Dyskinesia in brief: a summary of dyskinesia

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I disturb Dyskinesia: it is one of the disorders of a kinetic nature. It consists of involuntary movements - hyperkinetic or hypokinetic - of the muscles. Dyskinesia represents an "appreciable difficulty in controlling muscle movements. Etiopathological picture of dyskinesia Traumatic events, autoimmune diseases, ischemic pathologies of the cerebral circulation, infections of the CNS, disorders affecting the peripheral nerves and genetic degenerative diseases or caused by the improper use of drugs Dyskinesias and DIMD DIMD: heterogeneous group of movement disorders induced by drug specialties

• Dystonia: involuntary muscle contractions, protracted over time, characterized by repetitive and cadenced gestures
• Akathisia: internal tremor
• Tardive dyskinesias: collateral dyskinesia typical of the administration of antipsychotic-neuroleptic and antiemetic substances. Characterized by involuntary hyperkinetic movements, stiffness, muscle tension, bradykinesia, stereotyped, frequent and rhythmic movements
• Tardive withdrawal dyskinesia: hyperkinetic movements follow the interruption of drug therapy

Mechanism of action of antipsychotics Antipsychotic substances exert an "anti-dopaminergic action: antipsychotics block the D2 receptor for dopamine (a neurotransmitter also involved in brain movement control mechanisms) causing alteration of muscle movements General classification of dyskinesia

• Athetosis: involuntary movements are particularly slow
• Korea: movements appear rapid, continuous and uncontrolled
• Cramps: the movements are involuntary and painful, the cause of which lies above all in the excessive muscular effort
• Dystonia: abnormal posture assumed by the body
• Hemiballism: particularly violent movements of the body
• Myoclonus: short and temporary involuntary movements typical of sleep
• Synkinesia: involuntary movement with one limb, when the movement is being made in the other limb
• Tics: repeated, identical and rhythmic movements (psychogenic nature)
• Tremors: rhythmic muscle oscillations not predicted by the CNS, generated by antagonistic muscle bundles

Dyskinesias and internal anatomical movements

• uterine dyskinesia
• biliary dyskinesia
• myocardial dyskinesia
• dyskinesias of the upper esophageal sphincter
• primary ciliary dyskinesia

Dyskinesia: terminology Dyskinesia proper refers only to dysfunctions of the extrapyramidal system Dyskinesia: clinical picture Type of movements:

• Hyperkinesias
• Hypokinesias

Localization of dyskinesias: face, tongue, mouth (more common), trunk, limbs (less common)
Psychological consequences: possible psycho-social disturbances, mentally incapacitating
General clinical picture:

• Facial and eye movements
• Perioral dyskinesias
• Movements of the extremities
• Trunk dyskinesias

Dyskinesia: risk factors

• Constant and chronic administration of neuroleptic-antipsychotic drugs used in the treatment of depression, nausea and dyspepsia
• The risk of causing dyskinesia is directly proportional to the increase in dosage and duration of treatment.
• Aging of the patient
• Probably, women are more at risk, particularly during the menopausal period
• Depression, degenerative diseases (eg diabetes) and Parkinson's disease
• Smoking, alcohol and drugs
• Possible genetic predisposition

Dyskinesia: diagnosis Particularly complex diagnosis due to the variety of dyskinetic forms:

• Multidisciplinary approach
• Clinical-objective examination of the patient: control of all hypokinetic or hyperkinetic movements of the patient
• Psycho-neurological analysis of the patient
• AIMS scale: investigation tool useful for recognizing the initial symptoms of dyskinesia and for monitoring any pathological degeneration over time
• Laboratory tests (e.g. SMA-18, CBC, etc.)
• Family history (to verify hypothetical diseases of neurological origin)

Dyskinesia: therapies

• Reduction of the dosage of neuroleptic substances for patients who still have psychotic disorders
• Discontinuation of the drug when the patient has completely recovered from the psychosis
• New possible effective therapeutic options: vitamin D, botulinum toxin and tetrabenazine

Dyskinesia: possible side effects of therapy Withdrawal dyskinesia: The interruption of drug therapy generates an initial and paradoxical potentiation of dyskinesias (reversible condition) Dyskinesia: prevention Administration of atypical, new generation neuroleptics
Replacement of the neuroleptic drug with another, with fewer side effects on muscle movement

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1. Dyskinesia: Diagnosis, Therapy, Prevention
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3. Dyskinesia: clinical picture and risk factors