By V. Fedor. Ohio Valley College.
Reserpine is longer acting than tetrabenazine and side effects may include hypotension purchase fluoxetine 20 mg with amex, depression, and parkinsonism. Dopamine antagonists including the typical neurolep- tics haloperidol, pimozide, and chlorpromazine have been efﬁcacious in treating chorea. Early case reports describe rapid improvement of abnormal movements within a few days, using low doses of haloperidol, from 0. Other authors have suggested that pimozide may have a lower risk of inducing neuroleptics side effects, such as sedation, parkinsonism, weight gain, school phobia, hepatocel- lular dysfunction, leukopenia, and tardive dyskinesia. Carbamazepine has also been used to treat chorea, but its mechanism of action is unknown. Some authors have postulated that it stimulates cholinergic pathways and others have implicated structural similarity to tricyclic antidepressants and phenothiazines. Surgical Therapy Surgical approaches for the treatment of chorea are unproven. Deep brain stimula- tion (DBS) of the thalamus and pallidotomy have been performed in a small number of cases with mixed results. Chorea in Children 137 Therapy in Sydenham’s Chorea Since treatment is symptomatic and not curative, the decision to initiate therapy in patients with SC is based on the degree of patient disability, whether due to chorea, behavioral, or psychiatric symptoms. Numerous neuropsychiatric problems are seen in association with SC, including emotional lability, irritability, attention deﬁcit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), and psycho- sis, and speciﬁc therapy may be required to address these issues (see appropriate chapters). Studies in patients with SC have shown improvement of chorea with the use of anticonvulsants. In limited trials, there were no signiﬁcant differences between val- proic acid and carbamazepine in the time to clinical improvement, time to complete remission, duration of therapy, or recurrence rates. Other therapies have included neuroleptics, such as haldol and pimozide. In most patients, chorea improved dra- matically and the duration of therapy, although variable, ranged from 3 to 6 months. Immunomodulatory therapies, such as corticosteroids, plasmapheresis, and intravenous immunoglobulin (IVIG), have been used to treat SC. Case reports and retrospec- tive reviews of corticosteroid therapy in SC suggest that they may shorten the time to recovery.
Kraeplin classified catatonia as a subtype of schizophrenia but most catatonic patients in fact suffer a mood or affective disorder order fluoxetine 10 mg with visa. Furthermore, although initially thought to be exclusively a feature of psychiatric disease, catatonia is now recognized as a feature of struc- tural or metabolic brain disease. The original account contains descriptions suggestive of extrapyramidal disease. Catatonia of psychiatric origin often responds to lorazepam; there are also advocates of ECT. Baltimore: Johns Hopkins University Press, 1973 Muqit MMK, Rakshi JS, Shakir RA, Larner AJ. Movement Disorders 2001; 16: 360-362 Cross References Abulia; Akinetic mutism; Imitation behavior; Mutism; Negativism; Rigidity; Stereotypy; Stupor Cauda Equina Syndrome A cauda equina syndrome results from pathological processes affect- ing the spinal roots below the termination of the spinal cord around L1/L2, hence it is a syndrome of multiple radiculopathies. Depending on precisely which roots are affected, this may produce symmetrical or asymmetrical sensory impairment in the buttocks (sad- dle anesthesia; sacral anesthesia) and the backs of the thighs, radicular pain, and lower motor neurone type weakness of the foot and/or toes (even a flail foot). Weakness of hip flexion (L1) does not occur, and this may be useful in differentiating a cauda equina syndrome from a conus lesion which may otherwise produce similar features. Sphincters may also be involved, resulting in incontinence, or, in the case of large cen- tral disc herniation at L4/L5 or L5/S1, acute urinary retention. Causes of a cauda equina syndrome include: Central disc herniation Tumor: primary (ependymoma, meningioma. Schwannoma), metastasis Hematoma - 68 - Cerebellar Syndromes C Abscess Lumbosacral fracture Inflammatory disease, e. The syndrome needs to be considered in any patient with acute (or acute-on-chronic) low back pain, radiation of pain to the legs, altered perineal sensation, and altered bladder function. Missed diagnosis of acute lumbar disc herniation may be costly, from the point of view of both clinical outcome and resultant litigation. References Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostiuk JP.