Dyskinesia, also known as tardive dyskinesia, is a neurological disorder often caused by the long-term use of neuroleptic drugs. Such drugs are generally prescribed for psychiatric disorders, as well as for some gastrointestinal and neurological disorders.
Dyskinesia involves involuntary movements of the lips, tongue, mouth and face. These excess movements also may be experienced by people with Parkinson’s disease.
The movements can become more diffuse and can resemble generalized jitteriness, chorea or dystonias. Akithisia, a form of restlessness, is often associated with tardive dyskinesia and manifests itself as constant fidgeting or a necessity to keep moving.
Elderly women appear to be the most susceptible to developing tardive dyskinesia from neuroleptics.
Symptoms include movements that have continuous, repetitive and stereotyped patterns. Such movements include lip smacking, grimacing, blinking and grunting. Also, the patient may have rapid movements of the arms, legs and trunk.
Treatment of Movement Disorders
Medication is often prescribed to help restore the proper balance of chemicals in the body in people who have movement disorders.
The main goal of treatment is to keep movements as normal as possible with the smallest amount of medication, since many medications can cause side effects.
Cases that do not respond to medication may require surgery, often aimed at interrupting abnormal movements. Various available procedures may be used during surgery to optimize the benefit as different targets are tested.
One procedure is pallidotomy, a computer-assisted neurosurgery, aimed at reducing tremor, rigidity and other symptoms by destroying the areas of the brain that caused these symptoms.
Another option is thalamotomy, which involves making a lesion in the thalamus, the area of the brain that is the source of tremor. Both procedures are irreversible and may have permanent side effects.
In 1997, stereotactic insertion of a deep brain stimulator into the thalmus was introduced as a procedure for treating Parkinson’s disease and essential tremor. The advantage of this type of operation is that instead of destroying overactive cells that cause the symptoms, it temporarily disables them by firing rapid pulses of electricity between 4 electrodes at the tip of the lead.
The lead is permanently implanted and connected to a pacemaker controller installed beneath the skin of the chest.
An alternative to making a lesion with an electrode is to use highly focused radiation.
Two types of devices can be used to deliver stereotactic radiosurgery, namely the Gamma Knife® and the LINAC-Scalpel. Lesioning procedures tend to be preferred for younger patients because it eliminates the need for numerous battery changes or hardware in the body. Also, brains of younger people seem to have more plasticity and less chance of a new neurologic deficit.
With tardive dyskinesia, the 1st step of treatment may be to discontinue or alter the neuroleptic drug.
In the cases of dystonia and dyskinesia, other treatments such as injections of botulinum toxin may be the most desirable therapy. The drug weakens certain muscles and lasts several months.
Therapies may be necessary to help patients with language and movement.
Research of Movement Disorders
Research aimed at finding the sources of movement disorders and improved treatments and therapies fall into many categories.
One method under investigation includes fetal cell transplants to reconstitute damaged pathways.
Deep brain stimulators are under investigation for control of these movement disorders and for other conditions, such as multiple sclerosis, severe stroke or brain injury.
In addition, gene studies continue to help with the diagnosis and treatment of all movement disorders.
Also, drugs that greatly reduce the risk of movement disorders such as tardive dyskinesia, acute dystonia or drug-induced Parkinsonism are being used and studied.
Wake Forest Baptist Approach
The treatment of movement disorders at Wake Forest Baptist Medical Center is a collaborative effort between the Departments of Neurology and Neurosurgery.
Quality of life is further enhanced by the participation of physical, occupational and speech therapists and members of the Otolaryngology Department, who have special expertise in speech and swallowing difficulties.
Surgical treatments including pallidotomy, thalamotomy and thalamic or subthalamic deep brain stimulators are a special area of expertise of the Movement Disorders Unit.
Advanced image-guidance combining magnetic resonance imaging (MRI), computed tomography (CT) and microelectrode recording are available to optimize these procedures. Members of the unit also have expertise in botulinum toxin injections to treat movement disorders.
Gamma Knife Center is used to treat tremor, dyskinesia and Parkinson’s disease, as well as for research. The Gamma Knife is a type of stereotactic radiosurgery in which radiation is used with pinpoint accuracy.
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