1
|
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]
|
2
|
Stämpfli D, Weiler S, Burden AM. Movement disorders and use of risperidone and methylphenidate: a review of case reports and an analysis of the WHO database in pharmacovigilance. Eur Child Adolesc Psychiatry 2021; 30:1047-1058. [PMID: 32621088 DOI: 10.1007/s00787-020-01589-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
For patients with attention deficit hyperactivity disorder and comorbid conduct-dissocial disorder, a combination therapy of the psychostimulant methylphenidate and the antipsychotic risperidone may be prescribed. Case reports describe the occurrence of movement disorders under this combination therapy, but clinical trials had limited power to detect these events. This study aimed (1) to summarise published case reports and (2) to analyse pharmacovigilance data consisting of adverse drug event reports to elucidate these reactions. PubMed, Embase, and APA PsycInfo were used to retrieve case reports. For the pharmacovigilance data, aggregated information on individual case safety reports (ICSRs) within the database of suspected adverse drug events by the WHO were analysed. ICSRs were assessed for disproportionality in reporting. Thirteen published case reports (62% male) on movement disorders were identified, with ages between 5 and 15 years. Seven reports (54%) described incidents when risperidone was tapered down or switched to methylphenidate. From the WHO, we identified 25,556 ICSRs (16,118 for methylphenidate, 8,614 for risperidone, and 824 for both). Of these, 953 (5.9%), 1356 (15.7%), and 159 (19.3%) ICSRs reported movement disorders in association with methylphenidate, risperidone or both, respectively. The analyses on disproportionality showed an increased number of ICSRs with movement disorders when the two drugs were coded in combination. The potential of movement disorders as adverse effects might be amplified when methylphenidate and risperidone are used in combination. The results from the literature underline the necessity of caution and patient monitoring when risperidone dosing is modified during methylphenidate therapy.
Collapse
Affiliation(s)
- Dominik Stämpfli
- Pharmacoepidemiology, Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog-Weg 4, 8093, Zurich, Switzerland.
| | - Stefan Weiler
- Pharmacoepidemiology, Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog-Weg 4, 8093, Zurich, Switzerland.,National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, Zurich, Switzerland
| | - Andrea M Burden
- Pharmacoepidemiology, Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog-Weg 4, 8093, Zurich, Switzerland
| |
Collapse
|
3
|
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.
Collapse
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:
| |
Collapse
|
4
|
Torres-Russotto D. Clinical approach to tremor in children. Parkinsonism Relat Disord 2019; 59:111-116. [PMID: 30952437 DOI: 10.1016/j.parkreldis.2019.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 01/22/2023]
Abstract
Pediatric Movement Disorders encompass a very large and complex group of diseases, among which Tremor is one of the least studied. Evaluation of tremors in kids carries significant challenges, in particular the fact that many tremor etiologies have other associated movement disorders that make tremor identification more difficult. Also, it is sometimes difficult to differentiate tremors from other shaking disorders. Yet, the correct identification of tremor leads to appropriate treatments and sometimes practical cures. Thus, in this paper we have strived to provide a succinct, clinically useful and practical review of pediatric tremors. The most useful classification of tremors in based on their predominance during rest or activity. By far, the most common tremor in children is during action. We provide a clinical algorithm on how to assess pediatric tremors at the bedside, as well as multiple useful tables. We also review common tremor etiologies.
Collapse
Affiliation(s)
- D Torres-Russotto
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, 68198, United States.
| |
Collapse
|
5
|
Effect of Biperiden Treatment in Acute Orofacial and Extremity Dyskinesia With Methylphenidate Therapy. Pediatr Emerg Care 2018; 34:e217-e218. [PMID: 28328695 DOI: 10.1097/pec.0000000000001102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Methylphenidate is a stimulant drug commonly prescribed to individuals with attention-deficit/hyperactivity disorder. The suggested underlying mechanism of acute dyskinesias is dopaminergic transmission increase. We describe a 9-year-old boy with a diagnosis of attention-deficit/hyperactivity disorder admitted to emergency clinic with primarily orofacial and extremity dyskinesia after administration of a first dose of 18 mg OROS (osmotic [controlled] release oral) methylphenidate (Concerta). OROS methylphenidate was discontinued, and the patient's symptoms resolved within 20 minutes after injection of biperiden by intravenous route (0.04 mg/kg). We wish to emphasize that acute orofacial dyskinesia and extremity dyskinesia can be observed during methylphenidate therapy and that biperiden can be successfully used in the treatment of this unpleasant condition. To the best of our knowledge, this is the first report of the use of biperiden therapy in this condition. This case report highlights the importance for physicians of awareness of dyskinesia as a potential adverse effect of methylphenidate therapy and indicates benefit of biperiden therapy.
