eMedicine Specialties > Neurology > Behavioral Neurology and Dementia

Apraxia and Related Syndromes: Treatment & Medication

Author: Jasvinder Chawla, MBBS, MD, MBA, Associate Professor of Neurology, Director of Neurology Residency Training Program, Director of Clinical Neurophysiology Laboratory, Assistant Director of Neurology Clerkship Program, Department of Neurology, Loyola University Medical Center
Coauthor(s): Daniel H Jacobs, MD, Associate Professor of Neurology, University of Central Florida College of Medicine
Contributor Information and Disclosures

Updated: Jan 14, 2009

Treatment

Medical Care

  • Diagnosis is the most important aspect of apraxia. Consequences include diminished ability of the patient to live independently; patients therefore may require additional rehabilitation or skilled nursing care. Education of the patient's family is obviously a key part of evaluation.
  • Patients with childhood apraxia of speech are at risk for persistent reading and spelling disorder in addition to their spoken communication difficulties. A potential benefit has been shown of an integrated phonological awareness approach to improve speech, phonological awareness, and decoding ability simultaneously.
  • As per Morgan and colleagues, a recent Cochrane database review demonstrates a significant lack of well-controlled treatment studies addressing treatment efficacy for childhood or adolescent apraxia of speech (CAS). Thus, conclusions cannot be drawn about which interventions are most effective for treatment of CAS.17
  • Patients may not request physical or occupational therapy because they may be unaware of their deficits. Such therapy is important, as part of both assessment and treatment of the patient.
  • Medicines are not known to be effective for the treatment of ideomotor apraxia. Levodopa-carbidopa (Sinemet) and dopamine agonist medications (eg, ropinirole [Requip], pramipexole [Mirapex]), typically are not effective for corticobasal ganglionic degeneration, although they are tried frequently. Antispasticity treatments, such as baclofen (Lioresal), tizanidine (Zanaflex), and botulinum toxin (Myobloc), can be tried for patients with a clenched fist due to a useless limb. Cholinesterase inhibitors, such as donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne), and memantine (Namenda) may be used for progressive dementia syndromes, especially Alzheimer disease.

Diet

Patients with apraxia may have difficulty knowing how or what to eat. If a patient is losing weight or nutritional deficiencies are suspected, nutritional supplements or dietary assistance might be provided.

Activity

Patients with certain types of dementia may have a high risk of falling. Patients with corticobasal ganglionic degeneration or progressive supranuclear palsy may have a high fall rate relatively early in the disease, whereas patients with Alzheimer are more likely to fall in the middle to late stages. Patients with a useless upper limb may develop a clenched painful fist that severely limits activity.

More on Apraxia and Related Syndromes

Overview: Apraxia and Related Syndromes
Differential Diagnoses & Workup: Apraxia and Related Syndromes
Treatment & Medication: Apraxia and Related Syndromes
Follow-up: Apraxia and Related Syndromes
References
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References

  1. Heilman KM, Rothi LJG. Clinical neuropsychology. In: Apraxia. 3rd ed. 1993:141-163.

  2. Lezak MD. Neuropsychological Assessment. 3rd ed. NY: Oxford Univ Press; 1995.

  3. Aboitiz F, Carrasco X, Schroter C, et al. The alien hand syndrome: classification of forms reported and discussion of a new condition. Neurol Sci. Nov 2003;24(4):252-7. [Medline].

  4. Cooper RP. Tool use and related errors in ideational apraxia: the quantitative simulation of patient error profiles. Cortex. Apr 2007;43(3):319-37. [Medline].

  5. Gerstner E, Lazar RM, Keller C, Honig LS, Lazar GS, Marshall RS. A case of progressive apraxia of speech in pathologically verified Alzheimer disease. Cogn Behav Neurol. Mar 2007;20(1):15-20. [Medline].

