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Yadegar M, Guo S, Ricketts EJ, Zinner SH. Assessment and Management of Tic Disorders in Pediatric Primary Care Settings. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020; 6:159-172. [PMID: 32467820 DOI: 10.1007/s40474-019-00168-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose of Review Pediatricians and other primary care providers are often the first and sole healthcare clinicians of patients who present with tics. However, limited primary care pediatric training in neuropsychiatric concerns, as well as perceived lack of comfort and preparation, make it challenging for these clinicians to confidently identify and manage tic disorders. Recent Findings Current empirical findings of tic disorder management relevant to pediatric physicians, including assessment, psychoeducation, behavioral interventions, psychotropic medications, and alternative treatments are reviewed. Summary This article discusses neuropsychiatric and medical complexities of tic disorder assessment, with particular emphasis on differential and comorbid diagnoses. Tiered referral recommendations, based on symptom severity, impairment, and consideration of comorbid conditions, are provided. Future directions for tic management, including dissemination of evidence-based treatments of tic disorders and multidisciplinary teams within pediatric primary care settings, are included.
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Affiliation(s)
- Mina Yadegar
- Univeristy of California, Los Angeles.,Boston Child Study Center - Los Angeles.,Behavioral Associates Los Angeles
| | - Sisi Guo
- Univeristy of California, Los Angeles
| | | | - Samuel H Zinner
- University of Washington School of Medicine.,Seattle Children's Hospital
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Lubberdink AL, Sharif S, Pardhan K. You can dance if you want to: A case of Sydenham's chorea. Am J Emerg Med 2019; 37:2118.e5-2118.e7. [PMID: 31474378 DOI: 10.1016/j.ajem.2019.158414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022] Open
Abstract
Isolated motor disturbances in the paediatric population are uncommon presentations to the emergency department. Choreiform movements have a broad differential diagnosis and may present insidiously with progressive worsening of asymmetric clumsiness, hypotonia and dysarthria. The incidence of Sydenham's chorea (SC) caused by acute rheumatic fever (ARF) is very rare in developed countries. We report a previously healthy, vaccinated 9-year old male who presented to our ED with intermittent and progressive right sided clumsiness for four weeks. Physical examination findings showed dysdiadokinesis and dysmetric movements of the right side, which varied in intensity and were less pronounced on serial re-examination during the same ED visit. Basic bloodwork, MRI and MRA/V showed no abnormalities, and the patient was discharged home with urgent neurology follow-up. He re-presented to our ED four days later with worsening gait and inability to hold a pencil at school. He was subsequently diagnosed with chorea by the neurology team. The cause of chorea was later determined to be SC, and the patient's throat swab came back positive for group A-beta hemolytic strep (GAS) infection. We explore current literature regarding the various presentations of ARF, differential considerations in acute chorea, and diagnostic studies needed to determine the etiology of acute chorea. With the low incidence of chorea in developed nations, this diagnosis can be easily overlooked. We highlight the importance of this diagnosis, as well as primary and secondary treatment in ARF.
