Extrapyramidal symptoms

Extrapyramidal symptoms appear due to disorders in the extrapyramidal system. This is associated with changes in muscle tone, the appearance of hyperkinesia, hypokinesia and impaired motor activity. All this appears with damage to specific structures of the brain. These are the basal ganglia, the tubercular area, the optic tubercle and the internal capsule. In the process of manifestation of symptoms, a special role is played by a violation of neurotransmitter metabolism. It leads to a change in the balance between dopaminergic and cholinergic mediators, as well as the relationship with the pyramidal system. The system itself is engaged in ensuring the regulation of posture, changing muscle tone. The latter is responsible for the accuracy of movements, speed, smoothness, swinging arms and legs when walking.

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Symptoms of extrapyramidal disorders

Symptoms of extrapyramidal disorders mainly have subacute development, symmetrical manifestations, endocrine disorders. They are characterized by a non-progressive course, insignificant severity and absence of gross postural disorders.

• Parkinsonism syndrome. Symptoms include difficulty with initial movements, turning, excessive slowness, stiffness and muscle tension. Cogwheel signs, consisting of intermittent and stepped movements, are possible. Tremor of the limbs, salivation and a mask-like face manifest themselves. If the symptoms reach a pronounced degree, akinesia may develop. Sometimes mutism and dysphagia appear. Typical tremor is observed rarely, more common is a coarse generalized tremor, which manifests itself both at rest and during movement. Basically, Parkinsonism syndrome is reflected in the mental sphere. Emotional indifference, lack of pleasure from activity, anhedonia, inhibition of thinking, difficulty concentrating, decreased energy occur. In some cases, secondary signs are also observed. They consist of abulia, flattening of affect, poverty of speech, anhedonia and emotional detachment.
• Acute dystonia. The clinical picture of manifestations is characterized by a sudden onset of dystonic spasms of the muscles of the head and neck. Trismus, protruding tongue, opening of the mouth, forced grimaces, torticollis with rotation, stridor suddenly appear. Some patients experience oculogyric crises, which are characterized by forced concomitant abduction of the eyeballs. This process can last from several minutes to hours. Some patients experience blepharospasm or widening of the eye slits. If the trunk muscles are involved, opisthotonus, lumbar hyperlordosis, scoliosis appear. As for motor disorders, they can be local or generalized. The symptoms consist of general motor agitation with affects of fear, anxiety and vegetative disorders. Dystonic spasms look repulsive. They are difficult to endure. Sometimes they are so pronounced that they can lead to dislocation of joints.
• Akathisia. It is an unpleasant feeling of restlessness. A person constantly needs to move. Patients become restless, forced to constantly walk. They cannot stay in one place. Movement partially relieves anxiety. The clinical picture includes sensory and motor components. The first option is the presence of unpleasant internal sensations. Patients do not know what is happening to them, but are forced to constantly move. They are overwhelmed with anxiety, internal tension, irritability. The motor component has other manifestations. A person can fidget in a chair, constantly change position, cross one leg over the other, tap their fingers, button and unbutton buttons, etc. Akathisia can worsen the patient's condition. In this case, extrapyramidal symptoms are more pronounced.

The first signs of extrapyramidal disorders

The first signs of extrapyramidal disorders can be early and late. Much depends on the person's condition and heredity. Some symptoms appear at the age of 30-40 years, others are characterized by an earlier picture - 15-20 years.

Initially, a person begins to suffer from irritability and increased emotionality. Over time, nervous twitching of the face and limbs is added to this.

Primary signs of disorders are independent diseases. These can be diseases associated with the death of neurons and atrophy of certain structures of the brain. These include Parkinson's and Huntington's diseases. Initially, a person experiences tremors of the limbs, profuse salivation, and a mask-like facial expression. A person is unable to concentrate. Over time, dementia and speech impoverishment appear. There are also diseases that are characterized by certain pathomorphological changes. These are dystonia and tremor. A person twitches his limbs. In addition, he may experience spasms of the neck and head. Trismus suddenly manifests itself. A person makes violent grimaces, sticks out his tongue. Over time, the first extrapyramidal symptoms progress, and the condition worsens significantly.

Symptoms of damage to the extrapyramidal system

Symptoms of damage to the extrapyramidal system manifest themselves in different ways. The main ones are athetosis, chorea, torsional spasm, tic, myoclonus, hemiballismus, facial hemispasm, Huntington's chorea, hepatocerebral dystrophy, Parkinsonism.

• Athetosis. It manifests itself on the fingers. The person makes small, writhing, worm-like movements. If the problem has affected the facial muscles, then it manifests itself in the form of a curvature of the mouth, twitching of the lips and tongue. Muscle tension is replaced by complete relaxation. Such a manifestation is characteristic of damage to the caudate nucleus of the extrapyramidal system.
• Chorea. A person performs various rapid violent movements of the muscles of the trunk and limbs, neck and face. They are not rhythmic or consistent. They occur against the background of decreased muscle tone.
• Torsional spasm is a dystonia of the muscles of the trunk. The disease can manifest itself at any age. The manifestations are mainly noticeable when walking. These are bending, corkscrew-like, rotational in the muscles of the neck and trunk. The first manifestations begin with the muscles of the neck. They are characterized by violent lateral turns of the head.
• A tic is a constant twitching of individual muscles. It is most often seen on the face, eyelids and neck. The person throws back their head, twitches their shoulder, winks, and wrinkles their forehead. All movements are of the same type.
• Myoclonus. These are quick, short twitches. In some muscles they are lightning fast.
• Hemiballismus. These are unilateral throwing, sweeping movements of the limbs (often the arms). They occur when the body of Louis is affected.
• Facial hemispasm. It is characterized by the contraction of the muscles of half of the face, tongue, neck. In this case, the person closes his eyes, tightens his mouth. Violent laughter, crying, and various grimaces may appear. Convulsions, and disturbances in the precision and purposefulness of movements appear.
• Huntington's chorea. This is a severe hereditary disease, it begins to manifest itself at the age of 30-40. It is characterized by developing dementia. The degenerative process affects the shell, the caudate nucleus, and the cells of the frontal lobe of the brain.
• Hepatocerebral dystrophy is a hereditary disease. It can begin at any age. A person begins to "fly wings". The condition progressively worsens. Mental disorders are added to it. This can be emotional lability, dementia.
• Parkinsonism. This condition is characterized by non-specific movements, impaired thought processes, and emotional poverty. All of the above are extrapyramidal symptoms that manifest themselves when the extrapyramidal system is disrupted.