Extrapyramidal syndrome, what is it and why does it occur?

Extrapyramidal syndrome is a motor disorder produced, mainly, as an adverse reaction to treatment with antipsychotic drugs. We are talking about a motor disorder caused by a lesion of the extrapyramidal system, formed by the basal ganglia of the brain, which includes the gray nuclei and their pathways and connections.

The extrapyramidal system is responsible for controlling voluntary movements and muscle tone., as well as the production of automatic, instinctive and learned movements. Therefore, when there is a problem in this system, movement, tone and posture disorders occur.

The clearest example of extrapyramidal disease is Parkinson’s. In fact, to define extrapyramidal syndrome, we speak of parkinsonian symptoms.

Why does extrapyramidal syndrome occur?

Extrapyramidal syndrome It occurs mainly as an adverse reaction to treatment with antipsychotic drugs., although it can also be caused by damage to certain brain regions. The fundamental cause is the lack of regulation of dopamine, the neurotransmitter of the body’s motor function.

The drugs Antipsychotics or neuroleptics mainly block dopamine D2 receptors. to control the increased activation of dopaminergic pathways that occurs in psychoses. By blocking dopamine receptors, they cause motor disorders that we call extrapyramidal syndrome.

Typical antipsychotics are those that cause the most extrapyramidal symptoms. In fact, atypicals emerged to avoid this very common side effect. The most common drugs that can cause this syndrome are, for example, haloperidol or chlorpromazine.

Symptoms of extrapyramidal syndrome

The main symptoms of extrapyramidal syndrome are:

Hypokinesia: decreased speed and ability to make voluntary movements. It takes a lot of effort and the result is slow, clumsy movements.Hypertonia: increased muscle tension, especially in the extremities, as well as acute dystonias in the muscles of the face, neck and tongue.Akathisia: a condition of restlessness, anxiety and agitation that makes sitting impossible.

In addition, there are many other related motor symptoms that characterize this syndrome. Some of them are, for example:

Hyperkinesia: involuntary movements such as tics, ballisms or myoclonus.Involuntary tremorsoscillatory and rhythmic, which can occur at rest or while maintaining a specific posture.parkinsonian movementswith the head and trunk tilted forward and the elbows, knees and wrists flexed.Amimia: absence of expression on the face due to the rigidity of the facial muscles.Gait disturbanceswith small steps, without oscillating arm movements and very easy to lose balance.Language and writing disorders.Absence of postural reflexes and automatic and fast movements.

Treatment of extrapyramidal syndrome

As a rule, when rapid action is necessary, the treatment of extrapyramidal syndrome It is carried out with anticholinergic and dopaminergic drugs. However, Most of the time, the priority objective is to withdraw the drugs that have caused this adverse reaction.. In the case of treatment with typical antipsychotics, it is normal to try to replace them with others with fewer side effects, such as atypical antipsychotics.

However, to avoid the appearance of extrapyramidal syndrome during treatment with antipsychotic drugs, The doses administered must be monitored with special care.as well as keep track and monitor possible reactions that may appear to act early and avoid complications.

Regarding the treatment of muscle rigidity and motor alterations, especially when they have been caused or derived from brain damage in the extrapyramidal pathways, physiotherapy is a specialty that plays a very important role. His contribution to the patient’s rehabilitation has enormous value: what we are going to aim for is to improve the patient’s quality of life.

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