Recommended
More Related Content
What's hot
What's hot (20)
Similar to Disorders of movement
Similar to Disorders of movement (20)
Recently uploaded
Recently uploaded (20)
Disorders of movement
- 1. Disorders of Movement Dr Isha Deshmukh Assistant Professor Pediatrics BJGMC, Pune
- 2. Introduction Three general types of movement disorders encountered in critically ill patients 1. Involuntary movements (Seizures) 2. Weak or ineffective movements(neuromuscular weakness) 3. No movements (neuromuscular blockers)
- 3. Types of movements a) Tonic contractions b) Atonic contractions c) Clonic contractions d) Myoclonic contractions e) Automatisms Post –ictal period : Time immediately following a seizure and transient impairment of mentation and sensorium.
- 4. Drug Related Seizures in the PICU Drug Intoxication Drug Abuse Drug Withdrawal Pharmaceuticals: Amphetamines Barbiturates Ciprofloxacin Cocaine Benzodiazepines Imipenem Phencyclidine Ethanol Isoniazid Opiates Lidocaine Meperidine Penicillins Theophylline Tricyclics
- 5. Etiology for seizures • Drug intoxication • Drug withdrawal • Infections • Head trauma • Ischemic injury • Space occupying lesions • Hemorrhage • Systemic metabolic derrangements • Uremic encephalopathy • Cerebrovascular diseases • Non compliance of Anti-epileptic drug therapy
- 6. Complications • Hypertension • Lactic acidosis • Hyperthermia • Respiratory compramise • Pulmonary aspiration or edema • Rhabdomyolysis • Self mutilation • Irreversible neurodeficit • Neuroregression • Pseudotumour Cerebri
- 7. Intravenous drug therapy for convulsive seizures in the PICU • Inj Lorazepam 0.1 mg/kg/dose • Inj Fosphenytion 15mg/kg loading f/b 5 mg/kg • Inj Phenytoin 20 mg/kg loading f/b 5 mg/kg • Inj Phenobarbital 20 mg/kg f/b 5 to 8 mg/kg • Inj Propofol infusion • Inj Midazolam infusion • Phenobarbital coma
- 8. Anticonvulsant hypersensitivity syndrome • Idiosyncrytic reaction to phenytoin or phenobarbital associated with triad of fever , rash, hypotension and lymphadenopathy . • Lab features include Increased liver enzymes, Leucocytosis, Thrombocytosis or Thrombocytopenia. • Associated with Abnormal EEG.
- 9. Comparative Features of Myasthenia Gravis and GBS Features Myasthenia Gravis GBS Ocular Findings Yes No Fluctuating weakness Yes No Bulbar weakness Yes Yes DTR Intact Depressed Autonomic instability No Yes Nerve Conduction Normal Slowed
- 10. Comparative Features of Conditions Associated with Picu Acquired Neuromuscular weakness Critical Illness Polyneuropathy Residual Neuromuscular Block Critical illness Myopathy Sensory Mod to severe Normal Normal Motor Systemic weakness, Respiratory failure Systemic weakness, Respiratory failure Systemic weakness, Respiratory failure Creatine Kinase Normal Normal Mild elevation in 50% Elecrodiagnostic studies Motor and sensory axonal degeneration, Normal conduction velocity Fatigue at NM Junction Myopathic changes, normal conduction velocity Muscle biopsy Denervation Atrophy Normal Muscle atrophy , loss of thick filaments
- 11. Respiratory consequences of Neuromuscular Weakness Consequences Management Normal respiratory muscle strength Observe Impaired cough with difficulty clearing secretions Chest physiotherapy Accumulation of secretions, with risk of infection and airway obstruction Intubation and mechanical ventilation Atelectasis and progressive hypoxemia Supplemental oxygen Alveolar hypoventialtion and hypercapnia Mechanical ventilation
- 12. Disadvantages of Neuromuscular paralysis • Inadequate Sedation • Child ventilator asynchrony • Prolonged weakness • Depressed DTR • Hypostatic pneumonia • Hypocalcemia, hypomagnesemia • Venous Thromboembolism • Arterial Thromboembolism • Hyperviscosity of blood • DIC • Peripheral neuropathy