Movement disorder emergencies

Abstract

Movement disorder emergencies include any movement disorder which evolves over hours to days, in which failure to appropriately diagnose and manage can result in patient morbidity or mortality. It is crucial that doctors recognize these emergencies with accuracy and speed by obtaining the proper history and by being familiar with the phenomenology of frequently encountered movements. These disorders will be discussed based on the most common associated involuntary movement, either parkinsonism, dystonia, chorea, tics or myoclonus, and, when available, review the workup and treatment options based on the current literature.

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 .…”

“…This situation typically occurs due to additional medical conditions, as urinary or respiratory infections and metabolic disturbances (hypothyroidism and so on), or even due to a concomitant neurological disease, for example, subdural hematomas, compressive spinal cord lesion or brain tumor 8,10 . Treatment of both de novo and worsening of PD should be focused on resolution of the etiologic process and occasionally symptomatic treatment of parkinsonism using dopaminergic agents 11 .…”

“…Frequently, the introduction of a second generation antipsychotic,as clozapine or quetiapine, is necessary. Other options include risperidone or olanzapine, with a significant risk of motor symptoms worsening 8,11 .…”

“…Typically, symptoms and signs are action induced, following treatment initiation or dose increase 14,16 . Finally, tardive dyskinesias may became a MD emergency, particularly in the cases of severe respiratory/diaphragmatic dyskinesias and the case of so-called "withdrawal-emergent" dyskinesias (severe dyskinesias after withdrawal from neuroleptics) 8 . Table 1 shows the clinical manifestations of acute dystonia according to the affected muscle group.…”

Treatment of Movement Disorder Emergencies

“…We define a movement disorder emergency as an event where patients develop a movement disorder over hours or several days, and in which morbidity and even mortality can result from failure to appropriately diagnose and manage the patient [1]. A complete review of this topic is beyond the scope of this article, and interested readers are referred to a recent text devoted to this topic [2].…”