Objectives of Lecture

By the end of this lecture, the student will be able to:

1. Describe different extrapyramidalcenters and tracts.

2. Define parkinsonism, chorea, athetosisand dystonia.

3. List causes of extrapyramidal disorders.

4. Explain clinical picture of different extrapyramidal diseases.

5. List treatment of extrapyramidaldisorders.

6. Differentiate between involuntary movement in chorea, athetosis and dystonia.

ExtrapyramidalDisorders

Ref.Elwan H : Principles of Neurology . University Book Center , Cairo , 2007.

Extrapyramidal System• Definition .

Pontine

Mesencephalic

Diencephalic

Telencephalic

Cortical level

Cerebellarlevel

Centres

BASAL GANGLIA

Pyramidal and Extrapyramidal tracts

Connections of ExtrapyramidalCenters

• Functions .

Disturbance of Function

Static Tremors Rigidity Bradykinesia

PARKINSONISM

• Definition .

• Causes .I – Idiopathic .II – Symptomatic .

Substantia Nigra

Clinical Picture

• Tremors.

• Rigidity.Differences between rigidity & spasticity .

• Loss of emotional and associative movements .

• Other clinical manifestations .

Manifestations of Parkinsonism

Differentiation between types of parkinsonism according to cause:

• Paralysis agitans.

• Post-encephalitic.

• Atherosclerotic.

Treatment

Medical Aim• Anticholinergic drugs.• Levo-dopa.• Levo-dopa + Carbi-dopa (sinemet).• Dopaminergic agonists.SurgicalPallidectomy or Thalamotomy.

Chorea

• Definition.• Causes.• Types.1. Rheumatic chorea (Sydenham’s).2. Huntigton’s chorea .

Dancing involuntary movements

Athetosis

Different hand movements in athetosis.

Dystonia

• Types :Generalized Partial *Writer cramp.

*Oromandibular.*Blepharospasm .*Cervical dystonia.

Cervical Dystonia