Movement disorder emergencies

Abstract

Movement disorders may present acutely, and failure to recognize and exclude important differential diagnoses can result in significant morbidity or mortality. Unfortunately, much of the literature pertaining to this topic is scattered and not easily accessible. This review aims to address this deficit. Movement disorder emergencies are discussed according to their most likely mode of presentation. Diagnostic considerations and early management principles are reviewed, along with appropriate pathophysiology where relevant.

Movement disorders emergencies: a review

“…acute parkinsonism Acute severe de novo parkinsonism is an uncommon form of parkinsonism that occurs over hours or days. In general, the most frequent cause is exposure to dopamine-blocking agents, such as neuroleptics and anti-emetics, however other rare causes have been described, including hypoxic-ischemic encephalopathy, intoxications (organophosphate pesticide, carbon monoxide and drugs used for cancer therapy, as cytosine arabinoside, cyclophosphamide and amphotericin) and infections (viruses-similar to Von Economo's encephalitis lethargic, Japanese B encephalitis and neurocysticercosis) 1,8,9 .…”

“…Oculogyric crisis usually improves significantly with clonazepam 2 mg PO or diphenhydramine 25 or 50 mg IM. "Prophylaxis" with anticholinergics or amantadine is controversial and should not be routinely used 1,8,12,[15][16][17][18] .…”

“…Classically, the causative agents include the "classic" neuroleptics, however after the widespread use of newer agents, the "atypical" agents have also been implicated 21 . Additionally, NMS has been described during treatment with other dopamineblocking drugs or after abrupt withdrawal of dopaminergic agents 1,8,9,11,22,23 . Typically, symptoms onset occurs during the first two weeks of treatment initiation or change of dose.…”

“…serotonergic syndrome Serotonin syndrome (SS) is a potentially fatal disorder that results most often from the combined use of two or more agents that enhance serotonin activity or concentration in the central nervous system 1,9,11,12,28 . This under recognized syndrome is usually manifested by acute development of agitation, mental status changes, myoclonus, incoordination, postural instability, hyperreflexia, rigidity and dysautonomic features (diaphoresis, fever, diarrhea, tachycardia and hemodynamic instability) after a change in serotonergic drug regimen 29 .…”

“…Patients with MD usually have disabling symptoms; however, most cases are followed and treated in ambulatory care settings. A MD emergency is defined as a neurological disorder evolving acutely or subacutely, in which the clinical presentation is dominated by MD and in which failure to accurately diagnose and manage the patient may result in significant morbidity or even mortality 1 . In this review, we used these criteria to divide MD emergencies into six main topics.…”