Hypokinesia

Hypokinesia is a condition of the body manifested by an abnormal decrease in the activity and amplitude of movements (from Greek hypo - from below and kinesis - movement), i.e. A reduction in muscle function. This is the classical definition, but it is not always interpreted correctly. [1]

Nuances of terminology

The synonym "hypokinesis" may be used for movement disorders due to neurodegenerative, general somatic and muscular diseases, as well as for the clinical condition resulting from prolonged immobilization.

Specialists note the lack of unity of terminology in describing the spectrum of movement disorders. Complete cessation of movement is defined by the term "akinesia", and slow movements are called bradykinesia (from Greek bradys - slow). However, despite the semantic nuances, these terms are often used as synonyms.

Whereas, the specified terms, including hypokinesia, do not apply at:

• amyotrophic lateral sclerosis and spinal muscular atrophy with movement deficits due to damage or loss of motor neurons (motoneurons) and premotor interneurons - cells in the brain and spinal cord, respectively, that transmit signals from the brain to the muscles;
• dysfunctions of the somatic motor system (associated with stimulation and control of arbitrary movements of skeletal muscles and reflex reactions);
• weakening of neuromuscular transmission and muscle tone due to disorders of excitation and inhibition in the CNS or cerebellar damage;
• neurological syndromes - spastic paraplegia, paresis, paralysis.

It is often thought that hypodynamia and hypokinesia are synonyms, but this is not the case. The condition of hypodynamia (from Greek dinamis - strength) is interpreted in two ways: as a decrease in muscle strength and as a lack of physical activity (i.e. A sedentary lifestyle). But hypokinesia is characterized not by a lack of muscle strength, but by restricted movement. To a decrease in muscle strength can lead to a decrease in the number of movements, which is called oligokinesia (from Greek oligos - few). And it can be with prolonged bed rest or peculiarities of labor activity, which is defined as physiological hypokinesia.

But disorders of the motor function of internal organs are most often defined as dyskinesia (the Greek prefix dys means negation and in medical terms indicates a disease or pathological feature), although the very motor function of some organs is called motility (from Latin motor - putting in motion). In turn, the peculiar motor function of the intestine - with downward spreading wave-like contractions-relaxations of smooth muscles of its walls - is called peristalsis (from Greek peristaltikos - squeezing or embracing).

Causes of the hypokinesia

Hypokinesia in neurology is a symptom of lesion of basal (subcortical) nuclei, i.e. Basal ganglia of the brain, which is manifested by partial loss of motor (muscle) activity.

Causes of this disorder include a wide range of neurodegenerative diseases, including:

• Parkinson's disease;
• Alheimer's disease;
• dementia with Lewy bodies;
• Corticobasal ganglionar degeneration, a form of frontal temporal degeneration affecting motor and other functions;
• subcortical arteriosclerotic encephalopathy (Binswanger's disease);
• multiple systemic atrophy (Shay-Drager syndrome);
• Mersch-Woltman syndrome - rigid-man syndrome.

Hypokinetic movement disorders are often referred to as parkinsonism, as many of the clinical features of Parkinson's disease are manifested.

Hypokinesis after viral encephalitis, encephalitic meningitis, vascular lesions and brain tumors is associated with organic damage to cerebral structures.

Movement disorders of a hypokinetic nature can be caused by certain metabolic disorders, e.g. Hereditary Wilson-Konowalow disease.

In ischemic stroke, focal neurologic symptoms and hypokinesia result from impaired cerebral circulation and tissue hypoxia, which cause pathologic changes in brain structures - especially in frontal and subcortical regions.

Cardiac hypokinesia is directly related to coronary heart disease; myocarditis; dilated cardiomyopathy; myocardial infarction with postinfarction cardiosclerosis; ventricular hypertrophy (in which interstitial fibrosis leads to loss of contractile elements of the heart muscle).

Risk factors

Risk factors for pathologic decreased activity and movement amplitude are numerous, including:

• brain injury (leading to impaired function or death of brain neurons with their replacement by glia cells);
• toxic brain damage (carbon monoxide, methanol, cyanide, heavy metals);
• Intracerebral neoplasms and paraneoplastic syndromes;
• Sporadic olivopontocerebellar atrophy - degeneration of neurons in the cerebellum, pontine, and inferior olivary nucleus of the medulla oblongata;
• schizophrenia;
• hypoparathyroidism and pseudohypoparathyroidism;
• Liver disease with elevated blood ammonia levels leading to hepatic encephalopathy;
• some mitochondrial diseases;
• exposure to antipsychotic drugs that block the neurotransmitter dopamine - malignant neuroleptic syndrome.

