Childhood‐Onset Movement Disorders: A Clinical Series of 606 Cases

Bäumer, Tobias; Sajin, Valeria; Münchau, Alexander

doi:10.1002/mdc3.12399

Cited by 20 publications

(19 citation statements)

References 10 publications

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“…Baumer et al (2017) have also excluded CP from their study on childhood MD in Germany. 21 Our results therefore would be applicable to non-CP MDs only.…”

Section: Resultsmentioning

confidence: 97%

Movement Disorders in Children: An Observational Study in a Tertiary Care Center in North India

Pandey

Kumar

Malhotra

et al. 2019

Journal of Pediatric Neurology

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Movement disorders (MDs) are disorders of pathological movements that cannot be fully initiated, modulated, or interrupted voluntarily. Spectrum and etiology of MDs are likely to vary with geographical location, but there are few studies on pediatric MDs from India, and severity of the disease is not well documented. Response to treatment of MDs is often unpredictable. Objective of the study was to describe the relative prevalence, types, severity, etiology, and response to treatment of pediatric MDs as seen at a public teaching hospital in northern India. Over a period of 1 year, consecutive children with MDs seen in outpatient department (OPD) or wards were enrolled, after excluding cerebral palsy and musculoskeletal disorders. Detailed history, examination, treatment, and outcome were recorded. Severity was rated according to Battini's scale at initial contact and each follow-up. Neuroimaging and relevant investigations were done for etiology. Serial 2-minute video recordings were obtained. Out of 93 patients enrolled, the most common MDs were dystonia (24.7%), tremors (22.4%), ataxia (19.6%), and chorea (12.9%). Tics, hemiballismus, and myoclonus were also seen and 4% could not be classified. Mixed MDs were seen in 9.7%. Etiologies of MDs were infectious (acute encephalitis syndrome, tuberculous meningitis, subacute sclerosing panencephalitis, and rheumatic chorea) or nutritional (infantile tremor syndrome) in 46%. Genetic neurodegenerations accounted for a significant proportion (15.1%). Improvement occurred in majority (63.4%) of patients. Etiology of MDs was largely specific to this part of the world, related to infectious and nutrition causes. In the absence of complex genetic investigations, many cases were left with unknown etiology.

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“…Baumer et al (2017) have also excluded CP from their study on childhood MD in Germany. 21 Our results therefore would be applicable to non-CP MDs only.…”

Section: Resultsmentioning

confidence: 97%

Movement Disorders in Children: An Observational Study in a Tertiary Care Center in North India

Pandey

Kumar

Malhotra

et al. 2019

Journal of Pediatric Neurology

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“…The present sample by necessity was not epidemiologically representative; for instance, any study like ours will over-represent parents who notice tics and are able to participate. The typical delay from onset of tics to diagnosis (estimated retrospectively) has been reported as 10 years 35 , highlighting the difficulty in studying the PTD population from clinical samples alone.…”

Section: Limitationsmentioning

confidence: 99%

Transient tics aren't: Outcome of recent-onset tic disorder at one year

Kim¹,

Greene²,

Bihun³

et al. 2018

Preprint

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Motor and vocal tics are common in childhood. The received wisdom among clinicians is that for most children the tics are temporary, disappearing within a few months. However, that common clinical teaching is based largely on biased and incomplete data. The present study was designed to prospectively assess outcome of children with what the current nomenclature calls Provisional Tic Disorder. We identified 43 children with recent onset tics (mean 3.3 months since tic onset) and re-examined 39 of them on the 12-month anniversary of their first tic. Tic symptoms improved on a group level at the 12-month follow-up, and only two children had more than minimal impairment due to tics. Remarkably, however, tics were present in all children at follow-up, although in several cases tics were apparent only when the child was observed remotely by video. Our results suggest that remission of Provisional Tic Disorder is the exception rather than the rule. We also identified several clinical features present at the first examination that predict one-year outcome; these include baseline tic severity, subsyndromal autism spectrum symptoms, and the presence of an anxiety disorder.

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“…Recognition of common YMDs, such as tics and stereotypies, is usually straightforward for most clinicians. However, diagnosis of less common and more complex YMDs, such as disorders presenting primarily with myoclonus or dystonia, is often difficult, both for pediatric and adult neurologists [ 1 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…For instance, chorea is a normal feature in healthy infants and toddlers, and (subtle) signs of overflow dystonia and ataxia are found in healthy children up till the age of 12 years or even older [ 10 , 11 ]. Finally, YMDs can be caused by a broad spectrum of both acquired and genetic disorders, including infections, auto-antibody and auto-immune disorders, as well as rare metabolic disorders and other inherited defects [ 7 , 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…The complexity of the diagnosis and management of YMDs is becoming increasing clear, which has resulted in a growing number of specialized pediatric neurologists. Despite this development, the diagnostic process in complex YMDs often remains challenging, a burden for patients and their families, and costly for our health care system as patients often remain undiagnosed for many years [ 1 , 6 , 7 , 14 , 15 ]. This has been reflected in a recent study in a tertiary referral center that showed a mean delay of diagnosis of 11.1 ± 12,5 years in a cohort of 260 patients with non-tic YMDs [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Crossing barriers: a multidisciplinary approach to children and adults with young-onset movement disorders

et al. 2018

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BackgroundDiagnosis of less common young-onset movement disorders is often challenging, requiring a broad spectrum of skills of clinicians regarding phenotyping, normal and abnormal development and the wide range of possible acquired and genetic etiologies. This complexity often leads to considerable diagnostic delays, paralleled by uncertainty for patients and their families. Therefore, we hypothesized that these patients might benefit from a multidisciplinary approach. We report on the first 100 young-onset movement disorders patients who visited our multidisciplinary outpatient clinic.MethodsClinical data were obtained from the medical records of patients with disease-onset before age 18 years. We investigated whether the multidisciplinary team, consisting of a movement disorder specialist, pediatric neurologist, pediatrician for inborn errors of metabolism and clinical geneticist, revised the movement disorder classification, etiological diagnosis, and/or treatment.ResultsThe 100 referred patients (56 males) had a mean age of 12.5 ± 6.3 years and mean disease duration of 9.2 ± 6.3 years. Movement disorder classification was revised in 58/100 patients. Particularly dystonia and myoclonus were recognized frequently and supported by neurophysiological testing in 24/29 patients. Etiological diagnoses were made in 24/71 (34%) formerly undiagnosed patients, predominantly in the genetic domain. Treatment strategy was adjusted in 60 patients, of whom 43 (72%) reported a subjective positive effect.ConclusionsThis exploratory study demonstrates that a dedicated tertiary multidisciplinary approach to complex young-onset movement disorders may facilitate phenotyping and improve recognition of rare disorders, with a high diagnostic yield and minimal diagnostic delay. Future studies are needed to investigate the cost-benefit ratio of a multidisciplinary approach in comparison to regular subspecialty care.

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Childhood‐Onset Movement Disorders: A Clinical Series of 606 Cases

Cited by 20 publications

References 10 publications

Movement Disorders in Children: An Observational Study in a Tertiary Care Center in North India

Movement Disorders in Children: An Observational Study in a Tertiary Care Center in North India

Transient tics aren't: Outcome of recent-onset tic disorder at one year

Crossing barriers: a multidisciplinary approach to children and adults with young-onset movement disorders

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