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Chapter 12 of the book "Clinical Pediatric Neurology," Third Edition, is presented. The chapter discusses the description, evaluation and ancillary testing of several types of movement disorders in children, and the functional anatomy of the extrapyramidal system. Children who have chorea and family history of the disease may differentiate Huntington's and benign familial chorea from Sydenham chorea. It says that dopa-responsive dystonia and Wilson's disease should be ruled out in children with chronic progressive dystonia.

The aetiology, basal ganglia circuitry and therapy of Parkinson's disease (PD). PD is shown to be due to a degeneration of the nigrostriatal dopaminergic tract and there is a detailed neurophysiological analysis of how this affects the balance of activity in the basal ganglia to produce Parkinsonism. Therapies based on increasing the effectiveness of the remaining dopamine (e.g. MAO inhibitors), replenishing it with levodopa (along with various adjuncts like extracerebral dopa decarboxylase and COMT inhibitors) and the use of DA (especially D2) agonists are all considered in detail. The rationale and potential value of alternative treatments based on the known involvement in the basal ganglia of ACh, endogenous opioids and adenosine are all considered as are transplants and cell replacement. The possible causes of PD with particular emphasis on free radical production and neuronal destruction are reviewed. There is a short section on the cause and possible therapy of Huntington's Chorea. [ABSTRACT FROM PUBLISHER]

A definition of the term "extrapyramidal side effects" (EPS) is presented. It refers to adverse effects of D2-receptor antagonists acting on the nigrostriatal system. Such side effects include parkinsonism, akathisia and dystonia. Dose adjustment is often sufficient in managing EPS, though use of other medications may sometimes be necessary.