Saturday, February 14, 2009

Reglan and Movement Disorders

Reglan now has a blackbox warning, pursuant to the FDA. We're investigating those who may have been harmed by this drug.

Movement disorders describe a variety of abnormal movements of the body that have a neurological basis. These abnormal movements are characterized by changes in the coordination and speed of voluntary movement. They may also involve the presence of additional movements that are not voluntary.

Movement disorders are sometimes referred to by medical professionals as extrapyramidal diseases because this class of disorders is distinct from the disorders caused by disorders of the pyramidal region of the brain. Researchers have determined that movement disorders are caused by diseases in various parts of the brain, including the substantia nigra, the subthalamic nucleus, the globus pallidus, the striatum, and the basal ganglia.

Movement disorders are usually broken down into two types of movement: hyperkinetic movement and hypokinetic movement. Hyperkinetic movement disorders are characterized by a significant and excessive amount of motor activity. This type also includes cases in which there is a significant amount of abnormal involuntary movement. Hypokinetic movement disorders are those in which there is an abnormally reduced amount of intentional motor activity.

Hyperkinetic movement disorders are characterized by two types of behavior: rhythmical and irregular. Tremor is a rhythmic movement that is further divided into three forms: rest, postural, and intention. Rest tremor is most prominent when an individual is at rest and decreases with voluntary activity. Postural tremor occurs when an individual attempts to support a position against gravity (such as holding an arm outstretched). Intention tremor occurs during voluntary movement toward a specific target.

A side effect is a movement disorder, like Dystonia:

What is Dystonia?

Dystonia is a movement disorder characterized by involuntary muscle contraction leading to abnormal postures and twisting movements. The frequency of this disorder is similar to multiple sclerosis.

Are there different types of dystonia?
Several types are known and they are classified according to age of onset, distribution of dystonia, and cause. The primary dystonias are diseases that are characterized with only dystonia as their clinical feature. They are classified as early onset or adult onset disease.

* Early onset dystonia
The characteristic form of early onset form is called "primary childhood onset dystonia" otherwise known as Oppenheim's dystonia or DYT1 dystonia. This disease begins frequently with dystonia in a limb and with onset under the age of 28. It characteristically progresses to involve other body parts and ultimately becomes generalized.

* Adult onset dystonia
The adult onset dystonias are far more common and cervical distribution (otherwise known as spasmodic torticollis) is the most common type. The adult onset dystonias usually remain localized to specific areas such as neck, face or vocal cords. And they generally do not spread and are much less frequently hereditary.

* Cervical dystonia (or spasmodic torticollis)
For cervical dystonia, typical age of onset is around 40 years and women are more affected than men.

What causes dystonia?
The cause of dystonia is unknown although genetic studies may shed some light on this in the next decade. The genetic nature of this disorder has recently come to light as it is autosomal dominant and a number of genes have been isolated.

How is dystonia treated?
The primary treatment for the focal adult onset dystonias is Botulinum toxin. There are currently two types of toxins - Type A (approved in 1989) and Type B (approved in 1999). The most recent advance in the treatment of dystonia is deep brain stimulation surgery similar to that utilized in Parkinson's disease and essential tremor.

Another side effect is an essential tremor

What is essential tremor?

Essential tremor is probably the most common of movement disorders affecting about 5-10% of the population.

What are its symptoms?
It is characterized by tremors. But unlike Parkinson's disease

* Essential tremor is associated with postural and action tremors, which interfere with such activities as writing, eating and performing fine motor movements.

* With Parkinson's disease, tremors occur while sitting at rest.

Essential tremor can occur at any age. It is sometimes very mild and not troublesome but it can be progressive and result in severe disability.

What causes essential tremor?
The cause of essential tremor is unknown. We do know that it is inherited in an autosomal recessive manner in many cases, meaning that each child of a person with this disease has a 25% chance of inheriting it. Two genes have recently been associated with essential tremor and further research may delineate a cause.

How is it treated?
Currently there are some medications that may be helpful in diminishing the tremor. These include:

Medical Treatments

* Propranolol
* Primidone
* Gabapentin
* Topiramate
* Benzodiazepines

Unfortunately, there is no medicinal treatment that is capable of completely stopping tremor.

Surgical Treatments
In the last 10 years, developments in surgical therapy have helped some to slow the progression of essential tremor. For those who are severely disabled by tremor and do not respond to medicinal treatments, a surgical procedure known as deep brain stimulation may ease symptoms. During deep brain stimulation, a part of the brain is exposed to electrical pulses to help abolish or partially abolish tremor, Patients who undergo deep brain stimulation have continued to experience symptom improvement for years after the procedure for years.