Involuntary movement

Basal ganglia are a group of subcortical nuclei which are essential for the coordination of movements (so-called extrapyramidal system). They include the caudate nucleus, putamen, globus pallidus, and lenti-form nucleus. Damage of the basal ganglia results in involuntary movements, as are observed in Parkinson s disease and Huntington s chorea. 

The most common adverse reactions seen with pramipexole and ropinirole include nausea, dizziness, postural hypotension, hallucinations, somnolence, vomiting, confusion, visual disturbances, abnormal involuntary movements, and headache... 

Because there is no known treatment for tardive dyskinesia and because it is irreversible in some patients the nurse must immediately report symptoms These indude rhythmic, involuntary movements of the tongue, face, mouth, jaw, or the extremities... 

A. Antiparkinson drugp prevent symptoms of tardive diskinesia, such as involuntary movements of die face and tongue... 

B. Rhydimic, involuntary movements of die tongue, face, mouth, or jaw... 

The adverse reactions associated widi metoclopramide are usually mild. Higher doses or prolonged administration may produce central nervous system (CNS) symptoms, such as drowsiness, dizziness, Parkinson-like symptoms (tremor, mask-like facial expression, muscle rigidity), depression, facial grimacing, motor restlessness, and involuntary movements of die eyes, face, or limbs. Dexpandienol administration may cause itching, difficulty breadiing, and urticaria... 

Another indication of the importance of DA in motor control is the observation that in humans its precursor levodopa, and DA agonists like bromocriptine, not only overcome the akinesia of Parkinsonism but in excess will actually cause involuntary movements, or dyskinesia (Chapter 14). Also it is well known that DA antagonists like chlorpromazine and haloperidol produce Parkinsonian-like symptoms in humans (and catalepsy in animals) and, as indicated above, reduce the dyskinesia of Huntington s Chorea. Thus DA seems to sit on a knife edge in the control of motor function (Fig. 7.8). 

Abnormal involuntary movements (AIMs), manifest mainly as dyskinesias at the peak plasma level of dopa. 

Phenothiazines may cause sedation, orthostatic hypotension, and extrapyramidal symptoms (EPS) such as dystonia (involuntary muscle contractions), tardive dyskinesia (irreversible and permanent involuntary movements), and akathisia (motor restlessness or anxiety).1,21,22 Chronic phenothiazine use has been associated with EPS, but single doses have also caused these effects.23... 

Symptom Rating Scale (ESRS). Akathisia is commonly monitored by the Barnes Akathisia Scale (BAS). The emergence of dyskinesias (writhing or involuntary movements) could represent the emergence of TD. Monitor for TD at least annually, and if FGAs are used patients should be evaluated at each visit. The most commonly used instrument to measure these symptoms is the Abnormal Involuntary Movement Scale (AIMS). 

Dyskinesia Abnormal involuntary movements, which include dystonia, chorea, and akathisia. 

The spinal cord is the most anatomically inferior portion of the CNS and its functions are at the lowest level of sophistication (see Table 6.1). As mentioned earlier, the spinal cord receives sensory input from the periphery of the body and contains the cell bodies of motor neurons responsible for voluntary and involuntary movements. Once again, the involuntary and neurologically simple reflexes are processed entirely at the level of the spinal cord. Voluntary, deliberate movements are initiated and controlled by thought processes in the cerebrum. The second important function of the spinal cord is to transmit nerve impulses to and from the brain. Ascending pathways carry sensory input to higher levels of the CNS and descending pathways carry impulses from the brain to motor neurons in the spinal cord. 

Tardive dyskinesia A collection of involuntary movements that are a side effect of long-term administration of typical antipsychotic drugs. 

TD is sometimes irreversible and is characterized by abnormal involuntary movements occurring with chronic antipsychotic therapy. 

The Abnormal Involuntary Movement Scale (AIMS) and the Dyskinesia Identification System Condensed User Scale (DISCUS) should be used to screen (at baseline and at least quarterly) and can facilitate early detection of TD, but neither scale is diagnostic. 

An abnormal involuntary movement of the eyes. It may be rotational or horizontal or vertical plane. 

Involuntary movement of the outer ears produced by an auditory stimulus (especially in rats). 

Choreiform movements are purposeless, involuntary movements such as flexing and extending of fingers, raising and lowering of shoulders or grimacing. 

There are two classes of movements in the human body voluntary and involuntary. Voluntary movements are pretty clear they are the movements that we can control. Reaching for the French fries, swinging a baseball bat, turning on the TV, and typing at a computer keyboard provide obvious examples. Involuntary movements include those movements that we cannot readily control such as heart beats, vascular contraction, and movement of the gut muscles, and they basically control the internal environment of the body. Voluntary movements are controlled by the somatic nervous system. Involuntary movements are controlled by the autonomic nervous system, to which we now turn. 

The major adverse effects of first-generation drugs for schizophrenia are involuntary movement disorders. Symptoms include tremor, rigidity, restlessness, and slowness of movement, strongly reminiscent of the movement disorders in parkinsonism, about which more follows later. The worst of these movement disorders is tardive dyskinesia, an irreversible movement disorder. 

Autonomic nervous system a system of central and peripheral nerves responsible for involuntary movements. 

Some medication side effects also occur only after prolonged administration and, as such, are products of the adaptive response to the continued administration of the medication. For example, taking a so-called conventional or typical antipsychotic for a long period of time can cause involuntary movements called tardive dyskinesias. These dyskinesias are believed to occur after chronic administration of the antipsychotic has caused changes in the density and/or sensitivity of dopamine receptors in brain regions that coordinate movement. 

Infrequent side effects of dextroamphetamine include euphoria, nervousness, irritability, headache, involuntary movements (tics), increased heart rate, and para-... 

L-DOPA can be initiated at 50 mg taken at bedtime and increased stepwise over a few weeks until the symptoms are relieved. Bromocriptine can be initiated at 7.5 mg at bedtime, pramipexole is often dosed at 0.125-0.375 mg at night, and ropinirole, which has an indication for RLS, is typically administered at 0.25-3 mg at bedtime. These medications are not without side effects. They may cause nausea and, over time, insomnia. Less commonly, these medications can cause hallucinations or involuntary movements called dyskinesias. These side effects usually resolve rapidly upon discontinuing the medication. 

Less frequent side effects of stimulants include euphoria, nervousness, irritability, headache, involuntary movements (tics), increased heart rate, and psychosis. If psychosis or tics develop, the patient s doctor should be notified immediately, and the medication should be stopped. Other side effects should also be reported and may necessitate a medication change. 

Huntington s disease Onset at age 35-45, family history of Huntington s disease, involuntary movements, personality changes... 

The high potency antipsychotic haloperidol (Haldol) provides the same calming effects with minimal anticholinergic effects. Although haloperidol is very effective, dementia patients are quite sensitive to its extrapyramidal effects. These include stiffness, shuffling gait, a mask-like facial appearance, and involuntary movements. To minimize these effects, haloperidol is used in very low doses (0.5-1.0mg) when treating those with dementia. 

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