RESUMO
Movement disorders uncommonly require emergent intervention; however, there are acute/subacute clinical settings in which the neurologist is consulted for recommendations about the diagnosis and management of a movement disorder. In these circumstances the neurologist must be comfortable with the diagnostic evaluation and be prepared to properly manage the patient. This article focuses on diagnosis and management of acute-onset movement disorders occurring secondary to prescription drug use, illicit drug abuse, and drug withdrawal syndromes. In addition, drug-induced emergencies occurring in patients with movement disorders are reviewed.
Assuntos
Discinesia Induzida por Medicamentos/diagnóstico , Discinesia Induzida por Medicamentos/terapia , Drogas Ilícitas/efeitos adversos , Emergências , Humanos , Tremor/induzido quimicamente , Tremor/diagnóstico , Tremor/terapiaRESUMO
Although movement disorders do not usually present as neurologic emergencies, there are times when the abrupt onset of an unusual movement abnormality results in emergency department or intensive care unit consultations. Part 1 of this review discussed hypokinetic movement disorders emergencies. Part 2 provides a diagnostic approach to the recognition and treatment of hyperkinetic movement disorders emergencies by identifying phenomenology and reviewing common etiologies.
Assuntos
Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Hipercinese/diagnóstico , Hipercinese/terapia , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/terapia , Doença Aguda , Humanos , Hipercinese/fisiopatologia , Transtornos dos Movimentos/fisiopatologiaRESUMO
Movement disorders usually do not require emergent intervention; nevertheless, there are acute/subacute clinical settings in which the neurologist is consulted. It is in these circumstances that the neurologist must be prepared to accurately diagnose and properly treat the patient. We have reviewed the literature regarding movement disorder emergencies and divided them into hypokinetic (part 1) and hyperkinetic (part 2) presentations. In part 1, drug-induced syndromes including neuroleptic malignant syndrome, parkinsonism hyperpyrexia syndrome, and serotonin syndrome will be discussed. Emergency complications related to the management of Parkinson disease, including falling, motor fluctuations, and psychiatric issues, will also be reviewed.
Assuntos
Encéfalo/patologia , Febre , Hipocinesia , Transtornos dos Movimentos , Síndrome Maligna Neuroléptica , Doença de Parkinson , Síndrome da Serotonina , Acidentes por Quedas/prevenção & controle , Doença Aguda , Emergências , Febre/etiologia , Humanos , Imageamento por Ressonância Magnética , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/terapia , Síndrome Maligna Neuroléptica/complicações , Síndrome Maligna Neuroléptica/diagnóstico , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/etiologia , Doença de Parkinson/psicologia , Transtornos Psicóticos/etiologia , Síndrome da Serotonina/induzido quimicamente , Síndrome da Serotonina/complicações , Síndrome da Serotonina/diagnóstico , Fatores de TempoRESUMO
"Dystonia" is the term used to describe abnormal movements consisting of sustained muscle contractions frequently causing twisting and repetitive movements or abnormal postures. Dystonia is classified partly by age at onset because this helps guide the diagnostic work-up and treatment decisions. This chapter focuses on early-onset (<26 years old) primary dystonia. The history, clinical features, genetics, pathophysiology, diagnosis, and treatment of early-onset primary dystonia are discussed. Special emphasis is placed on DYT1 dystonia, the most common, autosomal-dominant, early-onset, primary dystonia. A diagnostic algorithm is proposed for gene-negative early-onset dystonia, and treatment recommendations for generalized, early-onset dystonia are made.
Assuntos
Distúrbios Distônicos/diagnóstico , Distúrbios Distônicos/terapia , Idade de Início , Distúrbios Distônicos/história , Distúrbios Distônicos/fisiopatologia , História do Século XX , HumanosRESUMO
Parkinson's disease (PD) is the second most common neurodegenerative disease and the most treatable. Treatment of PD is symptomatic and generally focuses on the replacement or augmentation of levodopa. A number of options are available for treatment, both in monotherapy of early PD and to treat complications of advanced PD. This review focuses on rasagiline and selegiline, two medications that belong to a class of antiparkinsonian drugs called monoamine oxidase B (MAO-B) inhibitors. Topics covered in the review include mechanism of action, efficacy in early and advanced PD, effects on disability, the controversy regarding disease modification, safety, and patient preference for MAO-B inhibitors.
