Video Anthology of Movement Disorders Due to Infections in South Asia

Abstract

South Asia, encompassing many populous countries including India, Pakistan, and Bangladesh, is home to a wide variety of infectious diseases several of which are disproportionately prevalent, endemic or distinctive to the region. These result in considerable morbidity and mortality, which can be greatly reduced through public‐health measures, timely diagnosis and treatment. Some of these infectious diseases have neurological manifestations including movement disorders either due to the pathogen being neuroinvasive or via an immune‐mediated response. For diseases such as Japanese encephalitis, movement disorders are the primary manifestation while for others, they can be a presenting feature. Thus, recognizing these movement disorders is often crucial to the diagnosis of the particular infection, and/or to exclude infection as a cause and arrive at the correct alternate diagnosis. Once diagnosed, the infection‐related movement disorders are treated by targeting the infectious agent, or symptomatically. In this article, we describe and illustrate a variety of movement disorders that are seen in patients infected by viruses, bacteria and parasites in South Asia. This would be of value to neurologists practicing in the region and, with the increasing ease in movement of people and pathogens, those practicing elsewhere.

Overview of management of infection-related movement disorders with focus on specific-infections

“…Flaviviruses (Japanese encephalitis virus (JEV), dengue virus, West Nile virus (WNV)) has a predilection to affect basal ganglia structures resulting in dystonia-parkinsonism [9] , [23] , [24] , [25] , [26] . Herpes simplex virus (HSV), varicella, mumps, measles, enterovirus, Influenza-A, Epstein-Barr virus and other viral infections can cause acute ataxia, OMAS and chorea-dystonic syndromes [10] , [11] , [27] , [28] , [29] . Recently coronavirus disease 2019 (COVID-19) and congenital Zika virus-related MD have also been reported [30] , [31] , [32] .…”

“…The therapy must be initiated and continued only on the circumstantial evidence or based on the classical presentation of a particular syndrome (e.g., SC, OMAS, pediatric acute cerebellar ataxia etc.). In a patient with recent onset of MD, presence of systemic signs of infection such as fever, rashes or skin lesions, lymphadenopathy, hepatosplenomegaly, unexpected weight loss, or multi system involvement should raise a possibility of infection [10] . Neurologically, acute to subacute onset focal neuro deficits, encephalopathy, meningeal signs, new onset seizures, multiaxial neurological involvement suggest a possibility of infectious etiology.…”

“… [5] , [6] , [7] , [8] , [9] . However, literature on IRMD prevalence, pattern, prognosis and management as a whole is lacking [1] , [4] , [10] , [11] . This narrative review aims to provide a brief overview of the common infections associated with MD, their common clinical presentations, underlying pathophysiology, and overall approach to their treatment, emphasizing specific treatments of prevalent and treatable IRMD.…”

Chorea as a Post‐COVID‐19 Complication

“…As far as we know, the two patient cases noted below are the first to be reported with more than a 2‐week interval between post‐COVID‐19 encephalitis and initiation of chorea. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 …”

“…As far as we know, the two patient cases noted below are the first to be reported with more than a 2-week interval between post-COVID-19 encephalitis and initiation of chorea. [4][5][6][7][8][9][10][11] A 67-year-old woman was referred to the movement disorder clinic because of acute onset of generalized choreiform movements. She stated an earlier admission because of coronavirus symptoms including nausea, loss of appetite, and high blood pressure 3 months prior.…”