What Are Dyspraxia Symptoms?

The regulation of motor function can be completed by the close cooperation of the pyramidal system, the basal nucleus and the cerebellum. These three are not independent and independent systems, but are functionally an integral whole. Dyskinesia (ie, extrapyramidal disease) is mainly caused by dysfunction of the basal nucleus.

Movement disorders

Movement disorders (also known as extrapyramidaldiseases) are mainly manifested as voluntary motor regulation dysfunction, muscle sensation, and cerebellar function are not affected. This group of diseases originates from dysfunction of the basal nucleus, which is usually divided into increased muscle tone-reduced movement and reduced muscle tone-excessive movement. The former two categories are characterized by poor exercise and the latter mainly show abnormal involuntary movement.

Etiology of movement disorders

Movement disorders pathogenesis

The basal nucleus has complex fibrous connections and mainly constitutes three important neural circuits: cortical-cortical circuit: cerebral cortex-caudate nucleus-medial pale bulb-thalamus-cerebral cortex; nigro-striatal circuit: Fibers are connected to and from the substantia nigra and caudate core-shell core; striatum-pallidium loop: caudate core-shell core-lateral pallidum-basal nucleus-medial pallidium.

There are direct pathways (striatum-medial paleospheres / substantia nigra reticulum) and indirect pathways (striatum-lateral paleospheres-subthalamic nucleus-medial paleosphere / nitriotic reticulum) in the cortex-cortex circuit ), The loop is the anatomical basis of the basal nucleus to achieve motor regulation. The balance of the activities of these two pathways is essential to achieve normal motor function.

Degeneration of the nigro-striatal DA pathway leads to excessive basal nucleus output and excessive inhibition of thalamus-cortex feedback activity weakens cortical motor function facilitation, resulting in hypokinetic diseases such as Parkinson's disease. Striatum neuronal degeneration leads to reduced basal nucleus output. Thalamic-cortical feedback facilitates cortical motor function too strongly, resulting in hyperkinetic diseases such as Huntington's disease. Therefore, abnormal basal nucleus transmitter biochemical abnormalities and circuit activity disturbances produce various movements. The main pathological basis of the symptoms of the disorder. The treatment of dyskinesias, whether pharmacologically or surgically, is based on the correction of transmitter abnormalities and disturbances of circuit activity.

Clinical manifestations of movement disorders

The clinical manifestations of movement disorders are:

1. Involuntary action.

2. Lack of movement or slowness without paralysis.

3. Abnormal posture and muscle tone.

Hyperfunction of the indirect pathway causes loss of motion and stiffness, insufficient function of the indirect pathway causes chorea and throwing; hyperfunction of the direct pathway causes dystonia, hand, foot, or throbbing movements, and insufficient function of the direct pathway causes slow movements.

Movement disorders complications

The decline in self-care ability is obvious. Some movement disorders are accompanied by mental retardation and / or mental behavior disorder.

Dyskinesia medical diagnosis

Medical history

(1) Age of onset: It can often indicate that the etiology such as infant or early childhood onset may be cerebral hypoxia, birth injury, bilirubin encephalopathy or genetic factors, and juvenile tremor may be hepatolenticular degeneration; it can also help determine Prognosis, such as the onset of primary torsional spasticity in childhood is much higher than the rate of severe disability in adulthood; in contrast, the delayed onset of dyskinesia in the elderly is more stubborn than the younger.

(2) Mode of onset: often etiological factors such as acute onset of dystonia in children or adolescents may indicate adverse drug reactions, and slow onset is mostly primary torsional spasm and hepatolenticular degeneration; etc .; Severe chorea or hemi-throwing may indicate a vascular cause, and slow onset may be a neurodegenerative disease.

(3) Course of disease: It is also helpful for diagnosis. For example, small dance disease usually resolves within 6 months after onset, which is different from other dance diseases that begin in childhood.

(4) Drugs such as phenothiazines and butyrylbenzenes can cause movement disorders.

(5) Certain diseases such as rheumatic fever, thyroid disease, systemic lupus erythematosus, and polycythemia vera can be associated with dance-like movements.

(6) Family history: It has diagnostic significance, such as Huntington's disease, benign hereditary chorea, idiopathic tremor torsion spasm, and tics- Tourette syndrome.

