Slow writhing distal movements affecting fingers, hands, toes New Delhi feet. Causes include lesions of basal ganglia, encephalitis, vascular lesions, birth injury etc. THERAPY
Benzhexol-Slow building up of dose up to 100mg/day Baclofen (5-20mg tid), diazepam (2-10mg tid), L Dopa (125, 2-6 doses) or Sodium valproate (100-200mg tid0. unilateral disease may get helped by steroatactic surgery. B) Chorea
Repetitive jerky, semi-purposive movements of limbs, face and trunk. Of two types
1) Inherited Hungtington’s chorea with progressive dementia, and seizures and
2) Acquired syndenham’s chorea due to streptococcal infection in Rheumatic fever. THERAPY
Huntington’s chorea- symptomatic with Tetrabenzine (25-50mg tid) or Haloperidol (0.5-1.5mg tid) C) Familial tremor
Tremors involving one or both hands, head and voice, starting in middle age and gtting worse with No neurologic deficit but interfering with writing and delicate movements. THERAPY
Treatment is often not required and avoided if possible, but once started, it may have to be continued indefinitely, Propranolol (40-120mg bid) helps reducing the amplitude of the tremor. Even a single dose could be taken prophylactically for a precipitating circumstance. Small doses of alcohol may abolish tremors for a short time. D) Hemiballismus
Wild flailing proximal movements of arm and leg on one side usually due to vascular lesion in the contra-lateral sub-thalamic nucleus. Usually, cease by a few weeks, but the patient may become exhausted, if untreated. THERAPY
Tetrabenazine (25-50mg tid) or Haloperidol (0.5-1.5mg tid) in persistent cases stereotactic thalamotomy helps. E) Spasmodic torticollis
Dystonic movements of neck, and head turned to a side for prolonged periods. Usually life long disorder. THERAPY
Tetrabanazine (2.5-5-mg tid), or Benzidazepines, local injection of botulinum toxin provides good relief. In extreme cases, selective section of spinal accessory muscles and upper cervical nerve roots. F) Writer’s cramps
Dystonic posturing of hand and forearm, when used of writing, and less often when using a screw driver or using cutlery. THERAPY
Drug therapy usually unsatisfactory. Patient may have to be asked to learn to use the other hand. Injection of botulinum a toxin helpful in some cases.