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Affiliation(s)
- Ashley L Lubberdink
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Sameer Sharif
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
| | - Kaif Pardhan
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada; Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Raucci U, Parisi P, Vanacore N, Garone G, Bondone C, Palmieri A, Calistri L, Suppiej A, Falsaperla R, Capuano A, Ferro V, Urbino AF, Tallone R, Montemaggi A, Sartori S, Pavone P, Mancardi M, Melani F, Ilvento L, Pelizza MF, Reale A. Acute hyperkinetic movement disorders in Italian paediatric emergency departments. Arch Dis Child 2018. [PMID: 29519947 DOI: 10.1136/archdischild-2017-314464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Limited data exist on epidemiology, clinical presentation and management of acute hyperkinetic movement disorders (AHMD) in paediatric emergency departments (pED). METHODS We retrospectively analysed a case series of 256 children (aged 2 months to 17 years) presenting with AHMD to the pEDs of six Italian tertiary care hospitals over a 2-year period (January 2012 to December 2013). RESULTS The most common type of AHMD was tics (44.5%), followed by tremors (21.1%), chorea (13.7%), dystonia (10.2%), myoclonus (6.3%) and stereotypies (4.3%). Neuropsychiatric disorders (including tic disorders, psychogenic movement disorders and idiopathic stereotypies) were the most represented cause (51.2%). Inflammatory conditions (infectious and immune-mediated neurological disorders) accounted for 17.6% of the cases whereas non-inflammatory disorders (including drug-induced AHMDs, genetic/metabolic diseases, paroxysmal non-epileptic movements and idiopathic AHMDs) accounted for 31.2%. Neuropsychiatric disorders prevailed among preschoolers and schoolers (51.9% and 25.2%, respectively), non-inflammatory disorders were more frequent in infants and toddlers (63.8%), whereas inflammatory conditions were more often encountered among schoolers (73.3%). In 5 out of 36 Sydenham's chorea (SC) cases, tics were the presentation symptom on admission to emergency department (ED), highlighting the difficulties in early diagnosis of SC. Inflammatory disorders were associated with a longer hospital stay and a greater need of neuroimaging test compared with other disorders. CONCLUSIONS This study provides the first large sample of paediatric patients presenting to the ED for AHMDs, helping to elucidate the epidemiology, aetiology and clinical presentation of these disorders.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital of Rome, Sapienza University, Rome, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance, and Health Promotion, National Institute of Health, Rome, Italy
| | - Giacomo Garone
- University Department of Pediatrics (DPUO), University of Rome Tor Vergata, Bambino Gesù Children's Hospital, Rome, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital-AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonella Palmieri
- Department of Pediatric Emergency, IRCCS Giannina Gaslini, Genova, Italy
| | - Lucia Calistri
- Department of Pediatric Emergency, Anna Meyer Children's Hospital, Florence, Italy
| | - Agnese Suppiej
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University of Padua, Padova, Italy
| | - Raffaele Falsaperla
- General Paediatrics Operative Unit, University Hospital Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Valentina Ferro
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Francesco Urbino
- Department of Pediatric Emergency, Regina Margherita Children's Hospital-AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ramona Tallone
- Department of Pediatric Emergency, IRCCS Giannina Gaslini, Genova, Italy
| | | | - Stefano Sartori
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University of Padua, Padova, Italy
| | - Piero Pavone
- General Paediatrics Operative Unit, University Hospital Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - Margherita Mancardi
- Unit of Child Neuropsychiatry, Head-Neck and Neuroscience Department, Giannina Gaslini Institute, Genoa, Italy
| | - Federico Melani
- Pediatric Neurology and Neurogenetics Unit and Laboratories, Neuroscience Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Lucrezia Ilvento
- Pediatric Neurology and Neurogenetics Unit and Laboratories, Neuroscience Department, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Maria Federica Pelizza
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University of Padua, Padova, Italy
| | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Athanasopoulos E, Kalaitzidou I, Vlachaki G, Stefanaki S, Tzagkaraki A, Niotakis G, Tritou I, Ladomenou F. Chorea revealing systemic lupus erythematosus in a 13-year old boy: A case report and short review of the literature. Int Rev Immunol 2018; 37:177-182. [PMID: 29595356 DOI: 10.1080/08830185.2018.1452920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Among the neurological manifestations of systemic lupus erythematosus (SLE), chorea is rare, presenting in less than 7% of the pediatric SLE patients. It can appear early in the onset of SLE, be the first or even the sole clinical feature of the illness and has strongly been associated with the presence of antiphospholipid antibodies. We report on the case of a 13-year old boy, admitted with acute onset chorea and finally diagnosed with SLE. Subsequently, we present a short review of the literature on the epidemiology, suggested pathogenesis, clinical presentation and treatment of this rare presentation of SLE.
