C Criteria For Diagnosing Each Diagnosis In The Method Above
Diagnosing the different types of movement disorders is a clinical diagnosis. Each movement disorder below, in turn, has its own differential diagnosis. A description of the movement and supporting /differentiating associated findings for each movement are listed below, in effort to help narrow the diagnosis. Again, all acute onset movement disorders should have an investigation for a precipitating agent .
Hypokinetic Dysarthria Due To Pd
Hypokinetic dysarthria results from dysfunction in the basal ganglia motor loop,7 which causes deficits in the regulation of initiation, amplitude and velocity of movement. This type of dysarthria is characterized by reduced vocal loudness, monotone, reduced fundamental frequency range, consonant and vowel imprecision, breathiness, short rushes of speech and irregular pauses.8,9 Close to 90% of individuals with PD experience voice disorders, while 45% experience articulation problems and 20% experience fluency disorders.10,11 Although voice disorders may be the primary concern regarding speech production in the early stages of the disease, disfluency and articulation impairments also emerge as the neurodegeneration progresses, with motor control deficits affecting articulation exerting the greatest negative impact on communication in the final stage of the disease.10
Although the motor speech disorder of dysarthria is a primary communication complaint of individuals with PD, it is worth noting that other aspects of communication are also affected. For example, difficulties with lexical retrieval and comprehension of figurative language have been reported,16 as well as with grammaticality, syntactic complexity and information content.17 Beyond the linguistic domain, the presence of hypomimia, a reduction in facial expression, also limits these individuals communicative interactions, social participation and the quality of their relationships with their care partners.18
What Conditions Cause Hypokinesia
Hypokinesia is most often seen in Parkinsons disease or Parkinson-like syndromes. But it can also be a symptom of other conditions:
Schizophrenia and other cognitive conditions often come with motor function problems like hypokinesia. These movement disorders may happen because different parts of the brain dont talk to one another correctly.
Dementia with Lewy bodies is a form of dementia. Symptoms can include visual hallucinations, cognitive problems, movement disorders like hypokinesia, repeated falls, fainting, delusions, sleep disorders, and depression.
Multiple system atrophy is a group of nervous system disorders that causes hypokinesia, incoordination, speech changes, stiffness, weakness, erectile dysfunction, urinary problems, and dizziness when standing up.
Progressive supranuclear palsy is a disorder with motor symptoms similar to Parkinsons. The conditions hallmark is an inability to move your eyes up and down; you may also have trouble keeping your eyelids open. You may have trouble with speech and swallowing, and you may think slowly.
Stroke usually gets better after 6 to 12 months.
Cortical basal ganglionic degeneration is a rare Parkinson-like disorder. You may have rigidity on one side of your body, painful muscle contractions, and speech problems. Sometimes your arm or leg will move without you telling it to.
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B Common Pitfalls And Side
Remember that Parkinsons patients in the hospital should have their medications continued. Stopping dopaminergic therapy suddenly can lead to a withdrawal that is identical to neuroleptic malignant syndrome, which is a neurologic emergency.
The most common side effect of carbidopa/levodopa therapy is nausea, which should be treated with extra carbidopa added to each dose. Too rapid titration of dopaminergic therapy can cause sedation/confusion, which is aided by slowing titration schedule. Dopamine agonists may cause pedal edema and are known for the rare side effect of causing obsessive-compulsive behaviors .
Trihexyphenidyl, if used for dystonia, is an anti-muscarinic agent and therefore has anticholinergic side effects.
Anticonvulsants used for treatment of myoclonus do not need levels checked as treatment is aimed at abating the movement not reaching a certain blood level.
When treating essential tremor, the typical contraindications to propranolol apply , so if these are present, just use primidone. The only side effect of primidone is sedation, so can go slower if this occurs.
