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O’Malley JA. Diagnosing Common Movement Disorders in Children. Continuum (Minneap Minn) 2022; 28:1476-1519. [DOI: 10.1212/con.0000000000001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Benrhouma H, Nasri A, Klaa H, Ben Achour N, Rouissi A, Kraoua I, Turki I. Acute Movement Disorders in Childhood: A Cohort Study and Review of the Literature. Pediatr Emerg Care 2021; 37:e719-e725. [PMID: 34469400 DOI: 10.1097/pec.0000000000002017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Acute movement disorders (AMD) are frequent in neurological and pediatric emergencies. Few studies analyzed AMD in children, none in Tunisia or other African country. The purpose of this study was to describe the peculiarities of AMD in a Tunisian pediatric population with a literature review. METHODS We conducted a retrospective descriptive study over 8 years including 80 children (sex ratio, 1.05; mean age of onset, 4.8 years) with AMD, followed in tertiary referral Child Neurology Department in North Tunisia. RESULTS Acute movement disorders were mainly hyperkinetic (n = 67 with dystonia (n = 33; mostly due to inherited metabolic diseases (IMD) in 11; with status epilepticus in 10 children), chorea (n = 14; with Sydenham chorea in 5); myoclonus (n = 14; mostly with opsoclonus-myoclonus syndrome in 10) and tremor (n = 6; of posttraumatic origin in half). Hypokinetic movement disorder (MD) included acute parkinsonism in 5 children of infectious (n = 3), postinfectious (n = 1, malaria) and posttraumatic origin (n = 1). Mixed MD, found in 8 children, were mainly due to IMD in half of them, and to familial lupus in two. Paroxysmal MDs were seen in 2 children, one with multiple sclerosis and one of idiopathic origin. Psychogenic MDs were found in 7 patients mainly of dystonic type. Management of AMD comprised symptomatic treatment according to the phenomenology of the MD and causative treatment depending on its etiology. CONCLUSIONS Our study illustrated the broad range of AMD in children and the wide spectrum of their etiologies. In our series, we described some exceptional findings and etiologies of AMD in children. These findings may denote a specific profile in of AMD in our country with predominant infectious, postinfectious, and IMD.
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Affiliation(s)
| | - Amina Nasri
- Child and Adolescent Neurology Department of Neurology, National Institute of Neurology, Tunis, Tunisia
| | - Hedia Klaa
- Child and Adolescent Neurology Department of Neurology, National Institute of Neurology, Tunis, Tunisia
| | - Nedia Ben Achour
- Child and Adolescent Neurology Department of Neurology, National Institute of Neurology, Tunis, Tunisia
| | - Aida Rouissi
- Child and Adolescent Neurology Department of Neurology, National Institute of Neurology, Tunis, Tunisia
| | - Ichraf Kraoua
- Child and Adolescent Neurology Department of Neurology, National Institute of Neurology, Tunis, Tunisia
| | - Ilhem Turki
- Child and Adolescent Neurology Department of Neurology, National Institute of Neurology, Tunis, Tunisia
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Garone G, Graziola F, Grasso M, Capuano A. Acute Movement Disorders in Childhood. J Clin Med 2021; 10:jcm10122671. [PMID: 34204464 PMCID: PMC8234395 DOI: 10.3390/jcm10122671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022] Open
Abstract
Acute-onset movement disorders (MDs) are an increasingly recognized neurological emergency in both adults and children. The spectrum of possible causes is wide, and diagnostic work-up is challenging. In their acute presentation, MDs may represent the prominent symptom or an important diagnostic clue in a broader constellation of neurological and extraneurological signs. The diagnostic approach relies on the definition of the overall clinical syndrome and on the recognition of the prominent MD phenomenology. The recognition of the underlying disorder is crucial since many causes are treatable. In this review, we summarize common and uncommon causes of acute-onset movement disorders, focusing on clinical presentation and appropriate diagnostic investigations. Both acquired (immune-mediated, infectious, vascular, toxic, metabolic) and genetic disorders causing acute MDs are reviewed, in order to provide a useful clinician’s guide to this expanding field of pediatric neurology.