Collapse
|
6
|
Russ JB, Nallappan AM, Robichaux-Viehoever A. Management of Pediatric Movement Disorders: Present and Future. Semin Pediatr Neurol 2018; 25:136-151. [PMID: 29735111 DOI: 10.1016/j.spen.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Management of movement disorders in children is an evolving field. This article outlines the major categories of treatment options for pediatric movement disorders and general guidelines for their use. We review the evidence for existing therapies, which continue to lack large-scale controlled trials to guide treatment decisions. The field continues to rely on extrapolations from adult studies and lower quality evidence such as case reports and case series to guide treatment guidelines and consensus statements. Developments in new pharmaceuticals for rare diseases have begun to provide hope for those cases in which a genetic diagnosis can be made. Advances in surgical therapies such as deep brain stimulation as well as new modes of treatment such as gene therapy, epigenetic modulation, and stem cell therapy hold promise for improving outcomes in both primary and secondary causes of movement disorders. There is a critical need for larger, multicenter, controlled clinical trials to fully evaluate treatments for pediatric movement disorders.
Collapse
Affiliation(s)
- Jeffrey B Russ
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Akila M Nallappan
- Undergraduate Program, Case Western Reserve University, Cleveland, OH
| | | |
Collapse
|
7
|
Pitzer M, Engelmann G, Stammschulte T. [Tardive movement disorders with antipsychotics – a case of aripirazole-induced tardive dystonia and review of the literature]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2017; 45:325-334. [PMID: 28682214 DOI: 10.1024/1422-4917/a000460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Extrapyramidal adverse events (EPS) occur less frequently with second-generation antipsychotics (SGAs) than with first-generation antipsychotics (FGAs). Tardive dyskinesia (TD), but not tardive dystonia (TDt), also seems to occur less often in adults. TD was found to occur less frequently in children and adolescents treated with FGAs than in adults. No data are available on TDt, and the data pertaining to SGAs are limited and conflicting. SGAs differ in their profile of adverse events. Aripiprazole is less frequently associated with adverse metabolic or cardiac events, but more often with EPS, at least in children and adolescents. To date, there are several case reports of TD or TDt with aripiprazole in adults. Symptomatology, differential diagnosis, pathophysiology, prevalence, and therapy of TDt are presented here based on a case report of TDt during aripiprazole therapy in a 13-year-old girl. During medication with SGAs, the occurrence of EPS, including tardive movement disorders, should be considered and regularly monitored.
Collapse
Affiliation(s)
- Martina Pitzer
- 1 Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Städtisches Klinikum Karlsruhe
- 2 Arzneimittelkommission der Deutschen Ärzteschaft (AkdÄ), Berlin
| | | | | |
Collapse
|
8
|
Koy A, Lin JP, Sanger TD, Marks WA, Mink JW, Timmermann L. Advances in management of movement disorders in children. Lancet Neurol 2016; 15:719-735. [PMID: 27302239 DOI: 10.1016/s1474-4422(16)00132-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/20/2016] [Accepted: 03/10/2016] [Indexed: 02/06/2023]
Abstract
Movement disorders in children are causally and clinically heterogeneous and present in a challenging developmental context. Treatment options are broad ranging, from pharmacotherapy to invasive neuromodulation and experimental gene and stem cell therapies. The clinical effects of these therapies are variable and often poorly sustained, and only a few of the management strategies used in paediatric populations have been tested in randomised controlled studies with age-appropriate cohorts. Identification of the most appropriate treatment is uniquely challenging in children because of the incomplete knowledge about the pathophysiology of movement disorders and their influence on normal motor development; thus, effective therapeutic options for these children remain an unmet need. It is vital to transfer the expanding knowledge of the movement disorders into the development of novel symptomatic or, ideally, disease-modifying treatments, and to assess these therapeutic strategies in appropriately designed and well done trials.
Collapse
Affiliation(s)
- Anne Koy
- Department of Neurology, University of Cologne, Cologne, Germany; Department of Paediatrics, University of Cologne, Cologne, Germany.
| | - Jean-Pierre Lin
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - Lars Timmermann
- Department of Neurology, University of Cologne, Cologne, Germany
| |
Collapse
|
9
|
Schneider C, Taylor D, Zalsman G, Frangou S, Kyriakopoulos M. Antipsychotics use in children and adolescents: An on-going challenge in clinical practice. J Psychopharmacol 2014; 28:615-23. [PMID: 24902872 DOI: 10.1177/0269881114533599] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Antipsychotic medications (APs) are a well-established pharmacological treatment in adults with serious mental health problems. However, many adult mental health disorders have their origins and onset in childhood or adolescence. The understanding that neuropsychiatric conditions of childhood are in part biologically determined, led to an increase in the number of clinical trials supporting evidence on the efficacy of antipsychotic agents as first-line treatment for childhood psychotic disorders and therapeutic augmentation of nonpsychotic conditions. In recent years the use of antipsychotics in children and adolescents for neurodevelopmental, behavioural and psychiatric disorders has significantly increased while the age of prescription has decreased. These trends have not been matched by advances in the understanding of APs' safety profile in this group of patients. It is therefore crucial that current and future practice is informed by up-to-date synthesis of the evidence and clinical guidelines about the use and monitoring of these treatments in paediatric populations, since the effectiveness of early therapeutic interventions in children can affect positively the long-term outcome.