Assuntos
Tauopatias , Idoso , Carbidopa/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Combinação de Medicamentos , Humanos , Levodopa/uso terapêutico , Imageamento por Ressonância Magnética/métodos , Masculino , Tauopatias/tratamento farmacológico , Tauopatias/patologia , Tauopatias/fisiopatologiaRESUMO
Multiple system atrophy (MSA) is an adult-onset, progressive, neurodegenerative condition that has several different initial presentations. Ultimately affected patients develop parkinsonian features, autonomic dysfunction, cerebellar ataxia, and corticospinal deficits. Patients with MSA are often misdiagnosed as having Parkinson disease. This article discusses the epidemiology and pathophysiology of MSA, in addition to addressing clinical and diagnostic signs and symptoms, and the limited treatment options available to physicians.
Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Sistema Nervoso Central/fisiopatologia , Atrofia de Múltiplos Sistemas/diagnóstico , Atrofia de Múltiplos Sistemas/fisiopatologia , Degeneração Neural/fisiopatologia , Vias Neurais/fisiopatologia , Sistema Nervoso Autônomo/patologia , Sistema Nervoso Central/patologia , Humanos , Atrofia de Múltiplos Sistemas/terapia , Degeneração Neural/patologia , Degeneração Neural/terapia , Vias Neurais/patologiaRESUMO
Essential tremor (ET) is one of the most common movement disorders. Although often considered a monosymptomatic disorder (postural and kinetic tremor), ET has more recently been considered a more heterogeneous syndrome, with motor and nonmotor features. The diagnosis is clinical and pharmacologic and surgical therapies exist. ET is frequently misdiagnosed as Parkinson disease or dystonia. The traditional notion of ET as a benign disorder has been challenged by those who view ET as a slowly progressive neurodegenerative disorder.
Assuntos
Braço/fisiopatologia , Tremor Essencial/diagnóstico , Tremor Essencial/fisiopatologia , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/fisiopatologia , Idade de Início , Braço/inervação , Diagnóstico Diferencial , Tremor Essencial/terapia , Humanos , Transtornos dos Movimentos/terapiaRESUMO
A case of prolonged encephalopathy and worsened parkinsonism in a Parkinson disease patient exposed to a short course of metoclopramide is described. Parkinson disease (PD) is the second most common neurodegenerative disease in the United States. Because of the increased susceptibility to adverse drug effects, PD presents a special challenge to physicians. Anti-emetic drugs such as metoclopramide are widely used and may be particularly deleterious to PD patients due to blockade of dopamine receptors.
Assuntos
Antieméticos/efeitos adversos , Metoclopramida/efeitos adversos , Síndromes Neurotóxicas/etiologia , Doença de Parkinson Secundária/induzido quimicamente , Idoso , Antieméticos/uso terapêutico , Constipação Intestinal/complicações , Constipação Intestinal/tratamento farmacológico , Humanos , Masculino , Metoclopramida/uso terapêutico , Síndromes Neurotóxicas/complicações , Doença de Parkinson/complicaçõesAssuntos
Sinais (Psicologia) , Terapia por Exercício/métodos , Transtornos Neurológicos da Marcha/fisiopatologia , Doença de Parkinson/fisiopatologia , Desempenho Psicomotor/fisiologia , Desempenho Atlético/fisiologia , Emoções/fisiologia , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/terapia , Humanos , Movimento/fisiologia , Doença de Parkinson/complicações , Doença de Parkinson/terapia , Estresse Psicológico/fisiopatologia , Gravação em VídeoRESUMO
Parkinson's disease is the second most common neurodegenerative illness diagnosed in the United States. Dementia is recognized as a common component of advanced Parkinson's disease (PD). In patients with early PD, cognitive changes occur and primarily reflect impairment in executive function. It is unknown if the early cognitive changes detected on neuropsychological testing in Parkinson's disease are predictive of the subsequent development of Parkinson's disease with dementia (PDD). Many patients with PD develop dementia characterized by a wide range of cognitive deficits distinct from those seen in Alzheimer's disease (AD). Neuropsychiatric problems frequently accompany PDD. This chapter reviews the epidemiology, clinical characteristics of early and late cognitive changes, pathology, neuroimaging, diagnosis, and treatment of PDD.
Assuntos
Demência/etiologia , Doença de Parkinson/complicações , Demência/epidemiologia , Demência/patologia , Humanos , Doença de Parkinson/epidemiologia , Doença de Parkinson/patologiaRESUMO
Pregnancy in Parkinson's disease (PD) is an uncommon occurrence. Available reports suggest that there may be a worsening of PD symptom severity related to pregnancy. In this special report, medical literature on pregnancy in PD will be reviewed with regard to disease progression and the safety of antiparkinsonian medications. A case report of pregnancy in a woman with PD will be described. It is speculated that the symptoms of PD may be affected by changing hormone levels.