What Is Dyskinesias?

Voluntary excitement, inhibition, or can not be controlled by the will, are common in neurological diseases, mental disorders, trauma, etc. There are two types of motor functions: voluntary movement and involuntary movement. Voluntary movement is a conscious movement that can be carried out with one's own will, also known as autonomous movement. Involuntary movement refers to the movement of the heart muscle and smooth muscle dominated by visceral motor nerves and vascular motor nerves, which is unconscious and uncontrolled by one's own will. Generally speaking, exercise refers to random movement. The motor nervous system refers to the pyramidal system, extrapyramidal system (striatum-pallidum system) and cortex-pontine-cerebellum system, and peripheral motor neurons send impulses to control skeletal muscle activity.

Dyskinesia

Introduction to Movement Disorders

Voluntary excitement, inhibition, or can not be controlled by the will, are common in neurological diseases, mental disorders, trauma, etc. There are two types of motor functions: voluntary movement and involuntary movement. Voluntary movement is a conscious movement that can be carried out with one's own will, also known as autonomous movement. Involuntary movement refers to the movement of the heart muscle and smooth muscle dominated by visceral motor nerves and vascular motor nerves, which is unconscious and uncontrolled by one's own will. Generally speaking, exercise refers to random movement. The motor nervous system refers to the pyramidal system, extrapyramidal system (striatum-pallidum system) and cortex-pontine-cerebellum system, and peripheral motor neurons send impulses to control skeletal muscle activity.

Main types of movement disorders

Loss of voluntary muscle movement. The main types are:

1. Painful dyskinesia. Seen in hysteria.

2. Intermittent dyskinesia. It is found in vascular lesions, impaired blood circulation in the limbs, muscles can not get the corresponding blood supply during exercise, so dyskinesia occurs, and it can be improved after rest or suspension of exercise.

3. Occupational dyskinesia. Belongs to occupational psychosis. Due to psychological factors, as soon as the patient engages in the sports required by his profession, muscle spasm or weakness will occur, and he will not be able to move or have a movement disorder. When he stops this kind of exercise or does other exercises, there is no movement disorder.

4. Face-to-mouth dyskinesia. It is a late-onset dyskinesia that specifically affects facial muscles and is caused by drugs.

5. Tardive dyskinesia. Cheek, mouth and neck muscles are involuntary. Typical repetitive movements are mainly caused by long-term use of mental relaxants and antipsychotic drugs. They are common in the elderly and may not be relieved for a long time after stopping the drug.

6. Dyskinesia caused by pathological pathological changes. Including dyskinesia caused by upper motor neuron disease and dyskinesia caused by lower motor neuron.

7. Dyskinesia caused by vertebral extracorporeal disease. The patient's muscle tension increased, and the whole body was stiff, so he had awkward movements, difficulty in fine movements, slow walking, flustered gait, and dull expression. Common in Parkinson's disease or Parkinson's disease. Hepatolenticular degeneration.

8. Dyskinesia caused by muscle disease, myasthenia gravis, progressive muscle atrophy, etc.

9. Dyskinesia caused by skeletal lesions.

10. Dyskinesias caused by emotional stress. Usually disappears during sleep.

Types of dyskinesias

The increase of voluntary movement is manifested by involuntary movement and psychomotor excitement; the inhibition of voluntary movement includes psychomotor inhibition and paralysis; the uncoordinated movement is ataxia.

Dyskinesia

Paralysis can be caused by damage to any part of the motor neurons from the motor cortex to the entire skeletal muscle. The complete loss of muscle strength is complete paralysis. Those with muscle weakness, that is, those who retain a certain degree of motor function, are incompletely paralyzed. According to the site of paralysis, it can be divided into single paralysis, hemiplegia, paraplegia, and quadriplegia. Monoparesis is a movement disorder on one side of the face and one limb. Monoplegia can be caused by damage to peripheral motor neurons, as well as damage to the cerebral cortex and motor center. Hemiplegia is a movement disorder in the left or right half. Central paralysis is the most representative dyskinesia. It is often caused by cerebral hemorrhage or cerebral infarction. Sometimes hemiplegia is called cross-over hemiplegia, that is, there is damage to one side of the cranial nerve, such as oculomotor nerve palsy (damage of the horn of the brain), facial nerve palsy (damage of the pontine) or sublingual nerve damage (damage of the bulbar) Hemiplegia of the lateral upper and lower limbs. Crossed hemiplegia indicates that the damage is in the brainstem and is mostly caused by brainstem tumors or brain parasites. Paraplegia refers to paralysis of the lower body or both lower limbs, while paralysis of the upper and lower limbs on both sides is quadriplegia. Paraplegia is the result of simultaneous damage to the pyramidal tracts on both sides of the spinal cord, so it is common in spinal trauma or myelitis. Paraplegia or quadriplegia can also occur during brain damage (such as cerebral palsy) or symmetrical peripheral nerve damage. Paraplegia caused by spinal cord injury often has a special spastic gait, hyperreflexia, and various pathological reflexes. Can be seen in spinal cord trauma, spinal tumors, amyotrophic lateral sclerosis, hereditary spastic paraplegia, syringomyelia and other pain.

