Micrographia (handwriting)

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Example of writing by a patient with Parkinson's disease that may show micrographia in addition to other abnormal characteristics. Published by Jean-Martin Charcot in 1879. Writing by a Parkinson's disease patient.png
Example of writing by a patient with Parkinson's disease that may show micrographia in addition to other abnormal characteristics. Published by Jean-Martin Charcot in 1879.

Micrographia, an acquired disorder, features abnormally small, cramped handwriting. [1] It is commonly associated with neurodegenerative disorders of the basal ganglia, such as in Parkinson's disease, but it has also been ascribed to subcortical focal lesions. [2] O'Sullivan and Schmitz describe it as an abnormally small handwriting that is difficult to read, as seen in the photo to the right. [3] Micrographia is also seen in patients with Wilson's disease, Obsessive Compulsive Disorder, Metamorphopsia, or with isolated focal lesions of the midbrain or basal ganglia. [1] [4]

Contents

Parkinson's disease

A common feature of Parkinson's disease (PD) is difficulty in routine activities due to lack of motor control. [5] Patients have trouble maintaining the scale of movements and have reduced amplitude of movement (hypokinesia). [6] In PD, the trouble in scaling and controlling the amplitude of movement affects complex, sequential movements, [5] so that micrographia is a common symptom. Another cause of micrographia is lack of physical dexterity.

James Parkinson may have been aware of micrographia in patients with shaking palsy (later renamed Parkinson's disease), when he described "the hand failing to answer with exactness to the dictates of the will". [2]

Occurrence in Parkinson's

Micrographia is often seen patients with Parkinson’s disease, although the precise prevalence is uncertain, with reported figures of between 9% and 75%. [7] Often appearing before other symptoms, it can help in diagnosis. [8]

Pharmacological management

Micrographia may worsen when a PD patient is under-medicated and when the medication is wearing off. [9]

Related Research Articles

<span class="mw-page-title-main">Putamen</span> Round structure at the base of the forebrain

The putamen is a round structure located at the base of the forebrain (telencephalon). The putamen and caudate nucleus together form the dorsal striatum. It is also one of the structures that compose the basal nuclei. Through various pathways, the putamen is connected to the substantia nigra, the globus pallidus, the claustrum, and the thalamus, in addition to many regions of the cerebral cortex. A primary function of the putamen is to regulate movements at various stages and influence various types of learning. It employs GABA, acetylcholine, and enkephalin to perform its functions. The putamen also plays a role in degenerative neurological disorders, such as Parkinson's disease.

<span class="mw-page-title-main">Parkinsonism</span> Medical condition

Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia, rigidity, and postural instability. These are the four motor symptoms found in Parkinson's disease (PD) – after which it is named – dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and many other conditions. This set of symptoms occurs in a wide range of conditions and may have many causes, including neurodegenerative conditions, drugs, toxins, metabolic diseases, and neurological conditions other than PD.

<span class="mw-page-title-main">Caudate nucleus</span> Structure of the striatum in the basal ganglia of the brain

The caudate nucleus is one of the structures that make up the corpus striatum, which is a component of the basal ganglia in the human brain. While the caudate nucleus has long been associated with motor processes due to its role in Parkinson's disease, it plays important roles in various other nonmotor functions as well, including procedural learning, associative learning and inhibitory control of action, among other functions. The caudate is also one of the brain structures which compose the reward system and functions as part of the cortico–basal ganglia–thalamic loop.

<span class="mw-page-title-main">Dystonia</span> Neurological movement disorder

Dystonia is a neurological hyperkinetic movement disorder in which sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures. The movements may resemble a tremor. Dystonia is often intensified or exacerbated by physical activity, and symptoms may progress into adjacent muscles.

<span class="mw-page-title-main">Athetosis</span> Medical condition

Athetosis is a symptom characterized by slow, involuntary, convoluted, writhing movements of the fingers, hands, toes, and feet and in some cases, arms, legs, neck and tongue. Movements typical of athetosis are sometimes called athetoid movements. Lesions to the brain are most often the direct cause of the symptoms, particularly to the corpus striatum. This symptom does not occur alone and is often accompanied by the symptoms of cerebral palsy, as it is often a result of this physical disability. Treatments for athetosis are not very effective, and in most cases are simply aimed at managing the uncontrollable movement, rather than the cause itself.

