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4 results

  • Dyskinesias in childhood, differential diagnosis and treatment. About a case

  • M. Valverde Barea, C. Mata Castro, P. Vargas Melero, A. España Osuna
  • Journal:
    European Psychiatry / Volume 65 / Issue S1 / June 2022
    Published online by Cambridge University Press:
    01 September 2022, p. S439
    • Article
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  • Introduction

    Dyskinesias are motor disorders that occur as a side effect to treatment with typical and less frequently with atypical antipsychotic drugs. They are more frequents in child population. Treatment usually consists of decrease the dose of drug or replace it with a better profile tolerability antipsychotic. Clozapine is an antipsychotic drug indicated as second-generation treatment of motor disorders that appear as side effects to treatment with neuroleptics.

    Objectives

    Demonstrate the efficacy and tolerability of clozapine in the treatment of dyskinesias in childhood.

    Methods

    The patient 12 year-old boy, has episodes of psychomotor agitation once a month. This will alternate with quiet moments in which dyskinetic movements are observed in upper limbs, without being able to detect any type triggering environmental factor. Personal history: hydrocele, diagnosed at 8 years becomes neurodevelopmental disorder considered. Neurosurgery tracking for Subarachnoid cyst. Psychopathological examination: Child presents psychomotor restlessness, disruptive behavior, impairments in communication, movement disorder, stereotypies and dyskinetic movements in shoulder and neck.

    Results

    In the patient suffering from an autistic disorder, stereotypies and other motor symptoms were observed, the predominant and most relevant being dyskinetic movements in the shoulder and neck, which appeared one month after starting treatment with risperidone and worsening psychomotor skills. Treatment of dyskinesia with clozapine improved the motor symptoms presented by the patient.

    Conclusions

    Clozapine should be the treatment of choice in the event of dyskinesias as a secondary effect to other antipsychotic treatments, proving effective in controlling them as well as well tolerated in both adults and children.

    Disclosure

    No significant relationships.

  • Chapter 21 - Abnormal Movements in Neurological Autoimmune Disorders

  • from Section 4 - Autoimmunity in Neurological and Psychiatric Diseases
  • Josep Dalmau, Universitat de Barcelona, Francesc Graus, Universitat de Barcelona
  • Book:
    Autoimmune Encephalitis and Related Disorders of the Nervous System
    Published online:
    27 January 2022
    Print publication:
    17 February 2022, pp 545-562

  • Summary

    In this chapter we describe different types of movement disorders that associate with autoimmune encephalitis, and the antibodies more frequently involved. In children the most common disorders are Sydenham chorea and anti-NMDAR encephalitis. Abnormal movements occur in ~80% of patients with anti-NMDAR encephalitis and include multiple different types such as chorea, oromandibular dystonia, stereotypies, opistotonus, catatonia, or myorhythmia. Children who develop anti-NMDAR encephalitis as a complication of previous herpes simplex viral encephalitis present prominent generalized chorea or choreoathetosis. In adults the most frequent autoimmune neurological disease that associates with movement disorders is anti-IgLON5 disease. More than 80% of patients this disease develop at least one type of movement disorder; gait instability or ataxia associated with craniofacial dyskinesias or generalized chorea are the most common combination of movement disorders. Hyperekplexia is a major manifestation of progressive encephalomyelitis with rigidity and myoclonus (PERM), which is usually associated with glycine receptor antibodies; some patients with similar symptoms have DPPX antibodies. Autoimmune chorea in adults may also be a paraneoplastic manifestation of small-cell lung cancer and CRMP5 antibodies. The most common paroxysmal abnormal movement of autoimmune origin is faciobrachial dystonic seizures associated with LGI1 antibodies. Patients with anti-CASPR2 encephalitis may have paroxysmal episodes of cerebellar ataxia that precede the encephalitis. Anti-CASPR2 encephalitis can also cause orthostatic myoclonus.

  • Self-awareness of Motor Dysfunction in Patients with Huntington's Disease in Comparison to Parkinson's Disease and Cervical Dystonia

  • Emilia J. Sitek, Witold Sołtan, Dariusz Wieczorek, Michał Schinwelski, Piotr Robowski, Ralf Reilmann, Katarzyna Guzińska, Michał Harciarek, Wioletta Krysa, Jarosław Sławek
  • Journal:
    Journal of the International Neuropsychological Society / Volume 17 / Issue 5 / September 2011
    Published online by Cambridge University Press:
    08 June 2011, pp. 788-795

  • Individuals suffering from Huntington's disease (HD) have been shown to present with poor self-awareness of a variety of symptoms. The aim of this study was to better assess the self-awareness of motor symptoms and activities of daily living (ADL) impairment in HD, in comparison to Parkinson's disease (PD) and cervical dystonia (CD). In particular, the anosognosia/anosodiaphoria of involuntary movements has been investigated. Self-awareness was tested in 23 patients with HD by comparing patient and caregiver ratings in reference to clinical control groups (25 PD with dyskinesias, PDdys; 21 PD without dyskinesias, PDndys; and 20 with CD). Patients were assessed neurologically by relevant rating scales. Self-awareness was tested using a scale based on 15 films demonstrating 3 types of motor symptoms (chorea/dyskinesias, parkinsonism, torticollis) as well as the Self-Assessment Parkinson's Disease Disability Scale. General cognitive status, verbal learning, cognitive control, and mood were also analyzed. Our results indicate that self-awareness of choreic movements was affected more severely in HD than in PDdys, despite comparable cognitive status. Patient–proxy agreement on ADL impairment was roughly similar in all clinical groups. The results are discussed in the context of orbitofrontal–limbic pathology as a potential trigger of anosognosia/anosodiaphoria in individuals with HD. (JINS, 2011, 17, 788–795)

  • Functional anatomy of movement disorders

  • A. R. CROSSMAN
  • Journal:
    The Journal of Anatomy / Volume 196 / Issue 4 / May 2000
    Published online by Cambridge University Press:
    01 May 2000, pp. 519-525
    Print publication:
    May 2000

  • Models of basal ganglia function are described which encapsulate the principal pathophysiological mechanisms underlying parkinsonian akinesia on the one hand and abnormal involuntary movement disorders (dyskinesias) on the other. In Parkinson's disease, degeneration of the nigrostriatal dopamine system leads to overactivity of the ‘indirect’ striatopallidal projection to the lateral (external) segment of the globus pallidus. This causes inhibition of lateral pallidal neurons, which in turn project to the subthalamic nucleus. Disinhibition of the subthalamic nucleus leads to abnormal subthalamic overactivity and, as a consequence, overactivity of medial (internal) pallidal output neurons. Dyskinesias, such as are observed in Huntington's disease, levodopa-induced dyskinesia and ballism, share mechanistic features in common and are associated with decreased neuronal activity in both the subthalamic nucleus and the medial globus pallidus.