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Affiliation(s)
- E Athanasopoulos
- a Department of Paediatrics , Venizeleion General Hospital , Heraklion, Crete , Greece
| | - I Kalaitzidou
- a Department of Paediatrics , Venizeleion General Hospital , Heraklion, Crete , Greece
| | - G Vlachaki
- a Department of Paediatrics , Venizeleion General Hospital , Heraklion, Crete , Greece
| | - S Stefanaki
- a Department of Paediatrics , Venizeleion General Hospital , Heraklion, Crete , Greece
| | - A Tzagkaraki
- a Department of Paediatrics , Venizeleion General Hospital , Heraklion, Crete , Greece
| | - G Niotakis
- b Peadiatric Neurology Clinics, Venizeleion General Hospital , Heraklion, Crete , Greece
| | - I Tritou
- c Department of Radiology , Venizeleion General Hospital , Heraklion, Crete , Greece
| | - F Ladomenou
- a Department of Paediatrics , Venizeleion General Hospital , Heraklion, Crete , Greece
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Pavone P, Praticò AD, Pavone V, Lubrano R, Falsaperla R, Rizzo R, Ruggieri M. Ataxia in children: early recognition and clinical evaluation. Ital J Pediatr 2017; 43:6. [PMID: 28257643 PMCID: PMC5347818 DOI: 10.1186/s13052-016-0325-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 12/26/2016] [Indexed: 12/19/2022] Open
Abstract
Background Ataxia is a sign of different disorders involving any level of the nervous system and consisting of impaired coordination of movement and balance. It is mainly caused by dysfunction of the complex circuitry connecting the basal ganglia, cerebellum and cerebral cortex. A careful history, physical examination and some characteristic maneuvers are useful for the diagnosis of ataxia. Some of the causes of ataxia point toward a benign course, but some cases of ataxia can be severe and particularly frightening. Methods Here, we describe the primary clinical ways of detecting ataxia, a sign not easily recognizable in children. We also report on the main disorders that cause ataxia in children. Results The causal events are distinguished and reported according to the course of the disorder: acute, intermittent, chronic-non-progressive and chronic-progressive. Conclusions Molecular research in the field of ataxia in children is rapidly expanding; on the contrary no similar results have been attained in the field of the treatment since most of the congenital forms remain fully untreatable. Rapid recognition and clinical evaluation of ataxia in children remains of great relevance for therapeutic results and prognostic counseling.
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Affiliation(s)
- Piero Pavone
- University-Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy. .,Unit of Pediatrics and Pediatric Emergency, Azienda Ospedaliera Universitaria Vittorio Emanuele-Policlinico, University of Catania, Italy, Via Plebiscito 767, 95123, Catania, Italy.
| | - Andrea D Praticò
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy.,Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Vito Pavone
- Department of Orthopaedics, University of Catania, Catania, Italy
| | | | - Raffaele Falsaperla
- University-Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Renata Rizzo
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
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Madeo M, Stewart M, Sun Y, Sahir N, Wiethoff S, Chandrasekar I, Yarrow A, Rosenfeld JA, Yang Y, Cordeiro D, McCormick EM, Muraresku CC, Jepperson TN, McBeth LJ, Seidahmed MZ, El Khashab HY, Hamad M, Azzedine H, Clark K, Corrochano S, Wells S, Elting MW, Weiss MM, Burn S, Myers A, Landsverk M, Crotwell PL, Waisfisz Q, Wolf NI, Nolan PM, Padilla-Lopez S, Houlden H, Lifton R, Mane S, Singh BB, Falk MJ, Mercimek-Mahmutoglu S, Bilguvar K, Salih MA, Acevedo-Arozena A, Kruer MC. Loss-of-Function Mutations in FRRS1L Lead to an Epileptic-Dyskinetic Encephalopathy. Am J Hum Genet 2016; 98:1249-1255. [PMID: 27236917 PMCID: PMC4908178 DOI: 10.1016/j.ajhg.2016.04.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/07/2016] [Indexed: 11/20/2022] Open
Abstract
Glutamatergic neurotransmission governs excitatory signaling in the mammalian brain, and abnormalities of glutamate signaling have been shown to contribute to both epilepsy and hyperkinetic movement disorders. The etiology of many severe childhood movement disorders and epilepsies remains uncharacterized. We describe a neurological disorder with epilepsy and prominent choreoathetosis caused by biallelic pathogenic variants in FRRS1L, which encodes an AMPA receptor outer-core protein. Loss of FRRS1L function attenuates AMPA-mediated currents, implicating chronic abnormalities of glutamatergic neurotransmission in this monogenic neurological disease of childhood.
