Torticollis

• AKA: wry neck, is a condition in which the head is tilted toward one side, and the chin is elevated and turned toward the opposite side.
• can be congenital, cause is unclear
  • Birth trauma or intrauterine malposition - causes damage to the sternocleidomastoid muscle in the neck.
• incidence is about 0.3-2.0%
• can be acquired
  • Trauma to the neck can cause the two vertebrae closest to the skull slide with respect to each other, tearing stabilizing ligaments
  • Tumors of the skull base (posterior fossa tumors) can compress the nerve supply to the neck
  • Infections in the posterior pharynx can irritate the nerves supplying the neck muscles
  • Ear infections and surgical removal of the adenoids can cause an entity known as Grisel's syndrome, a subluxation of the upper cervical joints
  • The use of certain drugs, such as antipsychotics

Tardive Dyskinesia

• caused by the long-term or high-dose use of dopamine antagonists, usually antipsychotics
• dyskinesia refers to an involuntary movement, so tics and other movements are often referred to as dyskinesias
  • repetitive, involuntary, purposeless movements.
  • Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking.
  • Rapid movements of the arms, legs, and trunk may also occur.
  • Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or piano.
  • For comparison, patients with Parkinson's disease have difficulty moving, while patients with tardive dyskinesia have difficulty not moving.
• The effect of antipsychotic drugs can be tardive, meaning the dyskinesia continues or appears even after the drugs are no longer taken
• cause appears to be related to damage to the system that uses and processes the neurotransmitter dopamine
• video clip another
• treatment - drugs should be withdrawn for a period of 3-6 months to see if this resolves the issue, but the problem may fail to improve or may even exacerbate.
• Thorazine Shuffle, Another Version

Tourette's syndrome

• inherited neuropsychiatric disorder with onset in childhood
• characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic
  • Tics are sudden, repetitive, stereotyped, nonrhythmic movements (motor tics) and utterances (phonic tics) that involve discrete muscle groups
  • Motor tics are movement-based tics
  • while phonic tics are involuntary sounds produced by moving air through the nose, mouth, or throat.
  • occur intermittently and unpredictably out of a background of normal motor activity
  • video clip
• tics characteristically wax and wane
• is defined as part of a spectrum of tic disorders, which includes transient and chronic tics
• often associated with the exclamation of obscene words or socially inappropriate and derogatory remarks, but this is present in only a small minority of people with Tourette's
• normal life expectancy and intelligence
• exact cause is unknown
• tics result from dysfunction in cortical and subcortical regions, the thalamus, basal ganglia and frontal cortex
• linked to failures in circuits connecting the brain's cortex and subcortex, and imaging techniques implicate the basal ganglia and frontal cortex
• The classes of medication with the most proven efficacy in treating tics-typical and atypical neuroleptics including risperidone (trade name Risperdal), haloperidol (haldol)

Parkinson's Disease

• degenerative disorder of the CNS that impairs motor skills and speech
• characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia) and, in extreme cases, a loss of physical movement (akinesia)
• result of decreased stimulation of the motor cortex by the basal ganglia, caused by the insufficient formation and action of dopamine
• from Wiki:

  Gait and posture disturbances:

  • Shuffling: gait is characterized by short steps, with feet barely leaving the ground, producing an audible shuffling noise. Small obstacles tend to cause the patient to trip.
  • Decreased arm-swing.
  • Turning "en bloc": rather than the usual twisting of the neck and trunk and pivoting on the toes, PD patients keep their neck and trunk rigid, requiring multiple small steps to accomplish a turn.
  • Stooped, forward-flexed posture. In severe forms, the head and upper shoulders may be bent at a right angle relative to the trunk (camptocormia)
  • Festination: a combination of stooped posture, imbalance, and short steps. It leads to a gait that gets progressively faster and faster, often ending in a fall.
  • Gait freezing: "freezing" is a manifestation of akinesia (an inability to move). Gait freezing is characterized by an inability to move the feet which may worsen in tight, cluttered spaces or when attempting to initiate gait.
  • Dystonia (in about 20% of cases): abnormal, sustained, painful twisting muscle contractions, often affecting the foot and ankle (mainly toe flexion and foot inversion) which often interferes with gait.

  Speech and swallowing disturbances.

  • Hypophonia: soft speech. Speech quality tends to be soft, hoarse, and monotonous. Some people with Parkinson's disease claim that their tongue is "heavy" or have cluttered speech
  • Monotonic speech
  • Festinating speech: excessively rapid, soft, poorly-intelligible speech.
  • Drooling: most likely caused by a weak, infrequent swallow and stooped posture.
  • Non-motor causes of speech/language disturbance in both expressive and receptive language: these include decreased verbal fluency and cognitive disturbance especially related to comprehension of emotional content of speech and of facial expression
  • Dysphagia: impaired ability to swallow. Can lead to aspiration, pneumonia.

  Other motor symptoms:

  • Fatigue (up to 50% of cases);
  • Masked faces (a mask-like face also known as hypomimia), with infrequent blinking
  • Difficulty rolling in bed or rising from a seated position;
  • Micrographia (small, cramped handwriting);
  • Impaired fine motor dexterity and motor coordination;
  • Impaired gross motor coordination;
  • Poverty of movement: overall loss of accessory movements, such as decreased arm swing when walking, as well as spontaneous movement.