Dysarthria is a speech sound disorder resulting from neurological injury of the motor component of the motor–speech system and is characterized by poor articulation of phonemes. In other words, it is a condition in which problems effectively occur with the muscles that help produce speech, often making it very difficult to pronounce words. It is unrelated to problems with understanding language, although a person can have both. Any of the speech subsystems can be affected, leading to impairments in intelligibility, audibility, naturalness, and efficiency of vocal communication. Dysarthria that has progressed to a total loss of speech is referred to as anarthria. The term dysarthria is from Neo-Latin, dys- "dysfunctional, impaired" and arthr- "joint, vocal articulation".

In neurology, abulia, or aboulia, refers to a lack of will or initiative and can be seen as a disorder of diminished motivation (DDM). Abulia falls in the middle of the spectrum of diminished motivation, with apathy being less extreme and akinetic mutism being more extreme than abulia. The condition was originally considered to be a disorder of the will, and aboulic individuals are unable to act or make decisions independently; and their condition may range in severity from subtle to overwhelming. In the case of akinetic mutism, many patients describe that as soon as they "will" or attempt a movement, a "counter-will" or "resistance" rises up to meet them.

<span class="mw-page-title-main">Hyperkinesia</span> Excessive movements due to basal ganglia dysfunction

Hyperkinesia refers to an increase in muscular activity that can result in excessive abnormal movements, excessive normal movements, or a combination of both. Hyperkinesia is a state of excessive restlessness which is featured in a large variety of disorders that affect the ability to control motor movement, such as Huntington's disease. It is the opposite of hypokinesia, which refers to decreased bodily movement, as commonly manifested in Parkinson's disease.

Hemiballismus or hemiballism is a basal ganglia syndrome resulting from damage to the subthalamic nucleus in the basal ganglia. Hemiballismus is a rare hyperkinetic movement disorder, that is characterized by violent involuntary limb movements, on one side of the body, and can cause significant disability. Ballismus affects both sides of the body and is much rarer. Symptoms can decrease during sleep.

Hypokinesia is one of the classifications of movement disorders, and refers to decreased bodily movement. Hypokinesia is characterized by a partial or complete loss of muscle movement due to a disruption in the basal ganglia. Hypokinesia is a symptom of Parkinson's disease shown as muscle rigidity and an inability to produce movement. It is also associated with mental health disorders and prolonged inactivity due to illness, amongst other diseases.

<span class="mw-page-title-main">Spasmodic torticollis</span> Medical condition

Spasmodic torticollis is an extremely painful chronic neurological movement disorder causing the neck to involuntarily turn to the left, right, upwards, and/or downwards. The condition is also referred to as "cervical dystonia". Both agonist and antagonist muscles contract simultaneously during dystonic movement. Causes of the disorder are predominantly idiopathic. A small number of patients develop the disorder as a result of another disorder or disease. Most patients first experience symptoms midlife. The most common treatment for spasmodic torticollis is the use of botulinum toxin type A.

Thalamocortical dysrhythmia (TCD) is a theoretical framework in which neuroscientists try to explain the positive and negative symptoms induced by neuropsychiatric disorders like Parkinson's Disease, neurogenic pain, tinnitus, visual snow syndrome, schizophrenia, obsessive–compulsive disorder, depressive disorder and epilepsy. In TCD, normal thalamocortical resonance is disrupted by changes in the behaviour of neurons in the thalamus.
TCD can be treated with neurosurgical methods like the central lateral thalamotomy, which due to its invasiveness is only used on patients that have proven resistant to conventional therapies.

In the management of Parkinson's disease, due to the chronic nature of Parkinson's disease (PD), a broad-based program is needed that includes patient and family education, support-group services, general wellness maintenance, exercise, and nutrition. At present, no cure for the disease is known, but medications or surgery can provide relief from the symptoms.

Premovement neuronal activity in neurophysiological literature refers to neuronal modulations that alter the rate at which neurons fire before a subject produces movement. Through experimentation with multiple animals, predominantly monkeys, it has been shown that several regions of the brain are particularly active and involved in initiation and preparation of movement. Two specific membrane potentials, the bereitschaftspotential, or the BP, and contingent negative variation, or the CNV, play a pivotal role in premovement neuronal activity. Both have been shown to be directly involved in planning and initiating movement. Multiple factors are involved with premovement neuronal activity including motor preparation, inhibition of motor response, programming of the target of movement, closed-looped and open-looped tasks, instructed delay periods, short-lead and long-lead changes, and mirror motor neurons.

