Akinesia
Akinesia is a disorder characterized by an inability to initiate voluntary movements.
Akinesia is more a difficulty in initiating movements than a complete inability, so the terms bradykinesia (reduced amplitude of movement) and hypokinesia would be more appropriate.
Causes of akinesia
Akinesia can coexist with any other manifestation of extrapyramidal system diseases, especially rigidity, but akinesia is regarded as an absolute necessity for the diagnosis of Parkinson’s disease.
In neurological and anatomical terms, akinesia is a characteristic feature of diseases affecting subcortical structures, the basal ganglia, the thalamus, and the limbic system.
Akinesia can be found in the following diseases:
– Parkinson’s disease
– Steele-Richardson
– Olszewski syndrome
– Striatonigral degeneration
Akinesia may occur in Pick’s and Alzheimer’s disease, in later phases.
The onset of Parkinson’s disease is insidious with a feeling of numbness and stiffness of a segment with difficulty in the execution and control of movements, sometimes the characteristic tremor begins with the distal end of the hand, walking becomes slowed, expressionless faces with slow speech;
During the state, there are confounding the three main syndromes:
– Akinesia, the fundamental symptom is the loss of motor initiative, the patient is immobile, with an expressionless and fixed face, blinking is rare or absent, automatic movements are diminished or absent, it shows the upper limb balance in walking, as flourish during the speech.
Walking is hesitant to start, with small steps after its center of gravity.
Speech is monotonous, without modulation.
Under the influence of stress is observed paradoxical kinesis, in which the patient is dynamic, moving easily (discharge of catecholamines) for a while; paradoxically appears akinesia with L-dopa treatment, in inadequate doses for a long time.
Another consequence of akinesia is akathisia, the state in which the patient cannot maintain for a long time the same posture.
– Hypertonicity is the second Parkinsonian symptom and has features of extrapyramidal hypertonia.
Often people experience a “psychic pillow” – lying down with their head raised as if they have a pillow, walking is moving in the block; to return is moving without moving the head.
– Parkinsonian tremor sometimes appears at the onset, but sometimes lacks in akinetic-hypertonic forms, has posture character, appears and disappears at rest during voluntary movements or speech.
Tremor is pseudo gestural, has a rate of 4-6 cycles per second, and is distal. The body does not tremble and is driven by involuntary movements of the legs.
Diagnosis is easy to put on the existence of three syndromes: akinesia, hypertonia of extrapyramidal type, and tremor.
The disease is slowly progressive, vital prognosis is generally good but there may be some complications (respiratory, pulmonary, urinary tract, and skin). Modern therapy with dopamine stretches life expectancy.