Central paralysis, which is paralysis caused by damage to the upper motor neurons (from the cerebral cortex and pyramidal tract to the anterior horn motor cells of the spinal cord), is manifested as spastic paralysis, increased muscle tone, hypertenoid reflexes, and shallowness on the paralyzed side Reflexes (abdominal wall reflexes, cremaster test reflexes, etc.) are reduced or disappeared, and pathological reflexes such as Babinski's sign and Huffman's sign are positive. However, the central paralysis of acute onset, flaccid paralysis at the beginning, is a manifestation of pyramidal shock. Spastic paralysis occurred after about 2 and 3 weeks. Central palsy is seen in cerebrovascular diseases, brain tumors, and intracranial space-occupying lesions. Peripheral paralysis is caused by damage to the lower motor neurons (anterior horn cells or cranial nerve motor nucleus), peripheral nerves, and neuromuscular junctions. For flaccid paralysis, muscle tension decreases, and deep reflexes decrease or disappear. Persistent and severe paralysis can be accompanied by muscle atrophy. Muscle atrophy caused by the disease itself is parallel to the degree of muscle weakness or paralysis. Peripheral paralysis can sometimes be accompanied by muscle tremors. Flaccid paralysis caused by anterior horn cell damage is more common in polio, some myelitis, and trauma. Paralysis caused by peripheral nerve damage is seen in trauma compression, infection, and toxic neuritis. In addition, abnormal blood potassium can cause periodic paralysis, rickets can also be paralyzed, and muscles of patients with myasthenia gravis are paralyzed due to fatigue after repeated application.

Dyskinesia

It is caused by the dysfunction of communication between the cerebral cortical motor center and other mental centers. Such as psychomotor excitement (significant increase in voluntary movement and speech) and psychomotor inhibition (significant decrease in movement and speech) are more common in mental disorders (see behavioral disorders). Apraxia refers to the loss of the ability to correctly use objects to perform purposeful movements, or the ability to memorize movements and the loss of fine movements, or the lack of flexibility to perform coarse movements (see Apraxia).

The coordination of ataxia movement is the result of the cooperation of the cerebellar vestibular system, deep sensation, and extrapyramidal system. Therefore, the damage of the above structure can hinder the coordination of movement. Cerebellar vermiform lesions cause trunk balance disorders, and cerebellar hemisphere damage causes coordinated dyskinesias of the limbs on the diseased side, poor discrimination, excessive range of motion, and intentional tremor. Patients with sensory ataxia cannot discern the position of the limb and the direction of movement, and therefore cannot perform autonomous movement correctly. Vestibular ataxia is dominated by balance disorders. In general, cerebral (such as frontal) ataxia is not as severe as cerebellar ataxia.

Involuntary movement of a part of a muscle, a group of muscles, or a group of muscles that cannot be controlled at will, with no purpose. Myofibrillation is the small and rapid contraction of individual muscle bundles caused by stimulation of the anterior horn cells of the spinal cord or the anterior roots of the spinal nerve. Spasticity is an involuntary contraction of one or more groups of muscles. Clonic spasms are sudden, transient, repetitive muscle contractions. Tonic spasm is a long-lasting muscle contraction. Spasms are more common in major seizures. Convulsions are a set of repetitive, rigid contractions of muscles, such as blinking, shrugging, turning your head, etc., mostly habitual.

Involuntary movements such as tremor, dance-like movements, hand and foot movements, and torsional spasms are extrapyramidal dyskinesias. Tremor is an involuntary, rhythmic shake of a part of the body. Appears in the state of limb quiescence is called resting tremor, which can be seen in Parkinson's syndrome. Tremors that occur in limb movements are called intentional tremors and are more common in cerebellar lesions. Dance-like movements are a kind of rapid and changeable, involuntary movements with no purpose, irregularity, asymmetry, and varying amplitudes, often caused by basal ganglia (extrapyramidal) lesions. Hand and foot movements are intermittent, slow, twisted, earthworm-like peristaltic extensions of fingers or toes, caused by striatum lesions. Torsion spasm is a weird twist of the trunk and proximal limbs that is slow and intense. It can be seen in the lesions of the basal ganglia, especially the caudate and putamen.

Dyskinesia Treatment Principles

The first step is to identify organic or functional paralysis. Functional paralysis requires suggestive treatment, combined with acupuncture and physical therapy. Etiology of organic paralysis is performed after a clear diagnosis. When breathing muscles are paralyzed and breathing difficulties occur, artificial respirators should be used to assist breathing and oxygen inhalation to keep the airway open. Pharyngeal muscle paralysis and nasal feeding during dysphagia to maintain nutrition. Paralysis should be treated with acupuncture, physiotherapy, nerve cell activators, and vitamin B drugs. And rehabilitation. For involuntary exercise, it can be combined with sedatives and muscle relaxants while treating the cause. Appropriate antiepileptic drugs are used in patients with epilepsy to control seizures. ^[1]