Professional Documents
Culture Documents
4 types of movements:
Voluntary movement Semivoluntary movement (=unvoluntary) Involuntary movement Automatic movement
2
Movement disorders
= Extrapyramidal disorder Disorder of regulation of voluntary motoric activity without direct influence towards muscle strength, sensibility, or cerebellum.
Extrapyramidal disorder
Hyperkinetic disorder: abnormal involuntary movements Hypokinetic disorder: reduction of movements. = Movement disorders are caused by dysfunction of basal ganglia
Basal ganglia:
Caudate nucleus Putamen Globus pallidus Subthalamic nucleus Substantia nigra
etc.
7
Parkinsonism (CONT)
3. Paraparkinson / Parkinson plus - Wilson disease - Huntington disease - Normotensive Hydrocephalus
Parkinson disease
= Parkinson idiopathic = Paralysis agitans
10
11
12
Hypotesis:
Aging process: dopaminergic neuronal death !!! anti oxydative-protective mechanism decreased Environmental toxin: - heavy metal (Iron, Zinc, mercury etc) - MPTP Genetic sensitivity Oxydative stress: dopamine reaction free radicals
13
Pathology
Cutting of mid-brain: degeneration & neuronal death which contain melanin in substansia-nigra. Microscopic: In compacta zone: - Most of neuron are loss - Residual : containings Lewy-bodies
14
15
Clinical findings.
Triad of symptoms: - rigidity - tremor - bradikinesis 1. tremor: - pill rolling tremor - during tension !!!, sleep disappear - resting tremor = Parkinsonian tremor
16
18
Gait:
20
Tremor:
21
Rising:
22
Sitting:
23
Hypomimia:
24
Retropulsion:
25
Freezing:
26
Diagnostic procedure
Diagnosis is made clinically based on clinical symptoms found EEG examination : may show diffuse slow wave MRI & CT Scan : may show cortical atrophy.
27
Treatment
It is considered: due to dopamine deficiency in CNS. 1. Levodopa 2. Anticholinergic drugs: trihexyphenidyl 3. Antihistamine: diphenhydramine 4. Bromocriptine 5. Amantadine 6. Selegiline
28
TH DD L-tyrosine ----- l-dopa ----- DA TH: tyrosine hydroxylase DD: dopa-decarboxylase DA located outside vesicles will be catalyzed by enzymes : MAO(monoamine-oxydase) inside the neuron cell COMT(catechol-o-methyl-transferase) outside the neuron cell.
29
In peripheral : 1. l-dopa dopamine I dopa-decarboxylase v ^ dopa-decarboxylase inhibitor = carbidopa sinemet = benserazide madopar
30
31
Prognosis:
The prognosis is still poor .
32
etc.
33
34
Parkinsonism (Cont)
3. Paraparkinson / Parkinson plus - Wilson disease - Huntington disease - Normotensive Hydrocephalus
35
ESSENTIAL TREMOR
Familial tremor Benign tremor Autosomal dominant Begin at teen-agers or young adults
36
Tremor usually affect one or both hands, head and voices, whereas foot is not affected. Neurological assessments show no other abnormality. Despite the longer the tremor the clearer the symptoms, usually it does not disturb ,but the patient feels ashamed.
37
Sometimes it disturbs fine and difficult movements, writing and speaking when laryngeal muscle is involved .
Consuming small amount of alcohol temporary improvement is reported, but the mechanism has not been known yet.
38
Treatment - Diazepam 6 15 mg per day - Propranolol 40 - 120 mg per day - Primidone - Alprazolam - Not responsive: # thalamotomy # thalamic stimulation
39
CHOREA SYDENHAM
Affecting children and young adults resulting from complication of streptococcus hemolytic A infection and the possible basic pathological features is arteritis. Approximately 30% of cases occur 2 or 3 months following rheumatoid fever or polyarthritis, the rest without such historys.
40
Onset can be acute or gradually within 4-6 months, can also occur during pregnancy or oral contraceptive users. Symptoms including abnormal chorea movements, sometimes unilaterally in mild cases. Changes of behavior In children may reveal easily to anger and doughty Labile of emotions
41
In 30% of cases involves the heart Treatment: bed rest, sedatives, prophylaxis antibiotics even though without acute rheumatoid fever . Penicillin injection to be continued orally until 20 years of age to prevent staphylococcal infection. The prognosis basically lies on the complication of the heart.
42
43
Parkinsonism.
Complication of dopamine receptor inhibitor drugs: - phenothiazine - butyrophenone - thioxanthene - metoclopramide
44
Parkinsonism (Cont)
Symptoms : - rigidity - mask-like face - bradykinesis - tremor (seldom) Treatment : - Discontinue the drug - anti-cholinergic drugs (trihexyphenidyl)
45
Blepharospasm
47
Akathisia
Motoric restlessness, compulsion to move or inability to sit still for more than a short period of time, keep standing or walking. Receiving phenothiazine Treatment: - Lowering the dose if possible - propranolol 40-120 mg/hari - anticholinergic drugs / benzodiazepines
48
Tardive dyskinesia
Repetitive involuntary movements of the mouth, tongue and lips, occasionally accompanied by dystonic posturing or choreoathetotic movements of trunk and limbs. Mostly following administration of neurolep tic, metoclopramide, antihistamines, tri-cyclic antidepressant and chronic alcohol abuse.
49
50
53
54
Others:
Levodopa various abnormal movement is related to dosage. Bromocriptine, anticholinergic drugs, phenytoin, carbamazepine, amphetamine, lithium and oral contraceptive may also result in chorea ect.
55