Movement disorders associated with complex regional pain syndrome in children

Abstract

The aim of the present study was to review the history, clinical course, treatment, and outcome of movement disorders in children and young people with complex regional pain syndrome (CRPS). Case notes were reviewed retrospectively of children and young people who presented with movement disorders in CRPS to our tertiary paediatric pain service over a period of 13 years. Ten children with CRPS presented with movement disorders (eight females, two males). The age at first presentation with symptoms of CRPS ranged from 8 to 15 years (mean 11y 2mo, median 13y). The most common movement disorder was dystonia (n=8), followed by tremors (n=3) and myoclonus (n=3); two patients had all three movement disorders. The movement disorder affected mainly the lower limb (n=9) with a predilection for the foot (n=7) and was frequently initiated by minor trauma (n=7). Follow‐up ranged from 6 months to 14 years. The outcome was variable, with good prognosis in nearly half of the cases: four children experienced complete resolution of symptoms. Two children showed a slight improvement. Four children showed no improvement. Movement disorders in CRPS are under‐recognized in children. The management has to be multidisciplinary with an expertize in paediatric pain.

Complex regional pain syndrome in children: incidence and clinical characteristics

“…In a study of 32 children with CRPS attending a paediatric service in the UK over 10 years, 10 patients (30%) also had dystonia 19. It is estimated that 25% of adult patients with CRPS also suffer from movement disorders mostly (20%) dystonia 26…”

“…A history of injury is almost always demonstrated in affected children and the lower limbs are more often affected than the upper limbs, while the upper extremity was affected more frequently than the lower extremity in adults. Abnormal movements and dystonia have also been frequently reported in adults and children with CRPS and may complicate the clinical picture 19 20…”

Basal ganglia dysfunction in complex regional pain syndrome – A valid hypothesis?

“…A larger study with 692 CRPS-I patients found 124 (19.9%) cases of dystonia (de Boerl et al, 2011). In paediatric population, dystonia is as well the most common movement disorder (Agrawal et al, 2009). Verdugo and Ochoa (2000) assessed 58 CRPS patients, of which only CRPS-I and not CRPS-II patients presented with combinations of dystonic spasms, coarse postural or action tremor and irregular jerks.…”

Chronic pain in children and young people

“…Physical therapy alone was reported to be highly effective many years ago [42]: many clinicians, however, find a significant proportion of children are unable to participate fully, due to pain, and require a multidisciplinary approach. Movement disorders are increasingly recognized in CRPS and can be very difficult to manage [43 ]. Multicentre trials for the management of CRPS in children are needed.…”