  6. Geschwind N. Disconnexion syndromes in animals and man. I. Brain. Jun 1965;88(2):237-94. [Medline].

  7. Geschwind N. Disconnexion syndromes in animals and man. II. Brain. Sep 1965;88(3):585-644. [Medline].

  8. Gillon GT, Moriarty BC. Childhood apraxia of speech: children at risk for persistent reading and spelling disorder. Semin Speech Lang. Feb 2007;28(1):48-57. [Medline].

  9. Goldenberg G, Hermsdörfer J, Glindemann R, Rorden C, Karnath HO. Pantomime of Tool Use Depends on Integrity of Left Inferior Frontal Cortex. Cereb Cortex. Mar 5 2007;[Medline].

  10. Heilman KM, Rothi LJ, Valenstein E. Two forms of ideomotor apraxia. Neurology. Apr 1982;32(4):342-6. [Medline].

  11. Liepmann H. Apraxia. Ergbn Ges Med. 1920;1:516-543.

  12. Mack L, Verfaellie M, et al. Ideomotor apraxia: error pattern analysis. Aphasiology. 1988;2:381-387.

  13. Peach RK. Acquired apraxia of speech: features, accounts, and treatment. Top Stroke Rehabil. Winter 2004;11(1):49-58. [Medline].

  14. Watson RT, Fleet WS, Gonzalez-Rothi L, Heilman KM. Apraxia and the supplementary motor area. Arch Neurol. Aug 1986;43(8):787-92. [Medline].

  15. Watson RT, Heilman KM. Callosal apraxia. Brain. Jun 1983;106 (Pt 2):391-403. [Medline].

  16. Wheaton LA, Hallett M. Ideomotor apraxia: A review. J Neurol Sci. Sep 15 2007;260(1-2):1-10. [Medline].

  17. Morgan AT, Vogel AP. Intervention for childhood apraxia of speech. Cochrane Database Syst Rev. Jul 16 2008;CD006278. [Medline].

  18. Goldenberg G. Apraxia and the parietal lobes. Neuropsychologia. Jul 25 2008;[Medline].

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Further Reading

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Keywords

apraxia and related syndromes, behavioral neurology syndrome, apraxia of speech, buccofacial apraxia, callosal apraxia, conceptual apraxia, dyspraxia, ideomotor apraxia, ideational apraxia, limb apraxia, limb kinetic apraxia, magnetic apraxia, motor agnosia, oral apraxia, parectropia, disorder of voluntary movement, voluntary movement disorder, alien hand syndrome

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Contributor Information and Disclosures

Author

Jasvinder Chawla, MBBS, MD, MBA, Associate Professor of Neurology, Director of Neurology Residency Training Program, Director of Clinical Neurophysiology Laboratory, Assistant Director of Neurology Clerkship Program, Department of Neurology, Loyola University Medical Center
Jasvinder Chawla, MBBS, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Daniel H Jacobs, MD, Associate Professor of Neurology, University of Central Florida College of Medicine
Daniel H Jacobs, MD is a member of the following medical societies: American Academy of Neurology, American Society of Neurorehabilitation, and Society for Neuroscience
Disclosure: Teva Pharmaceutical Grant/research funds Consulting; Biogen Idex Grant/research funds Independent contractor; Serono EMD Royalty Speaking and teaching; Pfizer Royalty Speaking and teaching; Berlex Royalty Speaking and teaching

Medical Editor

Stephen T Gancher, MD, Adjunct Associate Professor, Department of Neurology, Oregon Health Sciences University
Stephen T Gancher, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and Movement Disorders Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard J Caselli, MD, Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale
Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Howard A Crystal, MD, Professor, Departments of Neurology and Pathology, State University of New York Downstate; Consulting Staff, Department of Neurology, University Hospital and Kings County Hospital Center
Howard A Crystal, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association
Disclosure: Pfizer Honoraria Speaking and teaching; Myriad Honoraria Consulting

 
 
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