptic medication(s), the prognosis is not favorable.[encyclopedia.com]
  • Prognosis The earlier the problem is noticed and treatment begun, the better chance there is that the abnormal movements will go away. Most patients have a noticeable improvement in their symptoms within a year and a half.[minddisorders.com]

Etiology

  • This article presents an overview of the etiology, pathophysiology, phenomenology, and treatment of tardive dyskinesia.[medlink.com]
  • Managing, isolating and identifying contributing etiologies responsible for a significant catastrophic neurological alteration in muscular physiological activities found in TD may be a daunting challenge [5-8].[medcraveonline.com]
  • Some evidence suggests that mentally retarded individuals taking neuroleptics have a higher incidence of TD. 9 Pathophysiology There are gaps in our understanding of the pathophysiology and etiology of TD.[mdmag.com]
  • […] contain the movements with a strong, concentrated effort. 4,19 The major risk factors associated with TD are advanced age, female sex, mood disorders, organic brain dysfunction, greater total drug exposure, and early extrapyramidal symptoms (EPS). 2,4 Etiology[uspharmacist.com]

Epidemiology

  • ., Sachdev P.S. eds Пє epidemiology of tardive dyskinesia. - NY Marcel Dekker. - 2004. - P. 318-320. 9. Delay J, Deniker P. 1957; Schonecker M. Paroxysmal dyskinesia as the effect of megaphen. - Nervenarzt. -1957. - Vol. 28. - P. 550-553. 10.[bekhterevreview.com]
  • "Epidemiology of tardive dyskinesia before and during the era of modern antipsychotic drugs". In Vinken, P. J.; Bruyn, G. W. (eds.). Handbook of Clinical Neurology.[en.wikipedia.org]
  • Epidemiology of tardive dyskinesia before and during the era of modern antipsychotic drugs. Tarsy D, Lungu C, Baldessarini RJ. Handb Clin Neurol. 2011;100:601-16.[journalofpsychiatryreform.com]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • The syndrome parallels several of the features of clinical tardive dyskinesia, whose pathophysiology thus may not involve changes in the characteristics of striatal dopamine receptors.[ncbi.nlm.nih.gov]
  • This type of dyskinesia may occur with no underlying striatal lesion and resolve when phenytoin is discontinued; its pathophysiological mechanism is unknown. References [1] H.A. Peters, P.I. Eichmann, J.M. Price, F.A. Kozelka, H.H.[elsevier.es]
  • This article presents an overview of the etiology, pathophysiology, phenomenology, and treatment of tardive dyskinesia.[medlink.com]
  • Pathophysiology of Tardive Stereotypies The pathophysiology of tardive stereotypy is not understood but striatal Dopamine (D2) receptor super-sensitivity has been the traditional explanation.[cmdg.org]
  • Some evidence suggests that mentally retarded individuals taking neuroleptics have a higher incidence of TD. 9 Pathophysiology There are gaps in our understanding of the pathophysiology and etiology of TD.[mdmag.com]

Prevention

  • […] dose anti-psychotic medications, and some specific gastrointestinal drugs Please find comprehensive information on Tardive Dyskinesia (TD) regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention[dovemed.com]
  • Prevention Because there is no “gold standard” treatment for TD, it is important to minimize the risk of TD by taking preventive measures and detecting incipient signs of the disorder.[mdedge.com]
  • The authors concluded that melatonin could be screened as a potential drug candidate for the prevention or treatment of neuroleptic-induced orofacial dyskinesia. 2 In 2003, L.[globalrph.com]
  • The goal is to prevent TD.[webmd.com]

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