A prospective study of acute movement disorders in children

Abstract

ABBREVIATIONS APSAnti-phospholipid syndrome NMDAR N-methyl-D-aspartate receptor PMD Psychogenic movement disorder SLE Systemic lupus erythematosus AIM The purpose of this study was to report a prospective cohort of children with acute-onset movement disorders.METHOD We report on 52 individuals (31 females, 21 males; mean age 6y 5mo, range 2mo-15y) with acute-onset movement disorders managed at a busy tertiary paediatric referral hospital over a 40-month period. RESULTSIn descending order of frequency, the movement disorders reported were chorea, dystonia, tremor, myoclonus, and parkinsonism. It was possible to divide the participants into three groups: (1) those with inflammatory or autoimmune disorders (n=22), (2) those with non-inflammatory disorders (n=18), and (3) those with psychogenic disorders (n=12). The inflammatory or autoimmune aetiologies included N-methyl-D-aspartate receptor encephalitis (n=5), opsoclonusmyoclonus syndrome (n=4), Sydenham chorea (n=3), systemic lupus erythematosus (n=3), acute necrotizing encephalopathy (n=3), and other types of encephalitis (n=4). Other important noninflammatory movement disorder aetiologies included drug-induced movement disorder (n=6), post-pump chorea (n=5), metabolic (n=3) and vascular (n=2) disease. The participants with psychogenic movement disorders (n=12) were all over 10 years of age and were more likely to be female. Tremor and myoclonus were significantly over-represented in the psychogenic movement disorder subgroup. The outcomes of the total cohort were variable, and included full recovery, severe morbidity, and death.

Deep Brain Stimulation for Status Dystonicus: A Case Series and Review of the Literature

“…Frequently reported sequelae of SD include airway compromise, rhabdomyolysis, hyperpyrexia, renal failure, pain, and dehydration. To date, there have been fewer than 70 cases of SD reported in the literature [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29]. These cases are characterized by widely varying etiologies, clinical courses, treatments, and outcomes.…”

Partial Manifestation of Anti‐NMDA‐R Encephalitis with Predominant Movement Disorder

“…Acute/subacute onset movement disorders in children are often related to autoimmune or inflammatory disorders of basal ganglia . The prototype of these basal ganglia autoimmune disorders is Sydenham's chorea characterized primarily by chorea though hypotonia, speech difficulty, and emotional lability are common.…”

“…Another recently described entity is basal ganglia encephalitis associated with dopamine 2 receptor antibodies . Recently, autoantibodies have evoked a lot of interest in acute onset movement disorders with or without other neurological symptoms …”

Identifying Common Movement Disorders in the Emergency Department

“…[3] A retrospective study of 92 children that presented to a tertiary center in North India, found myoclonus was the most common acute movement disorder. [4] Most movement disorders in childhood, however are chronic and should not present as neurological emergencies.…”

“…[3] Patients usually develop a tremor abruptly and it tends to involve the dominant limb. Both history and exam may have inconsistencies that will lead the practitioner towards the correct diagnosis.…”