Pathogenesis

The mechanism of hypokinesia development in neurodegenerative diseases is due to dysfunctions of various cerebral structures, which cannot be restored, so it is not only prolonged hypokinesia, but in many cases - progressive.

In Parkinson's disease, there is a loss of dopamine-containing neurons in the substantia nigra area of the brain. This negatively affects the extrapyramidal system of the brain (consisting of subcortical nuclei - clusters of neurons in the forebrain, midbrain, midbrain and pontine), which is responsible for voluntary movements, regulation of reflexes and maintenance of posture.

In addition, excessive content in the substantia nigra of the excitatory neurotransmitter glutamate (glutamic acid), which stimulates the release of the main inhibitory mediator of the CNS, gamma aminobutyric acid (GABA), in the thalamus, leads to a decrease in motor activity.

Also read:

• Parkinson's Disease - Causes and Pathogenesis
• Extrapyramidal disorders

In advanced corticobasal degeneration and Alzheimer's disease, muscle hypokinesia develops due to an abnormal transformation of the brain-specific tau protein: it breaks down and undergoes aggregation into disorderly neurofibrillary tangles that accumulate in brain cells, impairing neuronal function.

In patients with schizophrenia, the researchers hypothesize, hypokinesia is caused by severing connections between the right supplementary motor area with the pale globe (globus pallidus) of the forebrain and the primary motor cortex of the left hemisphere with the thalamus.

The pathogenesis of ischemic or postinfarction myocardial hypokinesia is explained by damage or death of cardiomyocytes, the cells of its transverse striated muscle tissue containing actin and myosin myofibrils that provide rhythmic phasic contractions for rapid and continuous blood circulation.

Decreased motor function of the gastrointestinal tract - intestinal motility - can be related to the muscles involved in peristalsis, as well as problems with the muscle-controlled part of the peripheral nervous system, which experts call the enteric nervous system (ENS). All three types of GI smooth muscle cell contractions (rhythmic phasic, propulsive and tonic) can be affected.

A hormonal pathogenetic mechanism is not excluded: a deficiency or imbalance of the hormones ghrelin (produced in the gastric mucosa) and motilin (produced in the upper small intestine). These peptide hormones stimulate the motor neurons of the ENS, which coordinates digestive processes and is responsible for autonomous regulation of intestinal function.

Symptoms of the hypokinesia

In Parkinson's disease or Parkinsonism, symptoms of hypokinesia are manifested by slowed movements (bradykinesia), impaired coordination and gait with postural instability, muscle rigidity (stiffness) combined with limb tremor at rest. For more information, see. - Parkinson's Disease Symptoms

Hypokinesia can also be present in other diseases and conditions, and depending on the localization there are separate types or kinds of hypokinesia.

Thus, hypokinesia of the heart with a decrease in heart muscle contractions (systole) is clinically manifested by dyspnea, pain behind the sternum, feeling of fatigue, heartbeat irregularities, swelling of soft tissues of the distal parts of the extremities, and attacks of dizziness. Imaging during diagnosis identifies specific zones of hypokinesia, in particular, hypokinesia of basal myocardial segments: anterior, apical anterior, apical-lateral, hypokinesia of the inferior septal segment or anterior septal, apical inferior and apical-lateral, as well as anterior and inferolateral.

Localized or localized hypokinesia concerns specific structures of the heart, and it:

• Hypokinesia of the left ventricle - a decrease in the volume of left ventricular motion or impaired local contractility of its segments with such symptoms as weakness, HR disturbances (arrhythmia, tachycardia), dyspnea, dry cough, and chest pain. Systolic dysfunction with normal left ventricular size is defined by cardiologists as hypokinetic nondilated cardiomyopathy;
• Hypokinesia of the anterior wall of the left ventricle is most often observed at its apex and is the result of postinfarction cardiosclerosis - replacement of cardiomyocytes with connective tissue cells;
• Hypokinesia of the posterior wall of the left ventricle may be in myocardial damage in patients with genetically determined Becker muscular dystrophy;
• Hypokinesia of the right ventricle (anterior wall or inferior muscle segment) often develops with its dysplasia and acute pulmonary embolism;
• Hypokinesia of the interventricular septum (IVS) is congenital, meaning it occurs intrauterine or in infants immediately after birth.

