Chapter 51 Disorders Of Movement

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atonic contractions

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absence of postural muscle contraction

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clonic contractions

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(periodic symmetric body and extremity movements with regular amplitude and frequency),

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myoclonic contractions

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abrupt shock-like muscle contractions with an irregular amplitude and frequency)

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Atonic seizures cause

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a brief loss of motor tone (drop attack) that can cause falling

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Generalized tonic-clonic seizures have an initial

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tonic phase, which is associated with apnea and cyanosis, followed by a clonic phase where respirations become labored (5).

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Partial seizures originate as

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abnormal electrical discharges that are confined to a focal or restricted part of the cerebral cortex

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Partial seizures are subdivided into

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simple partial and complex partial

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Two types of complex partial seizures that deserve mention are

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temporal lobe seizures (characterized by a motionless stare and automatisms) and epilepsia partialis continua (characterized by persistent tonic-clonic movements of the facial and limb muscles on one side of the body).

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New-onset seizures can be the result of a drug intoxication (e.g

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., theophylline

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Because of its prolonged effect is the initial agent of choice for treatment of convulsive seizures

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, lorazepam

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Intravenous phenytoin has been widely used to treat seizures since 1956. The standard intravenous dose is

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20 mg/kg in adults

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The combination of benzodiazepines and phenytoin will control seizures in 60–90% of cases of convulsive status epilepticus (11). In refractory cases, intravenous

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phenobarbital can be effective when given in a dose of 50–75 mg/min until seizures are controlled or a maximum of 20 mg/kg is achieved. The therapeutic serum level for phenobarbital is 20 to 40 µg/mL.

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The therapeutic serum level for phenobarbital is

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20 to 40 µg/mL.

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In addition to concurrent illness and surgery, several medications can precipitate or aggravate the myasthenic syndrome. The principle offenders are

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antibiotics (e.g., aminoglycosides, ciprofloxacin), cardiac drugs (e.g., beta-adrenergic blockers, lidocaine, procainamide, quinidine), and magnesium (28). Magnesium blocks the presynaptic release of acetylcholine, and can be particularly detrimental in myasthenic patients.

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In addition to concurrent illness and surgery, several medications can precipitate or aggravate the myasthenic syndrome. The principle offenders are

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antibiotics (e.g., aminoglycosides, ciprofloxacin), cardiac drugs (e.g., beta-adrenergic blockers, lidocaine, procainamide, quinidine), and magnesium (28). Magnesium blocks the presynaptic release of acetylcholine, and can be particularly detrimental in myasthenic patients.

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The first line of therapy in myasthenia gravis is

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the administration of acetylcholinesterase inhibitors like pyridostigmine (Mestinon

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The first line of therapy in myasthenia gravis is

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the administration of acetylcholinesterase inhibitors like pyridostigmine (Mestinon

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The first line of therapy in myasthenia gravis is

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the administration of acetylcholinesterase inhibitors like pyridostigmine (Mestinon

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Pyridostigmine can be given intravenously to treat myasthenic crisis (the IV dose is 1/30 of the oral dose) (27,29). Immunotherapy is added if needed using either

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either prednisone (1–1.5 mg/kg/day), azathioprine (1 to 3 mg/kg/day), or cyclosporine (2.5 mg/kg twice per day) (

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Pyridostigmine can be given intravenously to treat myasthenic crisis (the IV dose is 1/30 of the oral dose) (27,29). Immunotherapy is added if needed using either

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either prednisone (1–1.5 mg/kg/day), azathioprine (1 to 3 mg/kg/day), or cyclosporine (2.5 mg/kg twice per day) (

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Guillain-Barré Syndrome

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some patients have circulating antibodies to gangliosides in peripheral nerv

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the results of nerve conduction studies in GBS

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slowing of nerve conduction due to demyelination

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the results of nerve conduction studies in GBS

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slowing of nerve conduction due to demyelination

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the results of nerve conduction studies in GBS

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slowing of nerve conduction due to demyelination

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The treatment of Guillain-Barré syndrome mostly involves supportive care. In severe cases requiring mechanical ventilation,

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plasmapheresis or intravenous immunoglobulin G (0.4 g/kg/day for 5 days) are equally effective in producing short-term improvement.Immunoglobulin G is often preferred because it is easiest to administer

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Critical illness myopathy is observed in about one-third of patients with

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status asthmaticus

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Critical illness myopathy is observed in about one-third of patients with

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status asthmaticus

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Critical illness myopathy is observed in about one-third of patients with

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status asthmaticus

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Life-threatening increases in serum potassium can occur when what is given in the prescence of denervation injury?

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Succinylcholine (Anectine)

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Life-threatening increases in serum potassium can occur when what is given in the prescence of denervation injury?

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Succinylcholine (Anectine)

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gelastic seizures are associated with

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Hypothalamic lesions (esp. Hamartomas)

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gelastic seizures are actually

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seizures that cause paraoxysms of laughter

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gelastic seizures are actually

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seizures that cause paraoxysms of laughter

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gelastic seizures are actually

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seizures that cause paraoxysms of laughter

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gelastic seizures are actually

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seizures that cause paraoxysms of laughter