Extrapyramidal disorders

50 %
50 %
Information about Extrapyramidal disorders

Published on January 12, 2009

Author: aSGuest10195

Source: authorstream.com

“EXTRAPYRAMIDAL” MOVEMENT DISORDERS : “EXTRAPYRAMIDAL” MOVEMENT DISORDERS Prof. AR AlTahan Division of Neurology EXTRAPYRAMIDAL SYSTEM : EXTRAPYRAMIDAL SYSTEM ANATOMY: Caudate nucleus Putamen Globus pallidus Subthalamic nucleus Substantia nigra These structures are functionally connected with the Thalamus and Pre-motor Cortex EXTRAPYRAMIDAL SYSTEM : EXTRAPYRAMIDAL SYSTEM PHYSIOLOGY Influence the details of a movement plan Modifies the order-plan “Pyramidal plan” Affects motor function by either: FACILITATION SUPPRESSION EXTRAPYRAMIDAL SYSTEM : EXTRAPYRAMIDAL SYSTEM PATHO-PHYSIOLOGY: Failure to facilitate Failure to suppress EXTRAPYRAMYDAL SYSTEM DYSFUNCTION : EXTRAPYRAMYDAL SYSTEM DYSFUNCTION Failure to facilitate - brady-hypokinesia - diminished postural responses - bradyphrenia - no weakness EXTRAPYRAMIDAL SYSTEM DYSFUNCTION : EXTRAPYRAMIDAL SYSTEM DYSFUNCTION Failure to suppress ? Dyskinesia “Involuntary movements” - tremor - chorea - athetosis - dystonia TREMORRhythmic, sinusoidal movement : TREMORRhythmic, sinusoidal movement Postural / Action Physiologic: - fine, exacerbated by: Thyrotoxicosis Beta agonists Essential: - head and hands (Titubation) spares legs Rubral: - Batwing tremor TREMORRhythmic, sinusoidal movement : Intention: Intention tremor = Cerebellar ( brainstem ) TREMORRhythmic, sinusoidal movement TREMORRhythmic, sinusoidal movement : TREMORRhythmic, sinusoidal movement Rest : -Rest or ‘Parkinsonian’ tremor -Coarse & slow 4-5/s. -Mainly distal. -Associated with rigidity & bradykinesia Slide 10: TREMORRhythmic, sinusoidal movement Differential Diagnosis: - Myoclonus - Asterixes - Tics (Guilles de la Tourette syndrome) CHOREA : CHOREA “dance” in Greek Rapid, forceful and semi-purposeful movement. Interferes with, and deforms voluntary movements . Differential Diagnosis: Tremor Myoclonus CHOREA Causes : CHOREA Causes Drugs : - phenothiazines (Tardive dyskinesia) - methoclopramide & levodopa Sydenham chorea: Rheumatic fever Chorea gravidarum / contraceptives CHOREA Causes : CHOREA Causes Huntington chorea Inherited AD, adulthood chorea & dementia. Focal or diffuse cerebral lesions: Cerebral palsy, Stroke Slide 14: Hemiballismus: lesion to subthalamic nucleos of lewis Commonly ischemic ATHETOSIS : ATHETOSIS Means “Changeable in Greek” Slow, writhing involuntary movement, Mainly distally. Causes Cerebral palsy, kernicterus Drugs (choreo-athetosis) Tardive dyskinesia DYSTONIA : DYSTONIA Involuntary, intermittent -.- persistent abnormal posturing: Focal : spasmodic torticollis, blepharospasm. Generalized : primary torsion dystonia Secondary : drugs, vascular. PARKINSON’s DISEASE : PARKINSON’s DISEASE A common idiopathic neurological disease of the elderly characterized by : Brady-hypokinesia, Rigidity Rest tremor PARKINSON’s DISEASE Etiology??? Multifactorial : PARKINSON’s DISEASE Etiology??? Multifactorial Environmental: - Neurotoxins MPTP ? -Parkinsonism epidemic in young addicts. -Toxic to substantia nigra - Viral infections: Enceph. Lethargica PARKINSON DISEASE Etiology : PARKINSON DISEASE Etiology Genetic: Mutations in essential proteins ? Accumulation of protein aggregate inside the cell “Lewy bodies” ? cell death - Alpha synuclein ? Synucleinopathy Parkinson’s DiseasePathology : Parkinson’s DiseasePathology Substantia Nigra, Locus ceruleus, cingulat gyrus, etc… Proteinacious inclusion bodies: Lewy bodies (a synuclein) PARKINSON DISEASE Prevalence1.5 : 1000 1% in over 50 years old. : PARKINSON DISEASE Prevalence1.5 : 1000 1% in over 50 years old. Natural history: Invariably progressive 25% dead or severely disabled ? 5 yrs 80% dead or severely disabled ? 15 yrs Increase Morbidity and Mortality “tripled” PARKINSON DISEASE Clinical Features : PARKINSON DISEASE Clinical Features Often unilateral ( early ). Exacerbated by anxiety. Ameliorated by relaxation. Disappear during sleep. PARKINSON DISEASE Clinical Features : PARKINSON DISEASE Clinical Features Rest Tremor: presention in 65%. Distal parts: hands, feet, jaw, tongue Head tremor unusual PARKINSON DISEASE Clinical Features : PARKINSON DISEASE Clinical Features Rigidity: Increased tone throughout movement. Lead pipe (plastic) or cogwheel. More in flexors (flexed posture). Parkinson’s DiseaseClinical features : Parkinson’s DiseaseClinical features Hypo-bradykinesia: Main disabling feature Poverty of movements Slowness in initiation and execution FACE EYES SPEECH WALKING POSTURAL REFLEX. PARKINSON DISEASE Clinical Features : PARKINSON DISEASE Clinical Features GI features: Drooling of saliva. Dysphagia. Heart burn. Constipation, Megacolon. Weight loss. PARKINSON’s DISEASE Clinical Features : PARKINSON’s DISEASE Clinical Features Mental Function : Depression. Dementia. Bradyphrenia. Drugs side-effects. PARKINSON’s DISEASE Diagnosis : PARKINSON’s DISEASE Diagnosis Typical Clinical features Elderly L-dopa. Good response When to investigate ? Atypical clinical picture, age. Atypical response to treatment. Differential Diagnosis : Differential Diagnosis Drug-induced parkinsonism Wilson’s disease Essential tremor Multiple system atrophy Progressive supranuclear palsy Multiple lacunar strokes Normal pressure hydrocephalus Pugilistic (post-traumatic) parkinsonism Depression Differential Diagnosis (Parkinsonism or P. Syndrome) : Differential Diagnosis (Parkinsonism or P. Syndrome) Drug induced : Phenothiazines Butyrphenones Reserpine Tetrabenazine Structural lesion: Commonest ? multiple-infarcts Vascular Parkinsonisms : Vascular Parkinsonisms A manifestation of strokes, affecting basal ganglia Features include: pyramidal, cerebellar and mental changes WILSON’S DISEASE“Hepato-Lenticular Degeneration” : WILSON’S DISEASE“Hepato-Lenticular Degeneration” Autosomal recessive Abnormality of copper metabolism Deposit in all organs: Brain: Cortex & Basal Ganglia Cornea Kidneys Liver WILSON’S DISEASE“Hepato-Lenticular Degeneration” : WILSON’S DISEASE“Hepato-Lenticular Degeneration” Clinical Features : Adolescence. Kayser-Fleischer ring. Parkinsonism. Psychiatric – mental changes. Liver cirrhosis. Renal tubular acidosis. WILSON’S DISEASE“Hepato-Lenticular Degeneration” : WILSON’S DISEASE“Hepato-Lenticular Degeneration” INVESTIGATIONS : Liver-Renal functions Copper studies Slit-lamp test Liver biopsy TREATMENT : Penicillamine Trientin Zinc compounds PARKINSON’s DISEASE Management : PARKINSON’s DISEASE Management General measures Pharmaceutical Surgical treatment Restorative «experimental» Transplantation Neurotrophic factors General measures : General measures Education of patient and family Support psychological and emotional needs Regular exercise Proper nutrition Symptomatic Therapy : Symptomatic Therapy L-dopa Dopamine agonists Anticholinergic agents Amantadine Restors neurotransmitter balance or deficiency L-dopa : L-dopa Most effective drug for symptomatic treatment Initiate when akinetic symptoms disabling Use lowest dose that produces response 300 to 600 mg daily Dopamine Agonists : Dopamine Agonists Ergot dopamine agonists Bromocriptine (Parlodel) Pergolide (Permax) Non-ergot dopamine agonists Piribedil (Trivastal) Pramipexole (Mirapex) Ropinirole (Requip) Apomorphine and lisuride IV for rescue therapy in sudden akinetic episodes Anticholinergic Drugs : Anticholinergic Drugs Trihexyphenidyl (Artane) Benztropine (Cogentin) Adverse effects common: Memory impairment, confusion, hallucinations Dry mouth, blurred vision, constipation, nausea, urinary retention, impaired sweating, tachycardia Surgery, Implantations and Infusions : Surgery, Implantations and Infusions Thalamotomy Pallidotomy Deep brain stimulation (DBS) Intra-striatal human retinal cells implant (Spheramine) Growth factor infusion Fetal tissue implant !

