NeuroAnatomy Case. Tardive Dyskinesia- Basal Ganglia

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NeuroAnatomy case of Tardive Dyskinesia (short)

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  • One of the 4 dopamine pathways in the brain
  • Define diffuse
  • NeuroAnatomy Case. Tardive Dyskinesia- Basal Ganglia

    1. 1. NeuroAnatomy Case Report GROUP 6
    2. 2. 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
    3. 3. 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
    4. 4. LEVEL OF LESION CEREBRUM BASAL GANGLIA BRAINSTEM CEREBELLUM SPINAL CORD PERIPHERAL
    5. 5. Why basal ganglia???
    6. 6. SUPRATENTORIAL BASAL GANGLIA Why supratentorial?? Basal ganglia is above tentorium cerebelli
    7. 7. SUPRATENTORIAL BASAL GANGLIA FUNCTIONS Control of posture and voluntary movement Coordinates Rapid and slow movements Regulation of voluntary movement and learning of motor skills Feed-back mechanism
    8. 8. Topography of the Lesion Non- focal and diffusely located  Manifestations include not only the face, but as well as the arms and hands
    9. 9. Pathologic Lesion Not a mass Nor a non-mass
    10. 10. Etiology of Lesion TOXIC/METABOLIC
    11. 11. ANTIPSYCHOTIC MEDICATIONS
    12. 12. ANTIPSYCHOTIC MEDICATIONS TYPES:  CONVENTIONAL  High potency  Low potency  ATYPICAL
    13. 13. ANTIPSYCHOTIC MEDICATIONS MECHANISM 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.
    14. 14. 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…
    15. 15. 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
    16. 16. ANTIPSYCHOTIC MEDICATIONS TARDIVE 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
    17. 17. DIAGNOSIS There 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
    18. 18. 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
    19. 19. In most severe and serious cases:  Torticollis, retrocollis, trunk twisting, and pelvic thrusting  breathing and swallowing irregularities  aerophagia, belching, and grunting
    20. 20. Laboratory Studies Thyroid Function Test Serum copper and Serum ceruloplasmin Test Serum Calcium Test RBC count Connective tissue disease screening tests
    21. 21. Neuro-imaging Studies CT Scan MRI PET Scan

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