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Affiliation(s)
- Marianna Madeo
- Children's Health Research Center, Sanford Research, Sioux Falls, SD 57104, USA
| | - Michelle Stewart
- Mammalian Genetics Unit, Medical Research Council Harwell, Oxfordshire OX11 ORD, UK
| | - Yuyang Sun
- Department of Basic Sciences, University of North Dakota, Grand Forks, ND 58202, USA
| | - Nadia Sahir
- Children's Health Research Center, Sanford Research, Sioux Falls, SD 57104, USA
| | - Sarah Wiethoff
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Indra Chandrasekar
- Children's Health Research Center, Sanford Research, Sioux Falls, SD 57104, USA
| | - Anna Yarrow
- Children's Health Research Center, Sanford Research, Sioux Falls, SD 57104, USA
| | - Jill A Rosenfeld
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Yaping Yang
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Dawn Cordeiro
- Division of Clinical & Metabolic Genetics and Genetics & Genome Biology Program, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Elizabeth M McCormick
- Division of Human Genetics, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Colleen C Muraresku
- Division of Human Genetics, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Tyler N Jepperson
- Children's Health Research Center, Sanford Research, Sioux Falls, SD 57104, USA
| | - Lauren J McBeth
- Children's Health Research Center, Sanford Research, Sioux Falls, SD 57104, USA
| | | | - Heba Y El Khashab
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia; Department of Pediatrics, The Children's Hospital, Ain Shams University, Cairo 11355, Egypt
| | - Muddathir Hamad
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Hamid Azzedine
- Institute of Neuropathology, Uniklinik RWTH Aachen, Aachen 52074, Germany
| | - Karl Clark
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
| | - Silvia Corrochano
- Mammalian Genetics Unit, Medical Research Council Harwell, Oxfordshire OX11 ORD, UK
| | - Sara Wells
- Mammalian Genetics Unit, Medical Research Council Harwell, Oxfordshire OX11 ORD, UK
| | - Mariet W Elting
- Department of Clinical Genetics, VU University Medical Center, Amsterdam 1007, the Netherlands
| | - Marjan M Weiss
- Department of Clinical Genetics, VU University Medical Center, Amsterdam 1007, the Netherlands
| | - Sabrina Burn
- Children's Health Research Center, Sanford Research, Sioux Falls, SD 57104, USA
| | - Angela Myers
- Children's Health Research Center, Sanford Research, Sioux Falls, SD 57104, USA
| | - Megan Landsverk
- Children's Health Research Center, Sanford Research, Sioux Falls, SD 57104, USA
| | - Patricia L Crotwell
- Children's Health Research Center, Sanford Research, Sioux Falls, SD 57104, USA
| | - Quinten Waisfisz
- Department of Clinical Genetics, VU University Medical Center, Amsterdam 1007, the Netherlands
| | - Nicole I Wolf
- Department of Child Neurology and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam 1007, the Netherlands
| | - Patrick M Nolan
- Mammalian Genetics Unit, Medical Research Council Harwell, Oxfordshire OX11 ORD, UK
| | - Sergio Padilla-Lopez
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ 85004, USA; Neurogenetics Research Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ 85016, USA
| | - Henry Houlden
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Richard Lifton
- Department of Genetics and Yale Center for Genome Analysis, Yale School of Medicine, New Haven, CT 06516, USA
| | - Shrikant Mane
- Department of Genetics and Yale Center for Genome Analysis, Yale School of Medicine, New Haven, CT 06516, USA
| | - Brij B Singh
- Department of Basic Sciences, University of North Dakota, Grand Forks, ND 58202, USA
| | - Marni J Falk
- Division of Human Genetics, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Saadet Mercimek-Mahmutoglu
- Division of Clinical & Metabolic Genetics and Genetics & Genome Biology Program, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Kaya Bilguvar
- Department of Genetics and Yale Center for Genome Analysis, Yale School of Medicine, New Haven, CT 06516, USA
| | - Mustafa A Salih
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | | | - Michael C Kruer
- Children's Health Research Center, Sanford Research, Sioux Falls, SD 57104, USA; Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ 85004, USA; Neurogenetics Research Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ 85016, USA; Program in Neuroscience, Arizona State University, Tempe, AZ 85287, USA; Pediatric Movement Disorders Center, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ 85016, USA.
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