Add a comment

Related presentations

Related pages

Movement disorder - Wikipedia, the free encyclopedia

Movement disorders include: (There are 25 disorders and 18 sub-disorders in this page.) Akathisia (inability to sit still) Akinesia (lack of movement ...
Read more

Extrapyramidal disorder - RightDiagnosis.com - Right Diagnosis

Extrapyramidal disorder information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues.
Read more

Extrapyramidal disorder | definition of Extrapyramidal ...

movement disorder, any of numerous neurologic disorders characterized by disturbances of muscular movement, distinguished as either hyperkinetic ...
Read more

Chapter 26: Extrapyramidal disorders - Dartmouth College

Chapter 26- Disorders of basal ganglia function. There is no definitive list of structures that are included in the extrapyramidal system, but all lists ...
Read more

Extrapyramidal disease | definition of extrapyramidal ...

extrapyramidal disease (extrapyramidal syndrome) any of a group of clinical disorders marked by abnormal involuntary movements, ...
Read more

Extrapyramidal Symptoms - Schizophrenia Home Page

Extrapyramidal symptoms are usually divided into different categories. Dyskinesias are movement disorders, while dystonias are muscle tension disorders.
Read more

Extrapyramidal Examinations in Psychiatry

Extrapyramidal signs include increased motor tone, changes in the amount and velocity of movement, and involuntary motor activity. They include two groups ...
Read more