Extrapyramidal disorders – features and treatment of neurological disorders


Extrapyramidal system regulates muscle tone, is responsible for the speed of motor reactions. Due to the relationship with all parts of the , higher forms of nervous activity are accessible to man.

At disturbance of a tone of muscles activity of movements changes. In this case, extrapyramidal disorders are diagnosed, which are accompanied by insufficiency or excessive movement. The syndrome occurs as a result of the death of brain cells or taking antidepressants, lithium, antipsychotics.

Characterization and classification of violations

The concept of “extrapyramidal disorders” includes a number of pathological conditions that develop as a result of damage to the cellular structure of the basal ganglia. This usually occurs after prolonged use of antipsychotics. Preparations of this group provoke the development of nervous tics, parkinsonism, stereotypy, tremor, chorea, and other diseases. Such violations lead to the restriction of motor activity, the appearance of involuntary impulses.

Neuroleptic disorders manifest themselves in hypokinetic disorders that limit mobility, and in hyperkinetic disorders, an increase in involuntary reflexes.

Hypokinetic manifestations (hypokinesia)

Such dysfunction is accompanied by a decrease in motor activity. This is expressed in akinesis, when the initiation of motor acts is disturbed, and in bradykinesia, when movements slow down. Painful conditions provoke muscle hypertonia, muscle stiffness.

Hyperkinetic manifestations (hyperkinesis)

Such violations are expressed by the following symptoms:

  • tremor, when repetitive muscle contractions cause rhythmic torso vibrations;
  • chorea, in which different parts of the body move irregularly;
  • ballism, accompanied by more sweeping and sharp movements compared to chorea;
  • dystonia, in which the muscles contract over a long period, which leads to torsion and unhealthy position of the body parts;
  • Akatizia, when a person cannot be in one place, he wants to fuss, move, walk;
  • myoclonus, in which limbs irregularly twitch synchronously;
  • ticks, which are manifested in stereotypical irregular movements.

Disorders of this group can be reflex (myoclonia), spontaneous (ballism, chorea), joint (dystonia, dyskinesia, tremor), specific (cramps when playing the piano, when embroidering).

Based on the severity of the motor act, hyperkinetic disorders are classified into rhythmic, when muscles are antagonists and agonists periodically reduced, tonic ones, when muscles are twitching at the same time, and fast, clonic ones.

According to localization, hyperkinesis is differentiated into segmental, multifocal, focal, generalized.

First symptoms of disorder

Initially, signs of extrapyramidal syndrome are expressed in aggressiveness, excessive irritability. Gradually joins twitching limbs, facial muscles. The primary manifestations of dysfunctions of the pyramidal system are separate diseases. Such pathologies are associated with atrophy of brain cells and the destruction of neurons.

Such diseases include parkinsonism, when tremor appears, excessive salivation, frozen expression. With the development of dementia is formed, speech skills are impaired. Allocate disorders characterized by pathological symptoms, tremor, dystonia. The patient twitches the limbs, muscles of the neck and head are cramped.

Description and treatment of individual forms of disorders

The concept of “extrapyramidal syndrome” unites a group of diseases, the symptoms and treatment of which depend on the dislocation and degree of damage.

Parkinson’s disease

The disease belongs to the category of degenerative pathologies of the central nervous system. Disruption of neurons and some parts of the extrapyramidal system leads to the disease. In medical practice, the primary form of Parkinson’s disease and the secondary syndrome of the same name are separately differentiated. The primary form is due to a genetic factor. Secondary syndrome – a sign of damage to the nervous system.

Note! It has been established that parkinsonism is a genetic disease.    

As the disease progresses, the patient notes the constraint of movement, the person cannot write fully, the fine motor skills are disturbed. As the pathology progresses, the following conditions increase:

  • tremor affecting the limbs, chin;
  • hypertonicity of skeletal muscles, manifested in stoop;
  • change of gait, the patient “mince” in small steps, can not establish balance;
  • the face of a person freezes in one grimace, there is no facial expression;
  • speech skills are lost, the patient slurred words;
  • Thinking abilities, attention worsen;
  • there is no motivation, there is no interest in life;
  • there are failures in vegetative functioning – constipation, decreased libido, problems with urination.

Extrapyramidal disorders - features and treatment of neurological disorders

Doctors prescribe drugs with marked motor limitations: levodopa, dopamine synergists, monoamine oxidase inhibitors, anticholinergic drugs.

A feature of the therapeutic course is the need to regularly increase the dosages of drugs.. This leads to the formation of a number of side effects. To reduce their development, you need to start therapy with minimal doses of medication. The most effective treatment method is the combination of drugs with a different mechanism of action. The patient also requires symptomatic treatment. With the development of , accompanied by insomnia and anxiety, antidepressants are prescribed.

Essential tremor

The disease is usually diagnosed simultaneously in several healthy members of the same family. Pathology is characterized by a genetic transmission mechanism. Often detected in people of middle age category. The reasons causing this extrapyramidal disorder are not established.

