Motor disturbances

Petit mal (PM) or absence seizures (AS). These are less dramatic and generally occur in children. They entail a brief and abrupt loss of awareness (consciousness) in which the patient suddenly ceases ongoing activity or speech and stares vacantly for a few seconds before recovering equally quickly. Motor disturbances are rare apart from blinking of the eyes and the patient has no recollection of the event. 

Signs and Symptoms Sudden onset of fever, headache, vomiting and possibly abdominal pain, progressing to neck stiffness, mental confusion, motor disturbances, and difficulty with equilibrium. Survivors may suffer significant impairment of mental functions. 

Lewis, J. et al. Neurofibrillary tangles, amyotrophy and progressive motor disturbance in mice expressing mutant (P301L) tau protein. Nature Genet. 25 402-405, 2000. 

The basal ganglia are a group of subcortical nuclei which are components of modular circuits involved in many cortical functions. They have received considerable attention from basic scientists and clinicians alike because of their prominent involvement in movement disorders, a spectrum of diseases including disorders which are characterized by poverty of movement (hypokinetic disorders), as well as disorders characterized by excess movement (hyperkinetic disorders). It has become clear in recent years that most basal ganglia disorders are not restricted to motor disturbances, but involve cognitive and emotional features as well. 

Psychiatric Scale (IMPS) is used to measure psychotic syndromes in hospitalized adults capable of being interviewed. The 89 items are rated on the basis of a psychiatric interview. This test has been well validated and requires 10 to 15 minutes following a 35- to 45-minute interview. There are ten scores excitement, hostile belligerence, paranoid projection, grandiose expansiveness, perceptual distortions, anxious intropunitiveness, retardation and apathy, disorientation, motor disturbances, and conceptual disorganization. 

Navarro M, Fernandez-Ruiz JJ, De Miguel R, Hernandez ML, Cebeira M, Ramos JA. (1993). Motor disturbances induced by an acute dose of delta 9-tetrahydrocannabinol possible involvement of nigrostriatal dopaminergic alterations. Pharmacol Biochem Behav. 45(2) 291-98. 

Inhibition of CNS neurons is the underlying cause of neurological effects such as vertigo, confusion, sensory disturbances, and motor disturbances (tremor, giddiness, ataxia, convulsions). 

Drags that exhibit central anticholinergic properties are used in treating Parkinsonism. It is believed that they do not affect the synthesis, release, or hydrolysis of acetylcholine. Their medicinal efficacy is manifest by the rednction or removal of motor disturbances cansed by damage to the extrapyramidal system. They reduce rigidity, and to a somewhat lesser degree, akinesia, and they have little effect on tremors. 

The clinical presentation of EOS comprises cognitive symptoms, emotional symptoms, and changes in social functioning, disturbances of speech and language, and motor disturbances. 

Motor disturbances are manifold and can extend from clumsiness and motor dysharmony to strange postures, stupor, and symptoms of catatonia. Bizarre movements and motor stereotypies such as finger stereotypies are frequent. Initially, and also during the course of the disorder, compulsive acts or rituals resulting in strange and unexpected movements can also be observed. 

Tardive dyskinesias are motor disturbances that sometimes arise following long-term treatment with neuroleptics. The first symptoms to appear are... 

Central and/or peripheral nervous system involvement is one of the most frequent features, often resulting in the neonatal period in drowsiness, poor sucking, severe hypotonia, abnormal movements, seizures, respiratory distress, and fatal keto-acidotic coma with lactic acidosis [3]. To these severe conditions echo late-onset diseases now frequently attributed to or associated with mitochondrial OXPHOS defects, such as Alzheimer s or Parkinsons disease [10]. Major neurological symptoms, in variable combinations, involve trunk hypotonia, cranial nerve and brainstem involvement (with abnormal eye movements, ophthalmoplegia, recurrent apneas), cerebellar ataxia, myoclonia, seizures, pyramidal syndrome, peripheral neuropathy, poliodystrophy, and leukodystrophy infections [27,28]. A diffuse impairment of the cerebral white matter (leukodystrophy) mostly results in motor disturbance with mental retardation and low incidence of seizures. 