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Surgical Management Of Dysarthria
Like pharmacological management, surgical management in PD has generally not yielded positive outcomes for dysarthria. Deep brain stimulation involves electrode implantation surgery in specific areas of the basal ganglia.27 This surgical procedure has been reported as an effective treatment option for motor symptoms such as dyskinesias in PD in several randomized controlled trials ;2830 however, its adverse effects on speech have been consistently reported in the literature.3136 Other surgical procedures have also been associated with a deterioration of speech. For example, in thalamotomies, a lesion is made in the thalamus with the goal of improving tremors. Thalamotomies have been reported to produce hypophonia, reduce speaking rate and lead to word blocking.37,38 This procedure is even thought to have resulted in some cases of palilalia.39 Consequently, thalamotomy has been abandoned as a treatment option for PD.20 Similarly, pallidotomy, in which a heated electrical probe is inserted in the globus pallidus, destroying a small region of cells in order to alleviate dyskinesias, has not been found to be conducive to improvement in dysarthric speech.20 In fact, it has been associated with the development of verbal fluency deficits, swallowing difficulties and facial weakness.40
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Tardive Dyskinesia / Tardive Dystonia
Tardive dyskinesia or tardive dystonia, both referred to as “TD”, refers to a wide variety of involuntary stereotypical movements caused by the prolonged use of dopamine receptor-blocking agents. The most common types of these agents are antipsychotics and anti-nausea agents. The classic form of TD refers to stereotypic movements of the mouth, which resemble chewing. However, TD can also appear as other involuntary movements such as chorea, dystonia, or tics.
What Treatment Options Are Available
You have many options for easing symptoms and improving your quality of life if you have hypokinesia or another movement disorder related to Parkinsons disease. A typical treatment plan may include medication, deep brain stimulation, and physical therapy.
However, there isnt a medication or treatment available at this time that can slow or stop the diseases progression.
Most of the medications to treat motor symptoms of Parkinsons increase the levels of dopamine in your brain. Other types of medications and therapies are used to treat non-motor symptoms.
Common options include:
Levodopa is converted to dopamine in your brain and is the most effective medication for hypokinesia related to Parkinsons disease. Its usually combined with carbidopa ,which is a medication that prevents the breakdown of levodopa in the body so more reaches the brain.
Dopamine agonists are another type of medication that increase your dopamine levels. They can be combined with levodopa. These medicines include bromocriptine , pergolide , pramipexole , and ropinirole .
Monoamine oxidase -B inhibitors slow the breakdown of dopamine in the brain. They allow your bodys available dopamine to work longer. These medications include selegiline and rasagiline .
Catechol-O-methyltransferase inhibitors slow the breakdown of levodopa in the body, allowing more levodopa to reach the brain. These medications include entacapone and tolcapone .
Examples include:
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Bradykinesia And Other Basal Ganglia Diseases
In Parkinson’s disease, slowness of movement occurs in conjunction with a reduction in the amount of spontaneous movement . However, in two other basal ganglia diseases, Huntington’s disease and dystonia, bradykinesia co-exists with hyperkinesia. One conclusion from this is that bradykinesia has a different mechanism from hypo- or hyperkinesia. However, analysis of the nature of the bradykinesia indicates that even this one symptom may have more than one cause. The maximum speed of simple voluntary arm movement is slower than in healthy subjects in patients with either Huntington’s disease or dystonia , but the pattern of EMG activity underlying the slowness of movement in patients with either of these conditions differs from that in patients with Parkinson’s disease. In Huntington’s disease and dystonia, the EMG bursts are often prolonged and the final position and peak velocity are more variable than in Parkinson’s disease.
Patients with Huntington’s disease are also abnormal in executing simultaneous and sequential movements and, like patients with Parkinson’s disease, have difficulty in performing a sequence of movements without external cues .
What Is The Course About
The ability to communicate effectively is vital, but highly compromised in the majority of patients with movement disorders, leading to inability to maintain employment and family/ social roles. Equally, the ability to enjoy a meal safely can be severely affected by tremor, bradykinesia and rigidity of the muscles involved in swallowing, with aspiration pneumonia being the main cause of death in Parkinson’s. ; In spite of advances in pharmacological and surgical treatments, speech and swallowing remain a challenge in the treatment of movement disorders. ; This course aims at bringing together the basic knowledge and clinical practice in assessing and treating speech and swallowing problems both in hypokinetic and hyperkinetic disorders. Saliva control, an often overlooked disability, is also going to be discussed as it affects both the ability to speak and to swallow.
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What Is Hyperkinetic Behavior
4.9/5behaviorhyperkineticmore on it
Hyperkinetic disorders include inattention, overactivity, and impulsivity. They include a variety of attention disorders such as attention deficit disorder and attention deficit hyperactivity disorder .