A curious fact! Reception of small doses of alcoholic beverages decreases the intensity of tremor.

Tremor is fixed in the hands and head, not spreading to the legs. The voice may begin to tremble. Gradually, trembling increases, but the person does not lose the ability to work. The treatment of this anomaly is not started immediately, since the treatment will last a lifetime. With mild manifestations of the disease treatment is not necessary.

Steele-Richardson-Olszewski syndrome

Paralysis is degenerative. Develops due to the destruction of neurons in the brain. Accompanied by a decrease in the concentration of dopamine – the hormone of joy. Pathology is more often diagnosed in older men.

A prominent symptom of the disease is ophthalmoplegia, which over time is supplemented by horizontal paresis and impaired movement of the eyeballs. There is dystonia and muscle rigidity, hypokinesia. The patient often falls due to muscular rigidity and ophthalmoplegia.

The nature of the syndrome is similar to Parkinson’s disease. The differentiating symptoms that distinguish pathologies include gaze paresis, hypertonus of the extensors of the body, and the absence of trembling limbs. In the final stages of the disease, vomiting is manifested, extensor and tendon reflexes increase, a person cries or laughs for no reason. Intellectual abilities are reduced.

Drug therapy does not have the desired effect. The patient’s life expectancy is no more than 10 years. To eliminate hypokinesia, dopaminergic drugs are required. To improve speech skills and gait, antidepressants, anticholinergics are prescribed. Despite therapeutic measures, the pathology progresses, gradually depleting the person.

Degeneration of corticobasal

The disease is detected in the elderly. Anomaly is expressed in the defeat of the limbs due to the destruction of neurons and the cerebral cortex. The clinical picture is similar to the manifestations of Parkinsonism, but anti-Parkinsonian drugs have no therapeutic effect.

Apraxia initially develops, then aphasia, dementia, agnosia, and a decrease in sensory sensitivity appear. The disease progresses, the person becomes disabled and dies.

Torsion dystonia

The disease develops as a result of improper functioning of the basal nuclei. Pathology does not cause other neurological disorders, except for hyperactive movements, strange postures. When the pathological signs appear in childhood, the muscles of the lower extremities are affected. Then the painful process captures the muscles of the face, neck, and body.

This form has a poor prognosis. Most patients become disabled. Symptomatic therapy that does not have a proper therapeutic effect is required.

Segmental dystonia

This type of dystonia is different from torsion in that unnatural muscle movements are observed in certain areas of the body. Blepharospasm develops – contraction of the eye muscles. Oromandibular dystonia is formed, which is expressed by uncontrolled spasms of the masticatory muscles, stretching the lips.

A separate form of segmental dystonia is torticollis when the head of a person moves in one direction. Initially, the symptoms are temporary, as the development of extrapyramidal disorder becomes chronic. Remissions are possible that do not affect the progression of the disease.

Pharmacological treatment is ineffective. Occasionally, symptoms are eliminated after the use of carbamazepine, diazepam. In case of violation of muscle tone, Botulinum toxin A is injected.

Spinocerebellar Degeneration

Pathology is often diagnosed in the Portuguese 30-40 years. Symptomatology is manifested in the reduction of reflex actions, neuropathy, cerebellar disorders. Intellectual abilities remain at the same level. Pathology therapy is not developed.

Syndrome Gilles de la Tourette

The disease is characterized by an unknown etiology. There is no established relationship between the onset of the disease and the impact of social or perinatal factors. Violation begins to develop in 5-15 years, usually in boys. Revealed many family cases. It is assumed that the cause of the formation of the disorder is the increased activity of dopamine receptors.

A curious fact! Among such patients more often left-handed people are detected.

A bright sign of the disease – voice and motor tics, manifested by blinking, twitching eyebrows, closing the eyelids. As the pathology develops, grunting, lowing, coughing, whistling appear. Often, patients involuntarily utter various expletive phrases, repeat what they heard.

Victims jump up, harm health: pull out hair, bite hands. The condition is accompanied by neurosis, obsessive ideas, depression, suicidal thoughts. Such patients require prolonged symptomatic therapy. Usually prescribed , despite the development of a number of side effects. Haloperidol is also effective.

Extrapyramidal disorders represent a large group of neurological syndromes that significantly reduce the patient’s quality of life. Timely therapy can alleviate the condition by eliminating symptomatic disorders, but it is impossible to completely cure these diseases.

The following sources were used to prepare the article:

Levin OS, Anikina MA, Vasenina EE. Cognitive and neuropsychiatric disorders in extrapyramidal diseases // Journal of Neurology, neuropsychiatry, psychosomatics – 2012.

Pizova N.V. Extrapyramidal disorders in persons undergoing acute cerebral circulatory disorders // Annals of Clinical and Experimental Neurology Journal – 2014.

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