NeuroAnatomy Case. Tardive Dyskinesia- Basal Ganglia
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Transcript of NeuroAnatomy Case. Tardive Dyskinesia- Basal Ganglia
NeuroAnatomy Case Report
GROUP 6
Case:A 55 YEAR OLD WOMAN IN A PSYCHIATRIC
WARD RECEIVED A DRUG FOR TREATMENT OF HER BIZARRE BEHAVIOR AND HALLUCINATIONS. AFTER THE TREATMENT WAS INITIATED, SHE HAD DECREASED FACIAL EXPRESSION AND AN ABSENCE OF ARM SWING WHILE WALKING. AFTER 6 MONTHS OF TREATMENT, STEREOTYPED, REPETITIVE INVOLUNTARY MOVEMENTS OF THE TONGUE, MOUTH AND FACE DEVELOPED. OTHER FINDINGS WERE NORMAL EXCEPT FOR MINIMAL PIANO PLAYING MOVEMENTS OF THE FINGERS
MANIFESTATIONSAfter initiation of treatment
Decreased facial expression Absence of arm swing while walking
After 6 months of treatment Stereotyped, repetitive involuntary movement
of tongue, mouth and face Minimal piano playing movements
LEVEL OF LESION
CEREBRUM
BASAL GANGLIA
BRAINSTEM
CEREBELLUM
SPINAL CORD
PERIPHERAL
Why basal ganglia???
SUPRATENTORIAL BASAL GANGLIA
Why supratentorial??Basal ganglia is above
tentorium cerebelli
SUPRATENTORIAL BASAL GANGLIA
FUNCTIONSControl of posture and voluntary
movementCoordinates Rapid and slow
movementsRegulation of voluntary movement
and learning of motor skillsFeed-back mechanism
Topography of the LesionNon- focal and diffusely located
Manifestations include not only the face, but as well as the arms and hands
Pathologic LesionNot a mass
Nor a non-mass
Etiology of LesionTOXIC/METABOLIC
ANTIPSYCHOTIC MEDICATIONS
ANTIPSYCHOTIC MEDICATIONSTYPES:
CONVENTIONAL High potency Low potency
ATYPICAL
ANTIPSYCHOTIC MEDICATIONSMECHANISM OF ACTION:
The therapeutic action of the conventional antipsychotic medications is correlated best with antagonist activity at postjunctional dopamine D-2 receptors, where dopamine normally inhibits adenylyl cyclase activity.
The therapeutic action of atypical antipsychotic drugs is correlated with antagonistic activity at both 5-HT-receptors and dopamine D2 or D4 receptors.
THE THERAPEUTIC ACTION IS BEST CORRELATED WITH THE ACTIONS OF THESE DRUGS IN THE MESOLIMBIC AND MESOCORTICAL AREAS OF THE CNS.
MANIFESTATIONS After initiation of treatment
Decreased facial expression Absence of arm swing while walking
After 6 months of treatment Stereotyped, repetitive involuntary movement
of tongue, mouth and face Minimal piano playing movements
Second Look…
ADVERSE EFFECTS: Central Nervous System
Extrapyramidal Syndromes Acute Dystonia Akathisia Parkinsonian-like syndrome (tremors, bradykinesia, rigidity, etc.
Tardive Dsykinesia Neuroleptic Malignant Syndrome Sedation Confusion / Memory Impairment Seizures
ANTIPSYCHOTIC MEDICATIONS
ANTIPSYCHOTIC MEDICATIONSTARDIVE DYSKINESIA
Likely with conventional drugs Characterized by disfiguring orofaciolingual movements and at
times dystonic movements of the trunk Result of developing supersensitivity of the postjunctional
dopamine receptors in the CNS, perhaps in the basal ganglia. Occurs months to years of drug exposure Often irreversible More likely to occur in elderly or institutionalized patients who
receive long term, high-dose therapy
DIAGNOSISThere is no single test for tardive dyskinesia
Diagnostic process may involve more than one physician
Requires thorough review of medical history
Physical examination and neuro-psychological evaluation is needed
Physical Exam abnormal, involuntary, irregular choreoathetoid
movements muscles of the head, limbs, and trunk
Perioral movements are the most common and darting, twisting, and protruding movements of
the tongue chewing and lateral jaw movements;
lip puckering; and facial grimacing Finger movements and hand clenching
In most severe and serious cases: Torticollis, retrocollis, trunk twisting, and pelvic
thrusting breathing and swallowing irregularities
aerophagia, belching, and grunting
Laboratory StudiesThyroid Function Test
Serum copper and Serum ceruloplasmin Test
Serum Calcium Test
RBC count
Connective tissue disease screening tests
Neuro-imaging StudiesCT Scan
MRI
PET Scan