Extrapyramidal syndrome

Extrapyramidal syndromes are an outdated term, but are still widely used in Russian-language literature. Extrapyramidal syndromes are usually those characterized by excessive movements or, conversely, 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 that do not affect the corticospinal (pyramidal) tracts. 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", since it has a broader semantic content and reflects excessive movements that can occur with organic damage to any levels of the nervous system (peripheral nerve, spinal cord, brainstem, basal ganglia and cerebellum, cerebral cortex) and even in the absence of such damage (for example, physiological tremor or physiological myoclonus, psychogenic hyperkinesis). In the world literature, the term "movement disorders" is used, combining all hyper- and hypokinetic syndromes of central origin, as well as ataxia, stereotypies, startle syndromes, "alien hand" syndrome and some others. Hyperkinetic syndromes of extrapyramidal origin are considered below. Hypokinetic movement disorders are described in the relevant sections of the manual.

The main hyperkinetic syndromes are tremor, chorea, ballismus, dystonia, myoclonus, and tics. These syndromes are diagnosed exclusively clinically.

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

Clinical diagnostics of any hyperkinesis begins with determining the nature of hyperkinesis, i.e. with the process of "recognizing" ("recognizing") a motor phenomenon that is constantly changing in time and space. Each hyperkinesis in the eyes of a doctor is nothing more than a complexly organized motor image, in the recognition of which such elements as motor pattern, topography (distribution), symmetry/asymmetry, stereotypy or its absence, speed and amplitude of movements, connection with voluntary movements, as well as with posture or with certain actions are important.

Syndromic diagnosis is only the beginning of diagnostic work. Its next stage is determining the disease that caused the development of hyperkinetic syndrome. It is important to take into account the accompanying symptoms, the "syndromic environment", analyze the provoking factors and factors that eliminate or reduce the severity of hyperkinesis (sleep, alcohol, etc.), as well as taking into account the characteristics of the course of the disease and the clinical picture as a whole.

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

Diagnosis of extrapyramidal syndrome

Laboratory and instrumental studies of hyperkinetic syndromes are primarily aimed at differentiating between primary and secondary forms. Given the huge range of diseases that can cause hyperkinetic syndromes, a wide variety of studies may be required. Thus, if necessary, toxicological studies of blood and urine are performed, the level of ceruloplasmin in the blood serum, the level of thyroid and other hormones, titers of viral antibodies, the content of lactate and pyruvate in the blood serum are determined, cerebrospinal fluid studies, ophthalmological, genetic and electrophysiological studies (EEG, EMG, evoked potentials and potentials of different modalities, transcranial TMS), stabilography, neuroimaging, neuropsychological testing; biopsy of muscles, nerves, skin, mucous membranes and even brain tissue.

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

Treatment of extrapyramidal syndrome

Treatment of the underlying disease is necessary. However, symptomatic therapy is also widely used, which in many cases is the only available treatment method. Depending on the type of hyperkinesis, neuroleptics, typical and atypical benzodiazepines, beta-blockers, muscle relaxants, levodopa preparations, anticholinergics and other drugs, as well as antioxidants, neuroprotectors, nootropics and general tonics are used. All forms of non-drug therapy are used, including neurosurgical methods. For local forms of dystonia, botulinum neurotoxin (botox, dysport) is widely used subcutaneously. The duration of the effect is about 3 months. Courses are repeated up to 3-4 times.