Also Know, what causes Hyperkinesia? Hyperkinesia can be caused by a large number of different diseases including metabolic disorders, endocrine disorders, heritable disorders, vascular disorders, or traumatic disorders. Other causes include toxins within the brain, autoimmune disease, and infections, which include meningitis.
In respect to this, what is the difference between ADHD and hyperkinetic disorder?
Unlike ADHD, a diagnosis of hyperkinetic disorder requires that the clinician directly observes the symptoms ; that onset must be by age 6 not 7; and that at least six inattention, three hyperactivity and one impulsivity symptom be present in two or more settings.
What are 3 Hypokinetic conditions?
Hypokinetic diseases are those conditions that occur as a result of lack of exercise and movement. Examples of hypokinetic diseases are obesity, diabetes, stroke, and heart disease. Those individuals that don’t exercise are at greater risk of these conditions.
Dysarthria And Speech Intelligibility Following Parkinsons Disease Globus Pallidus Internus Deep Brain Stimulation
Article type: Research Article
Authors: Chiu, Shannon Y.a; * | Tsuboi, Takashia; b | Hegland, Karen W.c; d | Herndon, Nicole E.c; d | Shukla, Aparna Waglea | Patterson, Addiea | Almeida, Leonardoa | Foote, Kelly D.e | Okun, Michael S.a | Ramirez-Zamora, Adolfoa
Affiliations: Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA | Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan | UF Health Rehab Center at the Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA | Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA | Department of Neurosurgery, University of Florida, Gainesville, FL, USA
Correspondence: Correspondence to: Shannon Y. Chiu, MD, MSc, Norman Fixel Institute for Neurological Diseases, 3009 SW Williston Rd, Gainesville, FL 32608, USA. Tel.: +1 352 294 5400; Fax: +1 352 627 4295; E-mail: .
Keywords: Parkinsons disease, globus pallidus, deep brain stimulation, dysarthria, speech intelligibility
DOI: 10.3233/JPD-202246
Journal: Journal of Parkinson’s Disease, vol. 10, no. 4, pp. 1493-1502, 2020
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History And Clinical Presentation
Ballism is derived from the Greek verb meaning to throw. This movement disorder involves large-amplitude involuntary jerking, irregular flailing, flinging, and exhausting movements. They are among the more distressing of the hyperkinetic disorders for patients to endure and for their families and clinical practitioners to observe. The term ballism or ballismus is variably credited, in its initial use, to Plouequet, Pfefferkorn, Kussmaul, and von Economo and probably dates back to the early 1800s. Ballismus is similar to chorea because of the unpredictable and random character of movements, but in ballism, the movements are more severe and proximal, whereas in chorea, the movements are distal. When ballism occurs on only one side of the body, the cause is usually a cerebrovascular accident and the condition is termed hemiballismus.
Pharmacological Management Of Dysarthria Due To Pd
Pharmaceutical and surgical management are approaches frequently called upon for treatment of motor symptoms of PD. However, these have shown less success in alleviating symptoms of dysarthria than has behavioral management. Levodopa, the precursor of the neurotransmitter dopamine, is the first medicine typically used in the clinical management of PD. The use of levodopa and dopamine agonists to treat motor symptoms such as tremors in PD is strongly supported by scientific evidence across all stages of the disease.19 However, pharmacological management of dysarthria is less straightforward.20 Early pharmacokinetic studies on the effects of levodopa medication on speech function revealed trends toward improvement during the ON phase of medication.21 Ho, Bradshaw and Iansek studied the effects of levodopa medication on the speech of nine individuals with idiopathic PD and observed an increase in sound pressure level in the ON phase,22 which was consistent with some previously reported findings,23 but contrasted with an absence of positive response to levodopa to ameliorate hypophonia found in other studies,24,25 suggesting heterogeneity of individual profiles influencing outcomes. Ho et al also observed an increase in speaking rate as a result of levodopa medication, consistent with the upscaling of gain noted for limb movements.22 Fundamental frequency and articulation, however, remained unchanged.