Where the esophagus "flows" into the stomach, there is the lower esophageal or cardiac sphincter (ostium cardiacum) in the form of a muscular ring (stomata), the contraction of which prevents the backflow of gastric contents into the esophagus (reflux). Hypokinesia of the cardiac sphincter or cardia is a motor disorder of the esophagus associated with loss of function of nerve cells of ganglionic plexuses in its walls, defined in gastroenterology as achalasia of the cardia (from Greek a-khalasis - lack of relaxation).

For more information, see:

• Causes of achalasia of the cardia
• Symptoms of achalasia of the cardia

Hypokinesia of the gallbladder - gallbladder dyskinesia of hypotonic type with dull pain in the right subcostal area - means a decrease in its motor and evacuatory function. Read about other clinical manifestations of this condition in the publication - Symptoms of gallbladder dyskinesia

For why hypomotor dyskinesia or hypokinesia of the biliary tract occurs and how it manifests, see the articles:

• What causes biliary dyskinesia?
• Symptoms of biliary dyskinesias

Hypotonic motility disorder or hypokinesia of the intestine is a functional disorder of its motility, i.e. Peristalsis. The commonly accepted definition of the diagnosis is intestinal atony, the clinical picture of which includes chronic constipation and flatulence.

Also read - Lazy Bowel Syndrome

Violation of motility is and hypokinesia of the large intestine - a general decrease in the tone of its muscles or impaired propulsive activity. All details in the material - Dyskinesia of the large intestine.

Fetal hypokinesia

Fetal movement is an essential condition and component of proper fetal development. In a normal pregnancy, fetal movement can be felt after the 18th week. Reduced fetal movement - fetal hypokinesia - may be associated with insufficient fetal weight in the second trimester of pregnancy, placental insufficiency, oligohydramnios (low amniotic fluid volume), fetal distress syndrome (impaired oxygen supply), with intrauterine infection or developmental anomalies.

Experts also note fetal akinesia/hypokinesia syndrome, characterized by intrauterine developmental delay, multiple joint contractures (arthrogryposis), facial skull anomalies, and underdevelopment of the lungs.

It should be borne in mind that with decreased fetal mobility in the second half of gestation, there is a high risk of preterm labor and intrauterine fetal death.

Uterine hypokinesia

The uterine musculature, myometrium, consists of three multidirectional layers and is innervated by sympathetic and parasympathetic nerve fibers originating from the inferior subcostal and sacral plexuses. And myometrial contraction is regulated by the hormone oxytocin, which is produced in the hypothalamus and released into the blood by the posterior lobe of the pituitary gland before and during labor - to stimulate contractions.

When myometrial contraction in response to oxytocin is weakened, uterine atony is diagnosed. This is a serious condition because uterine contractions are important for cervical opening before labor, and their weakening is classified as labor abnormality. See also - Weakness of labor (uterine hypoactivity, or uterine inertia)

Atony or hypokinesia of the uterine muscles can lead to life-threatening blood loss because uterine contractions after delivery not only expel the placenta but also compress the blood vessels connecting it to the uterus. Uterine atony can also occur with miscarriage or uterine surgery.

Hypokinesia in children

In some sources, hypokinesia in children is considered not as an abnormal decrease in activity and amplitude of movements due to a particular disease, but as a lack of general physical activity, that is, equated with the concept of "sedentary lifestyle". The importance of physical activity for the proper growth and development of children is indisputable, but in this case there is a lack of unification of the terminology used to define movement disorders.

While in pediatrics, there are quite a few conditions associated with hypokinesia. These include:

• Segawa syndrome (dopamine-dependent dystonia), signs of which usually appear around age 6 years in the form of inward and upward turning of the feet (clubfoot) and dystonia of the lower extremities, and often develop parkinsonism over time;
• congenital hypomyelinic neuropathy (a rare form of neonatal nerve cell pathology);
• Kufor-Rakeb congenital syndrome (Parkinson's-9 disease), with symptoms beginning to appear after age 10;
• Hereditary sensorimotor and peripheral motor neuropathies with congenital degeneration of spinal motor neurons;
• genetically determined (related to glycogen accumulation in muscle and other tissues) glycogenoses in children, in particular, Pompe disease - with decreased muscle tone, weakened muscles and delayed motor skills in children in the first year of life.

