The pyramidal tracts through the medullary pyramids and connect the cerebral cortex with lower motor centers of the brain stem and spinal cord.
Voluntary movements require a complex interplay of the corticospinal tracts (pyramidal tracts), the basal ganglia and cerebellum (center for motor coordination) to ensure uniform, specific movements without extraneous muscle contractions. The pyramidal tracts through the medullary pyramids and connect the cerebral cortex with lower motor centers of the brain stem and spinal cord. The basal ganglia (caudate nucleus, putamen, globus pallidus, the subthalamic nucleus and the substantia nigra) are the extrapyramidal system. They lie deep in the forebrain and redirect their output mainly rostral through the thalamus to the cerebral cortex. Most neural lesions that cause movement disorders occur in the extrapyramidal system; Therefore, movement disorders are sometimes called extrapyramidal disorder. Classification movement disorders are usually classified as those with reduced or slow movements (hypokinetic disorders) Increased movement (hyperkinetic disorders) The classic and most common hypokinetic disorder is Parkinson’s disease the hyperkinetic disorders are tremor, myoclonus, dystonia, chorea (incl. Hemiballism [fast chorea ] and athetosis [slow chorea]) and associated with tics. However, this classification does not account for overlap between categories (eg. As tremor that occurs in Parkinson’s disease). Hyperkinetic disorder hyperkinetic disorders (classification of common hyperkinetic disorders and hyperkinetic disorders) may be Rhythmically not rhythmically rhythmic disorders are primarily tremors-regularly alternating or oscillatory movements that occur mainly in peace at-retaining position and / or actively induced movements. In some cases, a tremor is irregular, although he is rhythmic; This occurs when the tremor associated with dystonic disorders. Non-rhythmic hyperkinetic disorders can be slow (eg. As athetosis) Stopping (z. B. dystonia) Fast (z. B. myoclonus, chorea, tics, Hemiballism) Rapide hyperkinetic disorders can be thrown off (eg tics) Nichtunterdrückbar (eg . B. Hemiballism, chorea, myoclonus) athetosis and chorea may occur together as choreoathetosis. Chorea is the characteristic movement disorder in M. Huntington. Multiple motor and phonetic tics are the defining characteristic of ourette syndrome. Classification of common hyperkinetic disorders hyperkinetic disorders Abnormal movements causes Description Athetosis M. Huntington, encephalitis, hepatic encephalopathy drugs / drug (eg. As cocaine, amphetamines, antipsychotics) The movements are not rhythmic, slow, writhing and screwing, primarily dista in len muscles; frequent changes in posture of the proximal extremities often merge continuously to a continuous flow of movement. A Athetosis has the properties of dystonia and chorea and often occurs together with chorea as Choreoathetosis on. Chorea Huntington’s disease, hyperthyroidism, hypoparathyroidism, paraneoplastic syndromes, SLE affecting the central nervous system, other autoimmune diseases, rheumatic fever, tumors or infarction in the caudate nucleus or putamen pregnancy, often in women who have rheumatic fever Senile Chorea drugs that can cause chorea ( z. B. levodopa, phenytoin, cocaine, oral contraceptives) drugs that can cause tardive dyskinesia (z. B. antipsychotics) the movements are not rhythmic, jerky, fast and not suppressed, v. a. in distal muscles or face. Sometimes abnormal movements in targeted effective actions are included which transfer the involuntary movements. Chorea often occurs along with a Athetosis as choreoathetosis. Dystonias primary (idiopathic) Degenerative or metabolic disorders (eg. BM Wilson, PKAN due to PANK2 mutation [formerly M. Hallervorden-Spatz], various lipidoses, multiple sclerosis, cerebral palsy, stroke, hypoxia in the brain) drugs that block dopamine receptors , most antipsychotics (eg. as phenothiazines, thioxanthenes, butyrophenones) or antiemetics Sustained muscle contractions often distort the posture or cause distorted, repetitive movements. Hemiballismus lesions (usually by stroke) in the contralateral subthalamic nucleus or in interconnecting afferent and efferent pathways, the movements are not rhythmic, fast, not suppressed, violent and flinging. Myoclonus Various causes are coming on very fast and jerky, nichtunterdrückbare, shock-like jerks that may be focal, segmental or generalized. (Can eg methylphenidate, cocaine, amphetamines, dopamine antagonists [the Spätdyskenesie cause.) M. Huntington, Neuroacanthocytosis, PKAN, infection, stroke, drugs / medicines The movements are not rhythmic, stereotyped, fast and: Tics Primary: Tourette’s syndrome secondary repetitive; characteristically, patients feel the urge to run it, and then they feel a brief relief. Tics can be suppressed for a short time and with conscious effort. Tics may be motor or phonetically simple (eg. As wink, growling, throat clearing) or complex (eg. B. shrug, arm swings, crying out words or phrases, incl. Obscenities). Tremor essential tremor Parkinson’s disease Wilson’s disease, certain drugs (such as lithium, valproate, olanzapine, other conventional and atypical antipsychotics-see table. Treatment) The movements are regular, usually rhythmic and oscillating. PKAN = pantothenate kinase-associated neurodegeneration.