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Affiliation(s)
- Giacomo Garone
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Federica Graziola
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
| | - Melissa Grasso
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
| | - Alessandro Capuano
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
- Correspondence:
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Abstract
Up to 90% of patients on chronic antipsychotic therapy will experience adverse neurologic side effects, with many of these effects attributable to the dopamine-blocking properties of these drugs. Even the newer, “atypical” antipsychotics are increasingly associated with neurologic complications. In the acute care setting, these medications have broad application beyond the management of psychiatric illness. Given the extent of their use, clinicians should be familiar with the spectrum of neurological syndromes that can develop. Some are common, such as akathisia, acute dystonic reaction, tardive dyskinesia, and drug-induced parkinsonism. Others, such as the life-threatening neuroleptic malignant syndrome, are rare yet must be recognized early to affect survival and improve outcome. This discussion highlights 2 idiosyncratic syndromes, acute dystonic reaction and neuroleptic malignant syndrome. The differential diagnosis for both syndromes and their management is discussed.
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Affiliation(s)
- Suzanne R. White
- Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan Regional Poison Control Center, Detroit, Michigan,
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Benowitz I, Cohen AR, Glykys JC, Gorstein SV, Burns MM, Miller ES. An Altered, Unresponsive Teenager in the Emergency Department. J Emerg Med 2015; 50:116-20. [PMID: 26508698 DOI: 10.1016/j.jemermed.2015.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Isaac Benowitz
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Ari R Cohen
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph C Glykys
- Department of Neurology, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel V Gorstein
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Michele M Burns
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Regional Center for Poison Control and Prevention, Boston, Massachusetts
| | - Emily S Miller
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Potter PO, John N, Coffey DBJ. Onset of abnormal movements and cardiovascular symptoms after acute change in complex polypharmacy in a child with attention-deficit/hyperactivity disorder and mood symptoms. J Child Adolesc Psychopharmacol 2012; 22:388-92. [PMID: 23083026 PMCID: PMC3532002 DOI: 10.1089/cap.2012.2253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Nadyah John
- East Carolina University, Brody School of Medicine, Greenville, North Carolina
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Serrano M, Sanz-Cuesta M, Villaronga M, Hayek LF, Perez-Dueñas B. Cloperastine-based cough syrup and acute dystonic reactions. Dev Med Child Neurol 2012; 54:287. [PMID: 22324643 DOI: 10.1111/j.1469-8749.2011.04105.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dale RC, Singh H, Troedson C, Pillai S, Gaikiwari S, Kozlowska K. A prospective study of acute movement disorders in children. Dev Med Child Neurol 2010; 52:739-48. [PMID: 20163436 DOI: 10.1111/j.1469-8749.2009.03598.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The purpose of this study was to report a prospective cohort of children with acute-onset movement disorders. METHOD We report on 52 individuals (31 females, 21 males; mean age 6y 5mo, range 2mo-15y) with acute-onset movement disorders managed at a busy tertiary paediatric referral hospital over a 40-month period. RESULTS In descending order of frequency, the movement disorders reported were chorea, dystonia, tremor, myoclonus, and parkinsonism. It was possible to divide the participants into three groups: (1) those with inflammatory or autoimmune disorders (n=22), (2) those with non-inflammatory disorders (n=18), and (3) those with psychogenic disorders (n=12). The inflammatory or autoimmune aetiologies included N-methyl-D-aspartate receptor encephalitis (n=5), opsoclonus-myoclonus syndrome (n=4), Sydenham chorea (n=3), systemic lupus erythematosus (n=3), acute necrotizing encephalopathy (n=3), and other types of encephalitis (n=4). Other important non-inflammatory movement disorder aetiologies included drug-induced movement disorder (n=6), post-pump chorea (n=5), metabolic (n=3) and vascular (n=2) disease. The participants with psychogenic movement disorders (n=12) were all over 10 years of age and were more likely to be female. Tremor and myoclonus were significantly over-represented in the psychogenic movement disorder subgroup. The outcomes of the total cohort were variable, and included full recovery, severe morbidity, and death. INTERPRETATION Acute-onset movement disorders in children are important and may be treatable. Management should focus upon identifying the cause and treating the underlying disease process, as symptomatic treatment of the abnormal movements is variably effective.
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Affiliation(s)
- Russell C Dale
- Neuroimmunology Group, Institute of Neuroscience and Muscle Research, Kids Research Institute at the Children's Hospital at Westmead, Sydney, NSW, Australia.