Lower GI motility disorders in children, include pelvic floor muscle dyssynergia and Hirschprung's disease (congenital megacolon).

Complications and consequences

The effect of hypokinesia on the body is negative. Thus, the consequences of prolonged hypokinesia in neurodegenerative diseases are: joint stiffness, decreased muscle mass and skeletal muscle atrophy, deterioration of the GI tract, problems with the cardiovascular system, general metabolic disorders (catabolic processes begin to prevail over anabolic processes), impaired coordination of movements and loss of motor skills.

Acute or chronic heart failure is complicated by hypokinesia of the left ventricle and interventricular septum.

The consequence of hypokinesis of the gallbladder and biliary tract is cholestasis - bile stagnation with the development of chronic cholecystitis and cholelithiasis.

Hypokinesia of the lower esophageal sphincter (achalasia cardia) leads to gastroesophageal reflux. And hypomotor intestinal dyskinesia can cause intestinal obstruction.

Diagnostics of the hypokinesia

In cardiology, electrocardiography (ECG), echocardiography (echocardiography) and contrast ventriculography are used; in neurology - magnetic resonance imaging of the brain, electromyography; in gastroenterology - ultrasound of the gastrointestinal tract, ultrasound of the gallbladder and bile ducts, endoscopic methods of examination, etc.

Hypokinesia tests are used: stress test with administration of Dobutamine (cardiotonic drug of β1-adrenomimetics group) to assess myocardial viability; neurophysiological study of neuromuscular excitability; tests to assess muscle tone and reflexes; study of muscle strength, etc.

Laboratory studies are performed to identify the biochemical component of pathological processes that may have led to the development of symptoms of hypokinetic movement disorders, as well as motor dysfunction of internal organs.

Differential diagnosis is performed to identify the true cause of hypokinesia or dyskinesia.

How hypokinesia and akinesia differ was noted at the beginning of this article.

But such opposite conditions as hypokinesia and hyperkinesia are difficult to confuse, as hyperkinesia is manifested by increased motor activity with abnormal movements.

Also read:

• Parkinson's Disease Diagnosis
• Diagnosis of biliary dyskinesias
• Diagnosis of colonic dyskinesias
• Diagnosis of achalasia of the cardia

Treatment of the hypokinesia

Treatment of hypokinesia depends on its etiology and type. With a significant loss of motor activity due to lesions of the basal ganglia of the brain, in particular, patients with Parkinson's disease, prescribe Carbidopa (Lodosin), Levodopa, Amantadine, Benzerazide, Selegiline, Ropinirole, Pergolide - individually, in various combinations. Drug therapy is combined with physical therapy.

In cardiac hypokinesia - depending on the symptomatology - antiarrhythmic agents (Verapamil, Veracard, etc.), anti-ischemic drugs (Advocard, Corvaton, Amiodarone), cardiotonics (Vazonate, Mildronate, Thiodarone, etc.) are used in therapy.

In GI motility disorders prokinetics are used - drugs from the group of dopamine receptor blockers (Domperidone, Itopride), stimulators of peristalsis (Tegaserod (Fractal), myotropic antispasmodics (Trimebutin, Trimedat, Neobutin), etc.).

To treat hypotonic dyskinesia of the gallbladder, in addition to appropriate drugs that normalize its function, is prescribed diet in gallbladder dyskinesiai.

And to activate uterine contractions during labor, there are uterotonic drugs, for example, Desaminooxytocin.

Also read - How is colonic dyskinesia treated?

Prevention

Hypokinesia as a symptom of lesions of the basal ganglia of the brain, as well as neurodegenerative diseases themselves, cannot be prevented. In case of organic lesions of cerebral structures or damage and loss of contractile elements of the heart muscle - there is no prevention either.

Forecast

The prognosis of hypokinesia - in all cases and for all patients - may not be favorable, especially when the outcome of an etiologically related pathology, syndrome, or disease depends on multiple factors, and motor disorders of a hypokinetic nature may be irreversible.