How Do I Recognize Extrapyramidal Symptoms?

The extrapyramidal system refers to the pathways of motor conduction outside the pyramidal tract, including the frontal lobe, thalamus, pale bulbs, striatum, substantia nigra, red nucleus, basal nucleus, pontine nucleus, vestibular nucleus, lower olive nucleus, cerebellum and brain Dried certain reticular nuclei etc. and their connecting fibers. Extrapyramidal diseases refer to a group of unique motor disorders caused by pathological changes in the extrapyramidal system, mainly in the basal ganglia of the brain.

The extrapyramidal system refers to the pathways of motor conduction outside the pyramidal tract, including the frontal lobe, thalamus, pale bulbs, striatum, substantia nigra, red nucleus, basal nucleus, pontine nucleus, vestibular nucleus, lower olive nucleus, cerebellum and brain Dried certain reticular nuclei etc. and their connecting fibers. Extrapyramidal diseases refer to a group of unique motor disorders caused by pathological changes in the extrapyramidal system, mainly in the basal ganglia of the brain.

Mainly manifested as voluntary motor regulation dysfunction, muscle strength, sensory and cerebellum are not affected.

Common locations

Pathological changes of extrapyramidal system based on cerebral basal ganglia

Common symptoms

Parkinson's disease and Parkinson's syndrome

Causes and common diseases of extrapyramidal diseases

Common extrapyramidal diseases:

1. Parkinson's disease and Parkinson's syndrome: Parkinson's syndrome is a common extrapyramidal syndrome caused by a variety of etiologies. Its clinical characteristics are that it has more than two of the following four main symptoms: (l) Resting tremor; (2) muscle stiffness; (3) reduced or slow movement, and (4) postural reflex disappeared.

2. Dance disease: It is characterized by rapid, transient, violent, irregular, and involuntary involuntary movements of the trunk and limbs; it also includes slower dance-hand, foot, and foot movement. The main types are: Huntington's disease of chronic progressive brain and basal ganglia degeneration with dominant autosomal inheritance, dance-like movement-echinocytosis; infectious dance disease (small dance disease) caused by infection or infection, of which Most of them are rheumatic chorea, drug-induced chorea caused by phenothianes, dihydroxyphenylalanine, pyridazinylpyrimidine, or olfactory pavilion; hepatolenticular degeneration caused by copper metabolism disorders ; Cerebrovascular damage such as cerebral infarction or hemorrhage, focal damage of diffuse lupus erythematosus or purpura and so on.

3. Dystonia: The part of the neck, trunk, and proximal limbs or whole body muscles that slowly, continuously, strongly, and irregularly twist involuntarily, causing an abnormal posture that is difficult to imitate, according to the development of the disease The degree is divided into three periods of dystonia, dystonia posture and torsion spasm. According to the cause classification, it can be divided into: (1) primary dystonia (deformity dystonia): the etiology is unknown, some are autosomal dominant or recessive, but most of them are sporadic. (2) Secondary dystonia: including toxic or drug-induced dystonia caused by nuclear jaundice or drugs such as phenothiases and dihydroxyphenylalanine; vascular dystonia caused by cerebral infarction and bleeding , Traumatic dystonia caused by birth injury or metabolic muscle tension disorder caused by hepatolenticular degeneration. (3) Limited or abnormal types such as spastic torticollis, writing cramps and so on.

4. Other pyramidal diseases: Idiopathic tremor (familial or sporadic), multiple tics, and twitches are common.

Differential diagnosis of extrapyramidal diseases

Dystonia is caused by abnormalities in the extrapyramidal system, mainly in the deep basal ganglia that control motor coordination. It can be caused by genetic factors, but also by structural damage to the brain or harmful external factors (such as drug, chemical (Metabolism, infectivity, etc.); symptoms involving body parts including limbs, trunk, face and jaw, neck, and even vocal structures, etc., can be divided into focal areas (the affected area is limited to one area of the body), Segmental (involving more than 2 parts of the body in close proximity), and systemic, leaning or multifocal (involving more than 2 distant parts of the body).

In many neurodegenerative, hereditary, toxic or metabolic abnormalities, and structural disorders of the basal ganglia, clinical manifestations can have Parkinson's syndrome and dystonia at the same time. The complications of Parkinson's syndrome become a sign of Parkinson's syndrome progression or treatment confusion.

Extrapyramidal disease treatment principles

The pathophysiological mechanism of levodopa in the treatment of motor complications in Parkinson's (PD) is mainly pulsed stimulation of abnormal dopamine receptors. Under normal circumstances, dopaminergic neurons in the substantia nigra have a continuous low-frequency discharge, which is not affected by exercise. Although physiologically there are short-term pulses of high-frequency discharges involved in feedback, relying on normal reuptake systems can maintain relatively stable dopamine levels in the synaptic cleft. In PD patients, due to the progressive reduction of dopaminergic neurons, striatum dopamine levels are more dependent on levodopa utilized from peripheral uptake. Due to the short plasma half-life of levodopa, it is not possible to stimulate the dopamine receptors in a continuous physiological manner, so that the dopamine receptors are exposed to fluctuating dopamine stimulation and eventually produce motor complications.