Brain Motor Centers and Pathways
Nassir H. Sabah in Neuromuscular Fundamentals, 2020
Whereas hypokinesia is associated with increased inhibition of the thalamus by the basal ganglia, a decrease in this inhibition results in hyperkinesia, or excessive, involuntary movement. These include rapid uncoordinated movement of body parts (chorea), twisting movements and sustained abnormal postures in the neck, trunk, and extremities (dystonia); and hemiballism, characterized by involuntary movements of the limbs on one side of the body. Hemiballism is caused by damage to the STN, which reduces excitation of the GPi and disinhibits the thalamus. The increased excitation and altered firing pattern of thalamocortical neurons cause these neurons to respond in an exaggerated manner or to discharge spontaneously, resulting in rapid, involuntary, and repetitive movements associated with violent flailing and swinging of the limbs and usually accompanied by a decrease in muscle tone.
Discussions (D)
Terence R. Anthoney in Neuroanatomy and the Neurologic Exam, 2017
Whereas the term “akinesia” is used in 10 of the 14 recent clinical neuroscience texts I examined, and the term “bradykinesia” is used in eight of them, the term “hypokinesia” appears in only four—undefined in one (G&M, p. 189) and defined in another only as a moderate degree of impaired movement without any disturbance in muscle power or coordination (Rowl, p. 529). Both Adams and Victor (1985, p. 59) and DeJong (1979, p. 299) define “hypokinesia” as “poverty of movement,” in contradistinction to “bradykinesia,” which involves slowed movement instead (A&V, p. 60) or as well (DeJ, p. 299). In other words, the term “hypokinesia” is used relatively seldom and is used primarily by authors who retain a distinction between it and the term “bradykinesia.”
Movement Disorders of the Larynx
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Idiopathic PD accounts for around 80% of cases of Parkinsonism; it is a nigrostriatal disorder characterized by a deficiency of dopamine. Generalized rigidity is seen, along with bradykinesia (slowness of movement). These two aspects are collectively described as hypokinesia. Tremor (typically a ‘pill-rolling’ tremor) is a very common feature. PD is a relatively common neurological disorder, with a prevalence of 1 per 1000 of the population, rising to around 1 per 100 in the over-60 age group.1 Although PD is usually thought of as a condition of older age, it can also affect younger patients.
VMAT2 Inhibitors for the Treatment of Tardive Dyskinesia
Published in Issues in Mental Health Nursing, 2022
Barbara Warren, Dawn Vanderhoef, Jessica Johnson
The key features of TD and other common antipsychotic-induced movement disorders (parkinsonism, acute akathisia, and acute dystonia) are summarized in Figure 2. The differentiation of TD can be challenging, as the movements associated with TD can look similar to those of other movement disorders. Additionally, TD can present together with other drug-induced disorders (e.g., parkinsonism) in the same patient. Finally, TD movements are sometimes mistaken for abnormal movements or behaviors associated with advanced age or underlying psychiatric conditions (Caroff & Campbell, 2016; Hauser et al., 2020; Savitt & Jankovic, 2018). It is helpful to consider the timing of onset (acute versus tardive), along with the type of movement (hypokinetic versus hyperkinetic). Acute syndromes usually present within hours or days of initiating antipsychotic treatment, while tardive syndromes often develop after more prolonged antipsychotic exposure (i.e., months or years). Hypokinetic syndromes (e.g., parkinsonism) are characterized by slow or insufficient movements. In contrast, hyperkinetic syndromes (e.g., TD, akathisia, and dystonia) are characterized by excessive abnormal movements with increased velocity, frequency, and amplitude. For an excellent summary of TD and other drug-induced movements, along with helpful video links depicting the various movements, we recommend a recent publication by Hauser et al. (Hauser et al., 2020).
Valbenazine as the first and only approved treatment for adults with tardive dyskinesia
Published in Expert Review of Clinical Pharmacology, 2018
Harini Sarva, Claire Henchcliffe
The term tardive dyskinesia is classically used to define isolated or predominant orobuccal-lingual movements following exposure to dopamine-blocking agents [1]. These ‘classic’ involuntary, nonrhythmic movements can be described as chewing, bruxism, lip smacking, protrusion or curling of the tongue, grimacing, or bulging of the cheeks [6]. However, dopamine blockers can produce a variety of hyperkinetic movement disorders, such as chorea, myoclonus, dystonia, akathisia, tremor, tics, and stereotypy. In addition in some cases the syndrome may manifest with hypokinetic symptoms of parkinsonism [4]. TD may develop 3 months after exposure to dopamine blocking agents or within 4 weeks of withdrawal of the offending agent (8 weeks if the agent is in a long-acting depot formulation) [4]. They can also persist after discontinuation of the agent [7].
Novel 4DCT Method to Measure Regional Left Ventricular Endocardial Shortening Before and After Transcatheter Mitral Valve Implantation
Published in Structural Heart, 2021
Gabrielle M. Colvert, Ashish Manohar, Francisco J. Contijoch, James Yang, Jeremy Glynn, Philipp Blanke, Jonathon A. Leipsic, Elliot R. McVeigh
Comparison 1: Subjects 1 and 2 in Figure 5 had baseline EFs ~39% and showed the same decrease in this global parameter after TMVI. Yet, their baseline functional maps were very different (p <0.05) and the changes in RSCT post implantation were also very different as shown in Figure 5a. At baseline, subject 2 displayed global hypokinesia with some higher functioning tissue located in the apex. After TMVI, RSCT in the apex was greatly reduced. For subject 1, at baseline a larger portion of tissue outside the apex on the anterior and antero-lateral wall was functioning well (20% was normal/kinetic in this region compared to 5% for subject 2). After TMVI, the magnitude of RSCTincreased in the anterior and antero-lateral apical region despite placement of the epicardial pad in the apex. In both subjects there was reduced function observed outside of the apical region. While an expected reduction in RSCT is seen in many subjects in the apical regions near the epicardial pad, this does not explain the total change in local function as shown in these subjects.
Related Knowledge Centers
- Movement Disorder
- Basal Ganglia
- Parkinson's Disease
- Hyperkinesia
- Fasciculation
- Huntington's Disease
- Tourette Syndrome
- Dopamine
- Substantia Nigra
- Γ-Aminobutyric Acid