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Jerrell JM, Hwang TL, Livingston TS. Neurological adverse events associated with antipsychotic treatment in children and adolescents. J Child Neurol 2008; 23:1392-9. [PMID: 18772491 DOI: 10.1177/0883073808319070] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A retrospective cohort design using medical and pharmacy claims from one state's Medicaid program compared incidence rates for neurological adverse events associated with antipsychotic use in 4140 youths prescribed antipsychotic medications and an untreated sample of 4500 youths, January 1998 to December 2005. The treated cohort evinced a higher prevalence of involuntary movements, sedation, and seizures. The odds of incident involuntary movements were significantly higher for those taking aripiprazole, risperidone, haloperidol, and multiple antipsychotics. The odds of incident seizures were greater for those taking risperidone, multiple antipsychotics, and serotonin-specific reuptake inhibitors. The odds of incident sedation were greater for those taking ziprasidone, risperidone, quetiapine, multiple antipsychotics, and serotonin-specific reuptake inhibitors. Exposure to risperidone, multiple antipsychotics, and serotonin-specific reuptake inhibitors consistently confers a higher risk of developing a range of neurological adverse events in young patients, especially those with preexisting central nervous system, mental retardation, or cardiovascular disorders.
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Affiliation(s)
- Jeanette M Jerrell
- Department of Neuropsychiatry, University of South Carolina School of Medicine, Columbia, SC 29203, USA.
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Johnson TD. Respiratory assessment in child and adolescent residential treatment settings: reducing restraint-associated risks. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2007; 20:176-83. [PMID: 17688555 DOI: 10.1111/j.1744-6171.2007.00108.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
TOPIC Crisis situations of youth in treatment settings may require restraints. Restraints should only be used in situations where there is imminent danger to the child and when there is no alternative. They are meant to maintain the child's safety, but there is risk for respiratory compromise. PURPOSE Nursing care of children in restraints must include respiratory assessment and, when indicated, immediate intervention to prevent disastrous outcomes. SOURCES Review using PubMed and established texts confirms that clinical skills and knowledge is essential to child and adolescent psychiatric nursing. CONCLUSIONS Clinical assessment and awareness of risks in physical restraints is essential for the safety and well-being of the child.
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Affiliation(s)
- T D Johnson
- Lupine Creative Consulting, Inc., and University of Rochester, School of Nursing, Rochester, NY, USA.
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Abstract
Chorea is one of the major types of involuntary movement disorders originating from dysfunctional neuronal networks interconnecting the basal ganglia and frontal cortical motor areas. The syndrome is characterised by a continuous flow of random, brief, involuntary muscle contractions and can result from a wide variety of causes. Diagnostic work-up can be straightforward in patients with a positive family history of Huntington's disease or acute-onset hemichorea in patients with lacunar stroke, but it can be a challenging and complex task in rare autoimmune or genetic choreas. Principles of management focus on establishing an aetiological classification and, if possible, removal of the cause. Preventive strategies may be possible in Huntington's disease where genetic counselling plays a major part. In this review we summarise the current understanding of the neuroanatomy and pathophysiology of chorea, its major aetiological classes, and principles of diagnostic work-up and management.
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Affiliation(s)
- Richard M Trosch
- Parkinson's Disease and Movement Disorder Center, Southfield, Michigan, USA.
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Balash Y, Giladi N. Efficacy of pharmacological treatment of dystonia: evidence-based review including meta-analysis of the effect of botulinum toxin and other cure options. Eur J Neurol 2004; 11:361-70. [PMID: 15171731 DOI: 10.1111/j.1468-1331.2004.00845.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The treatment of both generalized and focal dystonia is symptomatic. There is no evidence-based information about the efficacy of the different methods of the pharmacological therapeutic options currently being applied in dystonia. The specific questions addressed by this study were which treatments for dystonia have proven efficacy and which of them have unproven results. Following evidence-based principles, a literature review based on MEDLINE and the Cochrane Library, augmented by manual search of the most important journals was performed to identify the relevant publications issued between 1973 and 2003. All articles appearing in the professional English literature, including case reports, were considered. In the presence of comparable studies the meta-analysis was performed to obtain pooled information and make a reasonable inference. Based on this review, we conclude: (i) botulinum toxin has obvious benefit (level A, class I-II evidence) for the treatment of cervical dystonia and blepharospasm; (ii) trihexyphenidyl in high dosages is effective for the treatment of segmental and generalized dystonia in young patients (level A, class I-II evidence); (iii) all other methods of pharmacological intervention for generalized or focal dystonia, including botulinum toxin injections, have not been confirmed as being effective according to accepted evidence-based criteria (level U, class IV studies).
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Affiliation(s)
- Y Balash
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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