Extrapyramidal syndromes - Causes, symptoms and treatment. MF.

Extrapyramidal disorders are changes in muscle tone, impaired motor activity, the appearance of hyperkinesis( twitching) or hypokinesia( immobility) and their combinations.

There are such symptoms in the defeat of special structures of the brain - extrapyramidal system. It is an optic hillock, basal ganglia, a sub-abdominal region, an inner capsule.

In the process of development of extrapyramidal disorders, there is a violation of the neurotransmitter metabolism, an imbalance between the dopaminergic mediators and the cholinergic mediators, as well as the relationships with the pyramidal system. As a result, discoordination of movements occurs.

Extrapyramidal system provides regulation of posture, tone, changes in muscle tone provides readiness for movement, smoothness, quickness, accuracy of movements, friendly movements( for example, when walking arms and legs move).Thanks to connections with the cerebral cortex, hypothalamus and limbic system, extrapyramidal formations take part in providing higher nervous activity, especially in the emotional sphere.

Extrapyramidal hypokinesis occurs when the frontal lobe, black substance and reticular formation are affected. Hyperkinesis occurs when the striatal nucleus, the thalamus, the red core, the cerebellal-thalamic pathway are affected.

Extrapyramidal hyperkinesis is a superfluous, involuntary, violent movement.

Athetosis - manifested in the fingers, - slow, wriggling, vermiform movements. Athetosis of the facial muscles is manifested by the curvature of the mouth, twitching of the lips and tongue. The tension of the muscles is replaced by a decrease in tone and relaxation. Most often appear with a defeat of the caudate nucleus, a violation of the relationship between the pale sphere and the red nucleus.such violations are possible with birth trauma, epidemic encephalitis, craniocerebral trauma, atherosclerosis, syphilis.

Athetosis

Chorea - a variety of rapid violent movements of the muscles of the trunk and extremities, neck and face, not rhythmic and not consistent, arising against a background of reduced muscle tone.

spasm is a dystonia of the muscles of the trunk. The disease can begin at any age. Hyperkinesis appears when walking - crouching, spinning, rotational muscles in the neck and trunk. The first manifestations can begin with the muscles of the neck - torsion torticollis - violent lateral turns of the head. Torso torticollis can be an isolated pathology, without affecting other muscle groups. Can the disease manifest as a "writing spasm".When writing, the fingers come into a hypertension state, they strain and small movements become impossible, you can not unclench the brush. At certain moments, during a muscle spasm patients seem to freeze in one pose. Torsional spasm develops in inflammatory diseases - encephalitis, hereditary degenerative diseases. Applied for the treatment of muscle relaxants - midokalm, baclofen., Sedatives, vitamins B.

Spasmodic torticollis

Teak - repeated convulsive twitching of individual muscles, more often face, eyelids, neck - twitching of the neck, tilting the head, twitching the shoulder, winking, wrinkling of the forehead -same type of motion. It often manifests itself in nervous tension, stress. In the treatment use sedative drugs and muscle relaxants - valerian tablets, dormiplant, novopassit, sedavit, afobazol, pantokaltsin, midokalm, vitamin B6, reflexotherapy.

Myoclonia - rapid, short twitching, fulminant in individual muscles or a group of muscles. There are cases of kozhevnikovskaya epilepsy, encephalitis.

Gemiballism - one-sided flipping, sweeping motion of limbs( more often hands).It occurs when the luisa body is infected with tuberculoma, syphilitic gum, metastases of tumors, with encephalitis, vascular diseases.

All listed hyperkinesis can be isolated, can be combined. For example, choreoathetosis.

Choreoathetosis

Hyperkinesis is aggravated by agitation, physical stress and disappears in a dream.

Tremor - shaking - rhythmic fast movements of small amplitude. Postural tremor occurs when the posture is held, for example, arms extended forward. Kinetic tremor occurs during movements. Intensive tremor occurs when you approach the target, for example, when you try to hit your nose with your finger - the closer to the nose - the stronger the tremor. The tremor of rest arises at rest and decreases with movements, which is characteristic of Parkinson's disease.
Distinguish between primary and secondary tremor, essential and secondary, as a manifestation of somatic( liver, kidney, thyroid) and nervous system diseases( degenerative diseases - Konovalov-Wilson, Parkinson, cerebellar degenerations, craniocerebral traumas, tumors) or intoxication( alcohol, manganese, mercury, a number of drugs - psychotropic, bronchodilators, drugs).At occurrence of any tremor it is necessary to address to the neurologist and to pass or take place individually appointed inspections.

