Movement disorders in children and adolescents

Neuropsychiatric manifestations of Sydenham's chorea: a systematic review

AIM

Sydenham's chorea is a post-streptococcal, autoimmune, neuropsychiatric movement disorder. Sydenham's chorea is a major criterion for diagnosis of acute rheumatic fever with the implication of potential long-term sequelae including cardiac complications. It is well established that there is psychiatric comorbidity in Sydenham's chorea, but there are variations in the literature regarding the nature and prevalence of psychiatric diagnoses associated with Sydenham's chorea. The aim of this review was to systematically evaluate the evidence for psychiatric symptoms presenting with Sydenham's chorea. Knowledge of comorbid psychiatric symptomatology will support early diagnosis and treatment, leading to improved long-term outcomes for children with Sydenham's chorea.

METHOD

The study used a systematic search strategy, using MEDLINE, MEDLINE in Process, EMBASE, and The Cochrane Library. Abstracts were screened to identify relevant papers which were then assessed further. Eligible papers were summarized.

RESULTS

A total of 1429 abstracts of relevant studies were found, and 49 papers reporting neuropsychiatric symptoms in Sydenham's chorea were summarized. Obsessive-compulsive disorder was the most commonly studied, and hence reported, neuropsychiatric symptom in children with Sydenham's chorea. The studies analysed used a variety of tools to identify affected children and used different methods for analysing results. Attention-deficit-hyperactivity disorder, affective disorders, tic disorders, executive function disturbances, and psychotic features were also reported as comorbidities.

INTERPRETATION

There is good evidence of neuropsychiatric comorbidities in Sydenham's chorea. In countries with a high prevalence of rheumatic fever, the early recognition of salient cognitive and psychiatric symptoms may aid in the management of Sydenham's chorea.

Gilles de la Tourette syndrome: response to electroconvulsive therapy

Tourette syndrome is a chronic disease characterized by vocal and motor ticks. Self-injurious behavior is observed in one third of the patients and can be life-threatening. Current medical therapy includes dopamine receptor antagonists and atypical antipsychotics. In certain cases, there has been some evidence about the efficacy of electroconvulsive therapy (ECT). The case study below is a Tourette syndrome patient with self-injurious behavior and psychotic features and poor response to medical therapy. Two years of remission was achieved after 7 sessions of ECT and carbamezapine maintance therapy. In conclusion, ECT can be used as an efficacious treatment modality for Tourette patients with self-injurious behavior, psychotic features, or for those that are unresponsive to traditional methods.

Rash, fever, and neck pain in the office: is this a neurologic emergency?

Anticonvulsants, neuroleptics, and antispasticity agents are used with increasing frequency in the pediatric population. Each of the drugs discussed in this article has serious but potentially reversible adverse effects. Pediatric primary care providers must be aware of the potential emergencies associated with the use of these neurologic medications to provide prompt and effective treatment.

Drug-induced movement disorders in children and adolescents

The use of psychotropic medication among children and adolescents is increasing with a concomitant increase in the incidence of drug-related movement disorders. This class of adverse reactions to medications can be divided into those that are acute in onset, others that are continuous as long as the offending drug is administered, and a final category consisting of symptoms that are persistent, even after the causative agent has been discontinued. Within these three categories, this review discusses the epidemiology, risk factors, clinical features and treatment of acute dystonic reactions, drug-induced parkinsonism, neuroleptic malignant syndrome, serotonin syndrome, acute akathisia, and the tardive syndromes. In addition, drugs that commonly cause tremor, chorea, or myoclonus are included.

Sydenham Chorea in Children

Sydenham chorea is an important cause of acquired chorea in childhood. Although the symptoms of chorea frequently resolve spontaneously in a matter of months, abnormal movements can be debilitating when they are present. Neuropsychologic symptoms may antedate the motor abnormality, may be persistent, and often are of great concern. To date, there have been no adequate, double-blind, randomized studies to evaluate the symptomatic treatment of Sydenham chorea. This article will review proposed treatment options and dosing strategies.