2. Physical examination can understand the symptoms and symptoms of dyskinesia, and determine whether there are other symptoms and signs of the nervous system, such as resting tremor, lead-like or gear-like muscle rigidity suggesting Parkinson's disease corneal KF ring suggesting hepatolenticular degeneration, Huntington's disease and hepatoleptic Nuclear degeneration, in addition to movement disorders, is often accompanied by mental and intellectual impairment.

Differential diagnosis of dyskinesia

Extrapyramidal diseases should be distinguished from motor dysfunction caused by diseases of the pyramidal system. The main clinical characteristics of the latter are mainly paralysis (hypokinetic), and it is generally not difficult to identify. In addition, the identification of different types of extrapyramidal diseases is more important.

Dyskinesia laboratory test

Blood electrolytes, trace elements, and biochemical tests are helpful in the diagnosis of dyskinesias, such as the determination of serum copper, urine, copper, and ceruloplasmin in patients with hepatolenticular degeneration, and have important diagnostic significance.

Dyskinesia other auxiliary examinations

1. CT or MRI examinations such as patients with hepatolenticular degeneration can show bilateral low-density lenticular nuclei or abnormal signals on MRI.

2.Positron emission tomography (PET) or single photon emission tomography (SPECT) can show that the function of striatum DA transporter (DAT) is reduced, DA transmitter synthesis is reduced, and D2 type DA receptor activity is changed. The diagnosis is quite meaningful.

3. Genetic analysis is of great significance for the diagnosis of certain hereditary dyskinesias.

Movement disorders medical treatment

The treatment of dyskinesias, whether medical or surgical, is based on the correction of transmitter abnormalities and circuit disturbances. Treatment of different types of extrapyramidal diseases.

Beijing Tiantan Hospital recently adopted deep brain electrical stimulation surgery to restore the Albanian girl Aurora's life to take care of herself with severe delayed dystonia. Wang Zhongcheng, a well-known neurosurgeon expert and academician of the Chinese Academy of Engineering, said that this is the first time that China has successfully used deep brain electrical stimulation surgery to treat such diseases, filling a gap in China, and also marking that China's treatment of movement disorders has reached the world's advanced level.

The patient Aurora developed a "torsional spasm" symptoms of involuntary twisting of her right shoulder and right arm and continuous tremor in her right hand in May 1999. Subsequently, her condition continued to worsen, causing her gait instability while walking and involuntary movement of her limbs. Typical delayed dystonia. Tiantan Hospital's neurosurgeon specialists and Xiehe Hospital experts conducted a consultation on her condition. On July 21, 2008, an internationally unprecedented deep brain electrical stimulation operation was performed. After treatment, the patient's body gradually recovered, and various symptoms miraculously disappeared. More than three months after the operation, a beautiful, cheerful girl stood again in front of people.

According to reports, dystonia is a type of dyskinesia. Simply put, the neural circuit in the brain that coordinates body movements encounters "roadblocks", which are more common in school-age children and adolescents. Clinical symptoms include abnormal movement and abnormal posture caused by dystonia, and a combination of the two. Currently, there is no cure for this disease. The deep-brain electrical stimulation surgery performed for Aurora this time is to place a stimulation electrode in the patient's brain, and a microcomputer smaller than the cigarette case connected to it is installed under the skin of the patient's chest. Adjusting the parameters can significantly improve the symptoms of dyskinesias such as tremor, stiff limbs, and bradykinesia, and restore patient self-care ability. This provides an extremely effective platform for clinical treatment of dyskinesias, including Parkinson's disease, idiopathic tremor, and dystonia.

Movement disorder disease prognosis

Different types of extrapyramidal diseases have different prognosis. For example, patients with Parkinson's disease (PD) experience severe motor dysfunction or death on average for 10 to 15 years, and the symptoms of primary writing spasticity are fairly stable, with little tendency to spread.

Movement disorder disease prevention

Prevention of dyskinesias with a genetic background is even more important. Preventive measures include the avoidance of marriage between close relatives, the introduction of genetic counselling, carrier genetic testing and prenatal diagnosis and selective abortion to prevent the birth of children. Early diagnosis and early treatment and strengthening clinical care are of great significance for improving the quality of life of patients with movement disorders. ^[1]