Dopamine-responsive dystonia (DRD) also known as Segawa syndrome (SS), is a genetic movement disorder which usually manifests itself during early childhood at around ages 5–8 years.

<span class="mw-page-title-main">Parkinson's disease</span> Long-term degenerative neurological disorder

Parkinson's disease (PD), or simply Parkinson's, is a chronic degenerative disorder of the central nervous system that affects both the motor system and non-motor systems. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms become more common. Early symptoms are tremor, rigidity, slowness of movement, and difficulty with walking. Problems may also arise with cognition, behaviour, sleep, and sensory systems. Parkinson's disease dementia becomes common in advanced stages of the disease.

<span class="mw-page-title-main">Basal ganglia disease</span> Group of physical problems resulting from basal ganglia dysfunction

Basal ganglia disease is a group of physical problems that occur when the group of nuclei in the brain known as the basal ganglia fail to properly suppress unwanted movements or to properly prime upper motor neuron circuits to initiate motor function. Research indicates that increased output of the basal ganglia inhibits thalamocortical projection neurons. Proper activation or deactivation of these neurons is an integral component for proper movement. If something causes too much basal ganglia output, then the ventral anterior (VA) and ventral lateral (VL) thalamocortical projection neurons become too inhibited, and one cannot initiate voluntary movement. These disorders are known as hypokinetic disorders. However, a disorder leading to abnormally low output of the basal ganglia leads to reduced inhibition, and thus excitation, of the thalamocortical projection neurons which synapse onto the cortex. This situation leads to an inability to suppress unwanted movements. These disorders are known as hyperkinetic disorders.

Signs and symptoms of Parkinson's disease are varied. Parkinson's disease affects movement, producing motor symptoms. Non-motor symptoms, which include dysautonomia, cognitive and neurobehavioral problems, and sensory and sleep difficulties, are also common. When other diseases mimic Parkinson's disease, they are categorized as parkinsonism.

<span class="mw-page-title-main">Parkinsonian gait</span> Type of gait

Parkinsonian gait is the type of gait exhibited by patients with Parkinson's disease (PD). It is often described by people with Parkinson's as feeling like being stuck in place, when initiating a step or turning, and can increase the risk of falling. This disorder is caused by a deficiency of dopamine in the basal ganglia circuit leading to motor deficits. Gait is one of the most affected motor characteristics of this disorder although symptoms of Parkinson's disease are varied.

The cause of obsessive–compulsive disorder is understood mainly through identifying biological risk factors that lead to obsessive–compulsive disorder (OCD) symptomology. The leading hypotheses propose the involvement of the orbitofrontal cortex, basal ganglia, and/or the limbic system, with discoveries being made in the fields of neuroanatomy, neurochemistry, neuroimmunology, neurogenetics, and neuroethology.

References

  1. 1 2 A.J. Larner (12 November 2010). A Dictionary of Neurological Signs. Springer. p. 221. ISBN   978-1-4419-7095-4.
  2. 1 2 Encyclopedia of Movement Disorders, Three-Volume Set. Academic Press. 26 February 2010. ISBN   978-0-12-374105-9.
  3. O'Sullivan & Schmitz 2007 , p. 1339
  4. Kinematic analysis of handwriting movements in patients with obsessive-compulsive disorder
  5. 1 2 O'Sullivan & Schmitz 2007 , p. 858
  6. O'Sullivan & Schmitz 2007 , p. 857
  7. Ziliotto A, Cersosimo MG, Micheli FE (2015). "Handwriting Rehabilitation in Parkinson Disease: A Pilot Study". Ann Rehabil Med. 39: 586–91. doi:10.5535/arm.2015.39.4.586. PMC   4564706 . PMID   26361595.
  8. Robert B. Taylor (2 March 2013). Diagnostic Principles and Applications: Avoiding Medical Errors, Passing Board Exams, and Providing Informed Patient Care. Springer. pp. 57–. ISBN   978-1-4614-1111-6.
  9. Paul Tuite; Hubert Fernandez; Cathi Thomas; Laura Ruekert (23 March 2009). Parkinson's Disease: A Guide to Patient Care. Springer Publishing Company. p. 28. ISBN   978-0-8261-2269-8.

Bibliography