BRADYKINESIA: SYMPTOMS, CAUSES AND TREATMENT - MEDICINE - 2024

The bradykinesia is seen as slowing of complex voluntary body movements and speech. It is very common in the early stages of Parkinson's disease and can also be found in many other diseases, especially neurological in origin.

The pathophysiology of bradykinesia is not completely clear. Lesions in the basal ganglia of the brain have been detected in patients with this condition, which could explain some of its characteristics. Likewise, alterations in the production and uptake of dopamine have been found in patients with bradykinesia.

Some authors reserve the use of the term bradykinesia only for the slow movements typical of Parkinson's disease. It tends to be confused with other similar concepts such as akinesia or hypokinesia, which refer to little or no spontaneous movements or movements with little amplitude, respectively.

Symptoms

Bradykinesia is a symptom, not a disease or syndrome. This clarification is important because the term bradykinesia should not be used as a diagnosis.

Patients with different diseases can suffer from it; however, it does have its own characteristics that allow us to suspect the presence of some pathology.

The onset of bradykinesia is usually gradual and is commonly found in many different ways, including:

- Difficulty performing repetitive movements.

- Walk with short and unsafe steps. Arm movement during walking is also limited.

- Problems performing daily activities such as combing hair, brushing teeth, shaving, using silverware or getting dressed.

- Scarce or absent facial expressions. This condition is known as hypomimia.

- Speech becomes monotonous and smooth. There are no normal ups and downs in any conversation.

- Doubts or blocks to start a movement. Some patients report that they "freeze" just when they are going to perform an action. Their brains tell them to move but the body doesn't respond. It is the most frustrating manifestation of patients with Parkinson's or similar neurodegenerative diseases.

Causes

The most important causes of bradykinesia are related to damage to the central nervous system, with degenerative diseases being the most associated with this symptom.

Parkinson's disease

Bradykinesia is a common symptom of this condition. It is even part of the diagnostic criteria for it. According to researchers in the area, bradykinesia is one of the cardinal symptoms of this disease, along with tremors and joint stiffness.

It is known that in Parkinson's disease there is damage to the basal ganglia and the cerebral cortex. Among other functions, the basal ganglia are responsible for planning movements to achieve a specific goal, and the cortex is responsible for sending commands to the muscles to carry them out. When these fail, there is bradykinesia.

Many additional factors contribute to the presence of bradykinesia in Parkinson's patients. Muscle weakness, tremors, and stiffness worsen the situation, and bradypsychia or slowed thinking occurs in late stages of the disease, which ends up aggravating the condition.

Other neurodegenerative disorders

Bradykinesia may occur in the advanced stages of Alzheimer's. The same is true for other cortical and subcortical diseases, such as dementias, Huntington's disease, progressive supranuclear palsy, and primary aphasia.

Progressive neuropathies and demyelinating diseases such as amyotrophic lateral sclerosis, multiple sclerosis, neuromyelitis optica, and transverse myelitis have an obvious consequence of bradykinesia. As the neuromuscular junction is affected, movements are slowed down and hampered.

Mental diseases

From a psychological point of view, depression, drowsiness, stress or anxiety can cause bradykinesia without the existence of an organic disorder.

Some psychiatric illnesses, such as schizophrenia and obsessive-compulsive disorder, cause slowing of movements, sometimes voluntarily.

Systemic diseases

Diabetes and arterial hypertension, whose chronic complications produce peripheral and central neuropathies, can cause gradual loss of reaction speed and the efficiency of voluntary movements.

Treatment

Like any other sign or symptom associated with a syndrome, when the cause is treated it can improve and even disappear. Some of the most commonly used therapeutic approaches are mentioned below:

Pharmacotherapy

Unfortunately, most diseases that cause bradykinesia cannot be cured. Despite this, they can be controlled with the constant administration of certain medications such as the following:

Carbidopa / levodopa

It is an orally administered drug that helps control the symptoms of Parkinson's disease. Levodopa is transformed into dopamine by the action of neurons in the central nervous system. Dopamine is one of the most important neurotransmitters in the body, whose levels decrease in Parkinson's.

Carbidopa has a secondary role and its task is to reduce the amount of levodopa required by neurons to produce dopamine and, therefore, also reduces the adverse effects of it.

When dopamine receptors are activated centrally, Parkinson's symptoms, including bradykinesia, improve.

Dopamine agonists

Also known as dopaminergics, they are drugs that mimic dopamine activity centrally or help make its effects more noticeable.

There are several types, such as dopamine precursors, receptor agonists, reuptake inhibitors, releasing agents, metabolism inhibitors, and enhancers.

MAO inhibitors

Any medication that decreases the action of the enzyme mono-amino oxidase is useful for treating bradykinesia associated with Parkinson's.

Mono-amino oxidase is responsible for degrading certain neurotransmitters such as serotonin, so that when it is inhibited, higher serum levels are maintained and their activity is prolonged.

Psychotherapy

Treating depression, anxiety or stress through psychological therapies can improve psychogenic bradykinesia. Strategies must be established to improve the quality of life, nutrition, and sleep schedules to achieve adequate cognitive restructuring of the patient. Pharmacological treatment is reserved for psychiatric illnesses.

Physiotherapy

Physical therapy helps in controlling tremors, cramps, and joint stiffness. In addition, frequent exercise improves the patient's quality of life and mental state.

The use of support devices such as walkers or canes may be suggested to stabilize the gait and ensure that the person is not prostrated.

Surgery

Deep brain stimulation, a delicate neurosurgical procedure, is reserved exclusively for those patients who do not respond adequately to drug treatment or lifestyle changes.

This surgery is done to implant electrodes at specific locations in the brain. Upon receiving an electric shock, these electrodes stimulate the areas where they were attached and reduce shaking and slowing. They are not curative, but they do offer significant improvement in people with Parkinson's.

References

1. Downward, Emily (2017). Bradykinesia (Slowed Movement). Recovered from: parkinsonsdisease.net
2. Wells, Diana (2017). What is Bradykinesia ?. Recovered from: healthline.com
3. Castillero Mimenza, Oscar (sf). Bradykinesia: what it is, and disorders associated with this symptom. Recovered from: psicologiaymente.net
4. Ada, Louise and Canning, Colleen (2009). Common motor impairments and their impact on activity. Pocketbook of Neurological Physiotherapy, Chapter 7, 73-93.
5. Erro, Roberto and Stamelou, Maria (2017). The Motor Syndrome of Parkinson's Disease. International Review of Neurobiology, Volume 132, Chapter 2, 25-32.
6. Deuschl, Günther; Paschen, Steffen and Witt, Karsten (2013). Clinical outcome of deep brain stimulation for Parkinson's disease. Handbook of Clinical Neurology, volume 116, chapter 10, 107-128.
7. Gasser, Thomas; Whichmann, Thomas and DeLong, Mahlon (2015). Parkinson Disease and Other Synucleinopathies. Neurobiology of Brain Disorders, Chapter 19, 281-302.