Collapse
Affiliation(s)
- Carolina Schneider
- National and Specialist Acorn Lodge Children's Unit, South London and Maudsley NHS Foundation Trust, London, UK Institute of Psychiatry, King's College London, London, UK
| | - David Taylor
- Institute of Psychiatry, King's College London, London, UK Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Gil Zalsman
- Division of Child and Adolescent Psychiatry, Tel Aviv University, Tel Aviv, Israel Molecular Imaging and Neuropathology Division, Columbia University, New York, NY, USA
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marinos Kyriakopoulos
- National and Specialist Acorn Lodge Children's Unit, South London and Maudsley NHS Foundation Trust, London, UK Institute of Psychiatry, King's College London, London, UK Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
10
|
Ortega AOL, Dos Santos MTBR, Mendes FM, Ciamponi AL. Association between anticonvulsant drugs and teeth-grinding in children and adolescents with cerebral palsy. J Oral Rehabil 2014; 41:653-8. [PMID: 24824732 DOI: 10.1111/joor.12185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
The relation between teeth-grinding and the use of drugs acting on the central nervous system of cerebral palsy (CP) patients has not yet been described. The aim of this research was to evaluate the presence or absence of teeth-grinding (sleep and/or awake periods) in normal and in CP children and adolescents, as well as the association of teeth-grinding and use of anticonvulsant drugs. The sample consisted of 207 children and adolescents, divided into three groups: G1, individuals with CP who did not take anticonvulsant drugs; G2, individuals with CP administered medications on a regular basis; and CG, normal individuals. Logistic regression analyses were performed to evaluate the association of teeth-grinding with some variables. No significant statistical differences were observed regarding the presence or absence of teeth-grinding when G1 and G2 were compared. However, compared with the CG, a statistically significant difference was determined, with the CG showing fewer children presenting teeth-grinding (P < 0·001). Among those children/adolescents prescribed drug therapy, the barbiturate group showed a greater frequency of teeth-grinding. CP children and adolescents show a greater and significant presence of grinding of the teeth compared with normal individuals. Subjects taking barbiturate drugs showed greater presence of teeth-grinding, than those who were taking medications from the other groups of anticonvulsant drugs.
Collapse
Affiliation(s)
- A O L Ortega
- Department of Pediatric Dentistry, School of Dentistry of University of São Paulo, São Paulo, Brazil
| | | | | | | |
Collapse
|
11
|
|
12
|
Abstract
Butamirate citrate is a central-acting antitussive drug and is widely used in clinical practice in childhood. It is thought that to be centrally active antitussive drugs act through receptors in the brainstem to inhibit cough, and these findings were based on the evidence of animal models. Central nervous system adverse effects of cough suppressants are rare and include irritability, lethargy, hallucinations, and dystonic reactions. In this report, we present the first patient who developed cervical dystonia shortly after the first dose of butamirate citrate, and the patient's symptoms improved immediately after a single intramuscular dosage of biperiden.
Collapse
|
13
|
Abstract
The authors describe the case of a 13-year-old boy who exhibited progressive disabling motor restlessness, torticollis, urinary symptoms, and confusion following a fall from a bicycle. The differential diagnosis of this striking symptom complex in this clinical context can be problematic. In this case, the symptoms ultimately appeared most consistent with severe akathisia resulting from a single administration of haloperidol used at an outside hospital to sedate the patient prior to a head CT scan. The literature on akathisia in pediatric patients, and especially in patients following acute head injury, is reviewed, with suggestions for an approach to these symptoms in this clinical setting.
Collapse
Affiliation(s)
- Atman Desai
- Section of Pediatric Surgery (Neurosurgery), Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire 03756, USA.
| | | | | |
Collapse
|
14
|
Abstract
This review discusses diagnostic evaluation and management of chorea in childhood. Chorea is an involuntary, hyperkinetic movement disorder characterized by continuous, jerky, or flowing movement fragments, with irregular timing and direction. It tends to be enhanced by voluntary actions and generally causes interference with fine motor function. The diagnostic evaluation begins with accurate classification of the movement disorder followed by consideration of the time course. Most previously healthy children presenting with acute/subacute chorea have an autoimmune etiology. Chronic chorea usually occurs as part of encephalopathies or diseases causing more global neurologic symptoms. We review the management of acute/subacute and chronic choreas, with special emphasis on Sydenham chorea and benign hereditary chorea.
Collapse
|