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Functional Imaging Studies Of The Effect Of Surgery And Deep Brain Stimulation On Bradykinesia
Many imaging studies have been driven by the model of basal ganglia function outlined in the early 1990s. Overactivity of the inhibitory output projections from the basal ganglia to the thalamus in Parkinson’s disease was supposed to remove facilitatory thalamocortical drive, particularly to midline cortical motor areas . PET and fMRI activation studies had shown that these areas were less activated during movement in patients, and therefore pallidotomy was expected to improve activation by restoring normal levels of basal ganglia output .
Most studies on movement-related changes in metabolic activity have reported similar findings both after pallidotomy and during subthalamic nucleus stimulation . In tasks in which a free-choice joystick movement is used, increased activation of preSMA and anterior cingulate cortex is usually accompanied by increased activation of the dorsolateral prefrontal cortex. Although most reports of activation-induced metabolism suggest that there is no change in the primary motor cortex, there are some suggestions that stimulation of the subthalamic nucleus may reduce activity in the resting state . Whether this is related to a general reduction in rigidity or other involuntary muscle activity or to reduced input to the cortex via pathways direct from the subthalamic nucleus is not known.
B Describe A Diagnostic Approach/method To The Patient With This Problem
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Describe what the dominating abnormal movement looks like.
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Is the problem newly acquired ? If so, look for an underlying cause
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If hyperkinetic, determine which problem it is based on the criteria in next section.
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If hypokinetic, then the patient has a form of Parkinsonism. For full details, see that chapter, but briefly:
If you have ANY of these features within 3 years of onset of motor symptoms, suspect an atypical variant of Parkinsons disease: prominent instability/falls, hallucinations, freezing, dementia, severe dysautonomia.
Absence of these features plus asymmetric and insidious onset of symptoms suggests idiopathic Parkinsons disease.
New/abrupt onset during the hospitalization suggests vascular or drug-induced Parkinsonism.
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If tardive movement disorder, please note that these disorders:
Are 100% iatrogenic and the #1 most frequent single diagnostic code for which physicians are sued in the United States.
Are caused by potent dopamine-blocking drugs, which are used for their anti-emetic side effects and for their antipsychotic properties .
Can occur as early as a few days of taking a new medication .
Reversal of the abnormal movement can take months after stopping the offending drug.
Diagnostic pearls for the hospitalist:
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What Is A Hyperkinetic Disease
4.9/5Hyperkinetic Disorderhyperkineticexplained here
A specific and common behavior disorder in children, the hyperkinetic syndrome, may be due to organic causes and is characterized by: hyperactivity; short attention span and poor powers of concentration; impulsiveness; irritability; explosiveness; variability; and poor school work.
what is the difference between ADHD and hyperkinetic disorder? Unlike ADHD, a diagnosis of hyperkinetic disorder requires that the clinician directly observes the symptoms ; that onset must be by age 6 not 7; and that at least six inattention, three hyperactivity and one impulsivity symptom be present in two or more settings.
In this manner, what is the difference between hypokinetic and hyperkinetic?
Hypokinetic movement disorders are primarily akinetic or rigid. Hypertonic disorders include spasticity, dystonia, and rigidity. Hyperkinetic disorders include chorea, dystonia, athetosis, myoclonus, tremor, stereotypies, and tics.
What causes Hyperkinesia?
Hyperkinesia can be caused by a large number of different diseases including metabolic disorders, endocrine disorders, heritable disorders, vascular disorders, or traumatic disorders. Other causes include toxins within the brain, autoimmune disease, and infections, which include meningitis.
Neurobehavioral And Psychiatric Disorders
Movement disorders describe a variety of abnormal movements of the body that have a neurological basis. These abnormal movements are characterized by changes in the coordination and speed of voluntary movement. They may also involve the presence of additional movements that are not voluntary.
Movement disorders are sometimes referred to by medical professionals as extrapyramidal diseases because this class of disorders is distinct from the disorders caused by disorders of the pyramidal region of the brain . Researchers have determined that movement disorders are caused by diseases in various parts of the brain, including the substantia nigra, the subthalamic nucleus, the globus pallidus, the striatum, and the basal ganglia.
Movement disorders are usually broken down into two types of movement: hyperkinetic movement and hypokinetic movement. Hyperkinetic movement disorders are characterized by a significant and excessive amount of motor activity. This type also includes cases in which there is a significant amount of abnormal involuntary movement. Hypokinetic movement disorders are those in which there is an abnormally reduced amount of intentional motor activity.
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