Extrapyramidal syndrome Flashcards
- Extrapyramidal syndrome (EPS)*
- Define:*
- Extrapyramidal symptoms, also called drug-induced movement disorders, describe the side effects caused by certain antipsychotic and other drugs.
- These side effects include:
- involuntary or uncontrollable movements and tremors-
Extrapyramidal syndrome
Cause:
Extrapyramidal symptoms are most commonly caused by
typical antipsychotic drugs that antagonize dopamine D2 receptors
Extrapyramidal syndrome (EPS)
The most common typical
antipsychotics associated with EPS are:
haloperidol
and
fluphenazine
Symptoms of Extrapyramidal syndrome:
Name 6:
- dystonia
- akathisia
- parkinsonism
- bradykinesia
- tremor
- tardive dyskinesia
Symptoms of Extrapyramidal syndrome:
Sign:
Negative sign – bradykinesia, akinesia and abnormal posture adjustment
- Positive sign* – dyskinesia, hyper-tonicity and rigidity
- Basal ganglion* which is associated with initiation and adjustment of voluntary movement by enhancing the agonist muscle signals whereas diminishing the antagonist muscle signals from the premotor gyrus.
After sending information to pre-central motor cortex, signals transmit to the lower motor neuron by pyramidal tract
Symptoms of Extrapyramidal syndrome:
Parkinson disease
- Degeneration and depigmentation of neurons in substntia nigra.
- Depletion of dopamine in caudate nucleus and putamen
- Bradykinesia and hypokinesia (difficulty in initiating and performing volitional movement)
- Rigidity (small steps, bend forward)
- Resting tremor
- Finger tapping test, balance push back test
- MRI, EEG
- Should be differentiate from essential tremor
Symptoms of Extrapyramidal syndrome:
Huntington disease
- Degeneration of cholinergic* and *GABA-ergic neuron, which are located in caudate nucleus and putamen
- choreiform movement (Important!!)
- progressive dementia
- Chromosomes 4
- Huntingtin proteins
Choreiform movement:
define
jerking or writhing movements, called choreiform movements, or what appear to be minor problems with coordination; these movements, which are absent during sleep, worsen over the next few years and progress to random, uncontrollable, and often violent twitchings and jerks.
Choreiform movement:
causes:
Endocrine and metabolic disorders:
Hypoglycemia, hyperglycemia, hyperthyroidism, hypoparathyroidism, hyperparathyroidism, hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, polycythemia vera and hepatic failure are some of the conditions that can cause chorea.
Bradykinesia
define:
Bradykinesia (Slowness of Movement)
- Reduction of automatic movements (such as blinking or swinging your arms when you walk)
- Difficulty initiating movements
(like getting up out of a chair)
- General slowness in physical actions.
- The appearance of abnormal stillness or a decrease in facial expression.
hypokinesia
define:
- -classifications of movement disorders, and refers to decreased bodily movement.*
- Hypokinesia is characterized by a partial or complete loss of muscle movement due to a disruption in the basal ganglia.*
Extrapyramidal syndrome:
Symptoms:
- dystonia = continuous spasms and involuntary muscle contractions
- akathisia = motor restlessness
- parkinsonism = rigidity + bradykinesia + tremor
- - tardive dyskinesia* = irregular, jerky movements
Extrapyramidal syndrome (EPS)
Negative symptoms:
- negative symptoms:
- bradykinesia, akinesia, abnormal posture*
-
Extrapyramidal syndrome (EPS)
Most commonly caused by?
most commonly caused by typical antipsychotics(Haloperidol, Fluphenazine) which are D2 antagonists - examples: - Parkinson’s disease (see 42) below)
- Huntington’s disease: - degeneration of cholinergic and GABA-ergic neurons in caudate nucleus and putamen
- symptoms: chorea (dance-like movements), progressive dementia
