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Pathophysiology of akinetic movement disorders: a paradigm for studies in fibromyalgia (FM)?

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Patients with fibromyalgia sometimes have sign of a movement
disorder in addition to sensory disturbances sometimes similar
as those found in akinetic syndromes. Akinesia is due to
disturbances in the functions of the
cortico-thalamo-nigro-striatal system and associated areas.

The reason of this dysfunction in Parkinson's disease is a
decreased nigral dopaminergic efferent innervation due to a
neuronal degeneration in the pars compacta of the substantia
nigra. Changes in other neurotransmitters, like GABA or
serotonin, and in receptors and second messengers also occur,
with additional modulation due to therapy. The aetiology of
nigral malfunction is in only rarely known. Drugs and
mutations of some genes are examples which give much insight
in the pathogenesis of movement disorders in general. In other
akinetic disorders, like multisystem atrophy, corticobasal
ganglionic degeneration, and progressive supranuclear palsy,
more complex patterns of degeneration have been found. This
pathological anatomical disturbances have typical clinical
effects which can be studied physiologically and with imaging
in vivo. Since basal ganglia play also a role in pain, a
comparative study of their involvement in movement disorders
and nociception seems to be fruitful, especially in devising
new therapeutic strategies.

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