Facial hemispasm - tonic mixing of the muscles of the face, neck and tongue, at the same time the eye is closed, the mouth is pulled.
When the extrapyramidal system is affected, violent laughter, crying, and various grimaces are possible.
If any convulsions, twitches, changes in muscle tone, violation of accuracy and focus of movements, you need to contact a neurologist. The neurologist will examine you, conduct a series of tests to check the functions of the extrapyramidal system and a general neurologic examination. To determine the pathological process, blood tests, examination of the oculist, computer and( or) magnetic resonance tomography will be necessary. Self-diagnosis of such a pathology patient can not. Differential diagnosis is carried out with encephalitis, vascular and infectious diseases of the brain( tuberculosis, syphilis. ..).It is necessary to exclude oncopathology.

Huntington's Hortington( St Vitus Dance) is a serious progressive hereditary disease. Begins in the 30-40 years the appearance of choreiform hyperkinesis and progressive dementia( dementia).Hyperkinesis is slow, sweeping, there is no muscle hypotension. Degenerative process affects the shell, caudate nucleus, cells of the frontal lobe of the brain. In the blood, the content of tyrosine is increased, which plays an important role in the biochemistry of the extrapyramidal system.
An electroencephalogram can detect a diffuse change in brain activity, the absence of an alpha rhythm, the appearance of slow waves. At a computer tomography - atrophic processes. In the treatment, use abixu( memantine), dopamine antagonists - tryptazine, dopegit, reserpine, B vitamins, neuroprotectors.
The disease is severe, in the diagnosis plays the role of a family anamnesis. With progression leads to disability. Patients are observed by a neurologist, they need the help of a psychiatrist.

Hyperkinesis with Huntington's chorea and brain lesion zone

Hepatocerebral dystrophy( Konovalova-Wilson) is a hereditary disorder of copper metabolism disorder in which the synthesis of ceruloplasmin protein is disrupted and copper is deposited in tissues - liver, brain, eye cornea, and not removed fromorganism. It can begin at any age, but the earlier, the heavier the course and the faster the fatal outcome. Distinguish the abdominal form, rigidly - arrhythmogiperkinetic, tremulous, quivering - rigid, extrapyramidal - cortical. More often there is a trembling and trembling - rigid form. Beginning at the age of 15-20 years with sweeping hyperkinesis - the hands perform a "flight of wings", muscle rigidity. Describe atypical forms with the onset of writing spasm or torsion dystonia. The condition progressively worsens, mental disorders are added - emotional lability, disinhibition - dementia. Epileptic seizures are possible. The course of the disease is slowly progressing, without remissions. In the early stages it is necessary to differentiate with multiple sclerosis, brain tumor, encephalitis, Huntington's chorea, Parkinson's early debut. In the diagnosis, it is important to examine the oculist, who will find a brownish-green ring( Kaiser-Fleischer) when viewed on the slit lamp, the content of copper and ceruloplasmin is lower in the blood, in the urine the content of copper is increased. The liver is affected - cirrhosis, kidneys. Specific therapy is carried out for life - D-Penicillamine, kurrenin. Use courses unitiol, B vitamins, neuroprotectors, antioxidants, if necessary antiepileptic drugs. There are patients with life for a neurologist, gastroenterologist.

Athetosis with Konovalov-Wilson disease

Parkinsonism is a chronic, progressive neurodegenerative disease that causes specific movement disorders - akinesia, tremor, muscle rigidity, vegetative regulation disorders, cognitive( mental) disorders, emotional poverty. Parkinsonism may exist as Parkinson's disease, and it can develop again in infectious diseases, toxic, traumatic, vascular lesions of the nervous system-secondary symptomatic parkinsonism. More in this article Parkinson's disease, Parkinsonism.

In vascular diseases - atherosclerosis, hypertensive disease develops a chronic impairment of cerebral circulation - discirculatory encephalopathy, one of the symptoms of which may be extrapyramidal insufficiency, and in severe cases, Parkinsonian syndrome. In the treatment of attention to the underlying disease, use antihypertensives, anti-sclerotic, vascular drugs, sedatives, neuroprotectors, spa treatment. Treatment is appointed by a neurologist.

Advising a doctor on extrapyramidal syndromes:

Question: How is essential tremor treated?
Answer: Eliminate the neuro-emotional overload, limit the intake of coffee and consult a neurologist. Use drugs - vitamin B6 in large dosages, pantokaltsin, propranolol, drugs gabapentin( gabantine, gatonin, gabagama), afobazol, noophen, adaptol, psychotherapy, reflexology.

The doctor neurologist Kobzeva S.V.