Motor disorders, extrapyramidal

Side effects include fatigue, insomnia, and altered motor coordination. Parkinsonian side effects and acute dys-tonic reactions also have been reported. Metoclopramide stimulates prolactin secretion, which can cause galactorrhea and menstrual disorders. Extrapyramidal side effects seen following administration of the phenothiazines, thioxanthenes, and butyrophenones may be accentuated by metoclopramide. 

Parkinsonism is an extrapyramidal motor disorder, characterized by akinesia, rigidity and tremor with secondary manifestations such as excessive salivation, seborrhoea, mood changes (especially depression) and in certain patients, liver damage has been reported. It was first described by James Parkinson in 1817. 

The major motor disorder in neurological cretinism is extrapyramidal rather than pyramidal and is characterized by rigidity, with an added measure of spasticity. It is consistent with a putamino-pallidal lesion, in addition to other elements. 

Non-motor signs of the disorder are also treatable with symptomatic medications. The frequent mood disorder can be treated with standard antidepressants, including tricyclics (such as amitryptiline) or serotonin reuptake inhibitors (SSRIs, such as fluoxetine or sertraline). This treatment is not without risks in these patients, as it may trigger manic episodes or may even precipitate suicide. Anxiety responds to benzodiazepines, as well as to effective treatment of depression. Long-acting benzodiazepines are favored over short-acting ones because of the lesser abuse potential. Some of the behavioral abnormalities may respond to treatment with the neuroleptics as well. The use of atypical neuroleptics, such as clozapine is preferred over the typical neuroleptics as they may help to control dyskinesias with relatively few extrapyramidal side-effects (Ch. 54). 

When D2 receptors are blocked in the nigrostriatal DA pathway, it produces disorders of movement that can appear very much like those in Parkinson s disease this is why these movements are sometimes called drug-induced parkinsonism (Fig. 11 —4). Since the nigrostriatal pathway is part of the extrapyramidal nervous system, these motor side effects associated with blocking of D2 receptors in this part of the brain are sometimes also called extrapyramidal symptoms, or EPS. 

Laudanosine (6,7,3, 4 -tetramethoxy-1 -benzyltetrahydroisoquinoline) was isolated for the first time by Hesse (371) from opium. Intravenous administration of this substance to rabbits reduced the intraocular pressure (372). The whole effect manifested itself by motor restlessness, convulsions, disorders in coordination of movements, salivation, etc., which indicated an involvement of the extrapyramidal system and the mesencephalon. The effect produced by synthetic racemic laudanosine on rabbits was similar to that of the (+) form, but it was more toxic (373). The pharmacological properties of laudanosine have also been described (374). 

Most of the neurological disorders associated with the neuroleptics fall into the category of extrapyramidal reactions or extrapyramidal symptoms, and are often designated EPS. The extrapyramidal system of the brain is an extensive, complex network that moderates and adjusts motor... 

Adverse effects. Disorders of extrapyramidal motor function with development of pseudo-parkinsonism (p. 188), sedation, depression, stuffy nose, impaired libido, impotence and increased appetite. 

The authors suggested a causal association between use of marijuana and extrapyramidal disorders. The research literature contains evidence that the endogenous canna-binoid system plays a role in basal ganglia transmission circuitry, possibly by interfering with dopamine reuptake. Furthermore, central cannabinoid receptors are located in two areas that regulate motor activity, the lateral globus pallidus and substantia nigra (89). 

Basal ganglia Controls aspects of motor behavior Neuronal pathways connecting limbic system and prefrontal lobes Parkinson s disease, antipsychotic medication side effects (extrapyramidal symptoms (EPS)) Obsessive-compulsive disorder... 

Parkinsonism (Parkinson s disease) is a chronic neurologic disorder affecting balance and motion at the extrapyramidal motor tract. Five major symptoms of Parkinsonism are ... 

A number of case studies have reported induction of extrapyramidal motor effects in patients following severe anti-ChE intoxication (Muller-Vahl et a ., 1999 Shahar and Andraws, 2001 Arima et ai, 2003 Brahmi et ai, 2004). Joubert and Joubert (1988) reported two OP poisoning cases (unspecified toxicants) with choreiform movements. One patient exhibited choreiform movements in all limbs, but these were more extensive in the arms. Five months after exposure, the patient was depre.ssed, listless, and had episodic grimacing and chorea. The movement disorder improved with halopcridol therapy. The other patient had... 

A 69-year-old man with bipolar disorder, who had been taking venlafaxine up to 337.5 mg daily, thioridazine 25 mg at night, and sodium valproate 1.2 g daily for several months with no adverse motor symptoms, experienced extrapyramidal effects 3 to 4 days after the venlafaxine had been gradually replaced by nortriptyline 50 mg daily. Symptoms persisted despite withdrawal of thioridazine, but improved on reduction of the nortriptyline dosage to 20 mg daily. The cause of the reaction was not known, but it was suggested that there may have been an interaction between venlafaxine and nortriptyline possibly modulated by thioridazine or sodium valproate. 

Parkinsonism is associated with a number of degenerative changes in both the structure and the chemistry of the basal ganglia. The relationship between the symptoms of the disease and these changes is dependent upon what is the normal function in the extrapyramidal motor system of such substances as dopamine, noradrenaline, serotonin, and the melanins, as well as others such as acetylcholine whose levels appear to be normal in Parkinsonism. Nevertheless, normal levels do not exclude disordered function since dynamic systems can involve different rates of turnover with no apparent change in concentrations. Synaptic transmission in the central nervous system has been extensively reviewed [59-61] and only those factors relevant to Parkinsonism will be discussed here. 

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