Extrapyramidal syndrome

Extrapyramidal syndromes are an outdated term, but still widely used in Russian-language literature. To extrapyramidal syndrome, it is customary to refer to syndromes characterized by excessive movements or, on the contrary, insufficient motor activity. The first group of syndromes is called hyperkinetic disorders, the second - hypokinetic. Extrapyramidal syndromes develop with organic lesions of the central nervous system, which do not affect corticospinal (pyramidal) pathways. These syndromes are based on dysfunction of the subcortical nodes (basal ganglia) and their connections with other parts of the nervous system.

The term "hyperkinetic syndromes" is not an exact synonym for the term "extrapyramidal syndromes", as it has a broader meaning and reflects excessive movements that can occur with organic damage of any levels of the nervous system (peripheral nerve, spinal cord, brain stem, subcortical nodes and the cerebellum, the cerebral cortex) and even in the absence of such a lesion (eg, physiological tremor or physiological myoclonus, psychogenic hyperkinesis). In the world literature, the term " movement disorders" is used that combines all hyper- and hypokinetic syndromes of central origin, as well as ataxia, stereotypes, start-up syndromes, the syndrome of "someone else's hand" and some others. Hyperkinetic syndromes of extrapyramidal origin are discussed below. Hypokinetic movement disorders are described in the relevant sections of the manual.

The main hyperkinetic syndromes are tremor, chorea, ballistic, dystonia, myoclonus, tics. Diagnosis of these syndromes is carried out exclusively clinically.

In the recognition of any hyperkinetic syndrome, the analysis of the motor pattern of hyperkinesis is of key importance. In addition, each of the above hyperkinesia, in its own way, violates complex motor functions, such as maintaining the posture, speech, writing and walking.

Clinical diagnosis of any hyperkinesis begins with the definition of the nature of hyperkinesis, that is, with the process of "recognition" ("recognition") of a constantly changing in time and space motor phenomenon. Each hyperkinesis in the eyes of a doctor is nothing more than a complexly organized motor image, in recognition of which its elements such as motor pattern, topography (distribution), symmetry / asymmetry, stereotypedness or lack thereof, speed and amplitude of movements, connection with arbitrary movements, and also with a pose or with certain actions.

Syndromal diagnosis is only the beginning of diagnostic work. The next stage is the definition of a disease that caused the development of hyperkinetic syndrome. It is important to consider the accompanying symptoms, the "syndromic environment", the analysis of provoking factors and factors that eliminate or reduce the severity of hyperkinesis (sleep, alcohol, etc.), as well as the features of the course of the disease and the clinical picture in general.

[1], [2], [3], [4], [5], [6], [7], [8],

Diagnosis of extrapyramidal syndrome

Laboratory and instrumental studies in hyperkinetic syndromes are primarily aimed at distinguishing between primary and secondary forms. Given the huge range of diseases in which hyperkinetic syndromes are possible, a wide variety of studies may be required. Thus, if necessary, a toxicological examination of blood and urine is carried out, the level of ceruloplasmin in the blood serum is determined, the level of thyroid and other hormones, the titers of viral antibodies, lactate and pyruvate content in the serum, liquor studies, ophthalmological, genetic and electrophysiological studies (EEG, EMG , evoked potentials and potentials of different modalities, transcranial TKMS), stabilography, neuroimaging, neuropsychological testing; biopsy of muscles, nerve, skin, mucous membranes and even brain tissue.

[9], [10], [11], [12], [13], [14], [15], [16]

Treatment of extrapyramidal syndrome

It is necessary to treat the underlying disease. However, symptomatic therapy is widely used, which in many cases is the only available method of treatment. Depending on the type of hyperkinesis, neuroleptics, typical and atypical benzodiazepines, beta-adrenoblockers, muscle relaxants, levodopa preparations, anticholinergic and other drugs, as well as antioxidants, neuroprotectors, nootropic and restorative agents are used. All forms of non-drug therapy, including neurosurgical methods, are used. When local forms of dystonia are widely used botulinum neurotoxin (botox, dysport) subcutaneously. The duration of the effect is about 3 months. The courses are repeated up to 3-4 times.