Manual Current Topics in Extrapyramidal Disorders

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Further to his initial work on L-DOPA, Birkmayer has been in the forefront of supplementary parkinsonian therapy using enzyme inhibitors: benserazide in , unselective monoamine oxidase inhibitors in and deprenyl in FORMAT Paperback. Publisher Description The scientific work of Walther Birkmayer is grounded on his ability to turn what was often a mass of clinical details into the basis for a hypothesis for a new therapeutic approach toward solving the problems of a patient's illness. Pages Publisher Springer. Series Journal of Neural Transmission. Language English.

ISBN X. ISBN Media Book. Format Paperback. DEWEY Series Number Slowing of gait is frequent, but freezing is unusual. Almost one-half of DIP cases display additional signs of tardive dyskinesia or akathisia. Anosmia and rapid eye movement sleep behavior disorder are not typical of DIP.

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Prevention is the best approach to avoid the acute as well as long-term complications that may occur with all neuroleptic drugs, particularly in subjects at greater risk Table 1. A change in drug class to a low-dose atypical agent, ideally quetiapine or clozapine, would offer the best chance to reverse the condition and facilitate management in the long run. In the event, DIP remains symptomatic; a team approach with the treating psychiatrist and individualized treatment should be proposed, taking into account the patient age, the severity of the motor condition, and impact on quality of life.

Prescribing antiparkinsonian medications may threat the underlying psychopathology and cognition or exacerbate tardive dyskinesia. The clinical response highly depends on the robustness of the antipsychotic drug regime left in place for maintenance therapy.

Thus, mild DIP is probably best left untreated. Physical therapy should be proposed particularly in those with disordered posture and gait. The estimated population-attributable fraction of PD associated with drug exposure suggested that avoidance of drug exposure would yield a Parkinsonism as part of the NMS is an infrequent drug side effect, with prevalence estimates averaging 0. All neuroleptics may trigger NMS, and high dosing as well as polypharmacy combination of antipsychotics or adjunct therapy with lithium or carbamazepine constitutes pharmacological risk factors, whereas environmental factors include physical restraint and dehydration.

Profoundly altered dopamine transmission due to extensive D2 receptor occupancy in the basal ganglia 75 and hypothalamus disturbing thermoregulation , as well as musculoskeletal fiber toxicity, are thought to contribute, but current knowledge on precise mechanisms is lacking. Prompt recognition and withdrawal of the offending drug are important to prevent complications and mortality. Supportive treatment and use of dantrolene and dopamine agonists are common practice.

Thus, DIP requires a high index of suspicion and knowledge of the diverse offending drugs in order to be managed effectively. It is more complex than heretofore believed, with acute and chronic pictures documented and a variable interplay between nigrostriatal presynaptic and postsynaptic mechanisms implicated in different patients. Nonmotor features such as anosmia and cardiac denervation examined by I-metaiodobenzylguanidine scintigraphy may distinguish pure reversible DIP from PD.

Autopsy findings in reversible or irreversible DIP have shown Lewy-body midbrain pathology and neuronal loss in a fraction of cases only, leaving many cases unexplained. DIP management is challenging and requires a team approach with the treating psychiatrist to achieve the best outcome. VK reports no conflicts of interest in this work. Drug Induced Movement Disorders.


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Fifth ed. J Neurol Neurosurg Psychiatry. A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl. Clinimetric evaluation of the Simpson-Angus Scale in older adults with schizophrenia. J Clin Psychopharmacol. Failure of recognition of drug-induced parkinsonism in the elderly.

Sensitivity of older patients to antipsychotic motor side effects: a PET study examining potential mechanisms. Am J Geriatr Psychiatry. Ayd FJ Jr. A survey of drug-induced extrapyramidal reactions. Silver M, Factor SA. Valproic acid-induced parkinsonism: levodopa responsiveness with dyskinesia. Parkinsonism Relat Disord. Incidence and distribution of parkinsonism in Olmsted County, Minnesota, — Clinical correlates of the pathology underlying parkinsonism: a population perspective.

Neuroleptic-induced parkinsonism: clinicopathological study. Neurotoxic reactions resulting from chlorpromazine administration.

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J Am Med Assoc. Prevalence of PD and other types of parkinsonism in three elderly populations of central Spain. Gershanik OS. Drug-induced parkinsonism in the aged. Recognition and prevention. Drugs Aging. Tarsy D. Neuroleptic-induced extrapyramidal reactions: classification, description, and diagnosis. Clin Neuropharmacol.

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  6. His book, "Klinik und Therapie der vegetativen Funktionsstorungen" published with W. Winkler, brought Birkmayer recognition in the German-speaking world.

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    In he took over the Neurological Department of the Geriatric Hospital of Vienna in Lainz, where he remained until his retirement in