Headache, and rarely malaise, dizziness, somnolence, insomnia, vertigo, reversible blurred vision, reversible involuntary motor disturbances... 

Psychosis itself can be paranoid, disorganized-excited, or depressive. Perceptual distortions and motor disturbances can be associated with any type of psychosis. 

Apomorphine is a dopamine agonist with a variegated pattern of usage. Given parenter-ally as an emetic agent to aid elimination of orally ingested poisons, it is not without hazards (hypotension, respiratory depression). In akinetic motor disturbances, it is a back-up drug. Taken orally, it supposedly is beneficial in erectile dysfunction. 

In some types of rhythm disorders, antiar-rhythmics of the local anesthetic, Na+-channel blocking type are used for both prophylaxis and therapy. These substances block the Na+ channel responsible for the fast depolarization of nerve and muscle tissues. Therefore, the elicitation of action potentials is impeded and impulse conduction is delayed. This effect may exert a favorable influence in some forms of arrhythmia, but can itself act arrhythmogenically. Unfortunately, antiarrhythmics of the local anesthetic, Na+-channel blocking type lack suf -cient specificity in two respects (1) other ion channels of cardiomyocytes, such as K1 and Ca+ channels, are also affected (abnormal QT prolongation) and (2) their action is not restricted to cardiac muscle tissue but also impacts on neural tissues and brain cells. Adverse effects on the heart include production of arrhythmias and lowering of heart rate, AV conduction, and systolic force. CNS side effects are manifested by vertigo, giddiness, disorientation, confusion, motor disturbances, etc. 

The butyrophenones (prototype haloper-idol) were introduced after the phenothiazines. With these agents, blockade of D2 receptors predominates entirely (p. 235B). Antimuscarinic and antiadrenergic effects are attenuated. The extrapyramidal motor disturbances that result from D2 receptor blockade are, however, preserved and constitute the clinically most important adverse reactions that often limit therapy. 

Q10 Haloperidol is an antipsychotic or neuroleptic agent. It is an antagonist at dopamine receptors, particularly of the D2 subtype. These drugs help to control the symptoms (mainly the positive symptoms) of schizophrenia by antagonizing the dopamine receptors in different brain areas, such as the frontal and temporal lobes. Antipsychotic agents, such as haloperidol, take days or weeks to achieve their therapeutic effect and may produce some motor disturbances. 

Haloperidol helps to control the positive symptoms of schizophrenia by antagonising dopamine receptors (D2 receptors) in several brain areas, but may produce motor disturbances. 

SAFETY PROFILE A poison by inhalation. A very toxic gas whose effects are not completely understood. The chief effects are central nervous system depression and lung irritation. There may be pulmonary edema, dilation of the heart, and hyperemia of the visceral organs. Inhalation can cause coma and convulsions leading to death within 48 hours. However, most cases recover without after-effects. Chronic poisoning, characterized by anemia, bronchitis, gastrointestinal disturbances, and visual, speech, and motor disturbances, may result from continued exposure to very low concentrations. 

The clinical picture is characterized by xanthomas, particularly on the tendons (especially the Achilles tendon). Xanthomas consist of cholesterol and cholestanol. The enzyme defect also results in disturbed vitamin D metabolism. Osteoporosis is thus observed quite often, with a tendency towards spontaneous fractures. (208) Striking clinical features are cerebral functional disorders (from deviant behaviour to severe dementia, motor disturbances and convulsions) as well as peripheral neurological symptoms caused by cholestanol deposits. (211) High concentrations of apolipoprotein B and cholestanol are found in the CSF. (213) Treatment is based on the administration of chenodeoxycholic acid (750 mg/day). Effectiveness is improved if HMG-CoA reductase inhibitors (e. g. pravastatin) are used concomitantly. (207, 212)... 

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