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Kumar N, Desai I, Kumar M, Singh J, Tiwari A, Dhar N, Madhaw G, Manchanda R, Jatale V, Radhakrishnan DM, Warrier AR, Shree R, Kumari S. Phenomenological patterns and aetiological spectrum in patients visiting a tertiary care Movement disorders service in India: An observational study. Clin Neurol Neurosurg 2024; 245:108492. [PMID: 39146723 DOI: 10.1016/j.clineuro.2024.108492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/18/2024] [Accepted: 08/01/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE Although previous studies have described phenomenological diagnoses, they lacked description of aetiological spectrum in patients visiting movement disorders (MD) service. Herein, we classify the MD phenomenology and describe aetiology wise distribution of each phenomenology in patients visiting a tertiary care movement disorders service. METHODS Collected information included demographic profile (age of onset, age at presentation, gender, duration of illness before presentation), predominant MD phenomenology [such as parkinsonism, dystonia, ataxia, tremor, chorea, ballism, myoclonus, tics, stereotypy, restless legs syndrome (RLS) and others], diagnostic evaluations and detected aetiology. RESULTS This observational study included 1140 MD patients over a span of 5 years. The median (IQR) age of onset was 49 (35-60) years and age at presentation was 54 (40-65) years, with median duration of illness being 36 (18-72) months. Nearly two-third of patients were males (M:F=731:409). Parkinsonism (n=494, 43.3 %) was the most common MD phenomenology observed, followed by dystonia (n=219, 19.2 %), ataxia (n=125, 11 %), tremor (n=118, 10.4 %), myoclonus (n=73, 6.4 %), chorea (n=40, 3.5 %), spasticity (n=22, 1.9 %), tics (n=8, 0.7 %), and RLS (n=8, 0.7 %). Thirty-three (2.9 %) patients were grouped under miscellaneous MDs. Overall, neurodegenerative disorders (57.4 %) were the most common cause of MDs. Parkinson's disease, genetic dystonia, essential tremor, genetic ataxias, hemifacial spasm, and Huntington's disease were the most common aetiologies for parkinsonism, dystonia, tremor, ataxia, myoclonus, and chorea, respectively. CONCLUSION Parkinsonism was the most common phenomenology observed in MD patients, and was followed by dystonia, ataxia and tremor. Neurodegenerative disorders were the most common aetiology detected.
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Affiliation(s)
- Niraj Kumar
- Dept. of Neurology, All India Institute of Medical Sciences, Rishikesh, India; Dept. of Neurology, All India Institute of Medical Sciences, Bibinagar, Metropolitan Region, Hyderabad, India.
| | - Ishita Desai
- Dept. of Neurology, All India Institute of Medical Sciences, Rishikesh, India
| | - Mritunjai Kumar
- Dept. of Neurology, All India Institute of Medical Sciences, Rishikesh, India
| | - Jagbir Singh
- Dept. of Neurology, All India Institute of Medical Sciences, Rishikesh, India
| | - Ashutosh Tiwari
- Dept. of Neurology, All India Institute of Medical Sciences, Rishikesh, India
| | - Nikita Dhar
- Dept. of Neurology, All India Institute of Medical Sciences, Rishikesh, India
| | - Govind Madhaw
- Dept. of Neurology, All India Institute of Medical Sciences, Rishikesh, India
| | - Rajat Manchanda
- Dept. of Neurology, All India Institute of Medical Sciences, Rishikesh, India
| | - Vinayak Jatale
- Dept. of Neurology, All India Institute of Medical Sciences, Rishikesh, India
| | - Divya M Radhakrishnan
- Dept. of Neurology, All India Institute of Medical Sciences, Rishikesh, India; Dept. of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anand R Warrier
- Dept. of Neurology, All India Institute of Medical Sciences, Rishikesh, India; Dept. of Neurology & Neuro-intervention, Baby Memorial Hospital, Calicut, Kerala, India
| | - Ritu Shree
- Dept. of Neurology, All India Institute of Medical Sciences, Rishikesh, India; Dept. of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sweety Kumari
- Dept. of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, India; Dept. of Ophthalmology, MediCiti Institute of Medical Sciences, Hyderabad, India
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Holla VV, Pal PK. Overview of management of infection-related movement disorders with focus on specific-infections. Clin Park Relat Disord 2024; 10:100233. [PMID: 38304096 PMCID: PMC10831291 DOI: 10.1016/j.prdoa.2024.100233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/09/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Infections are important treatable causes of secondary movement disorders (MD) that can have heterogeneous presentations. According to various studies, infection-related movement disorders (IRMD) account for around 10-20% of secondary MD. Certain infections have a predilection for causing various MD, and some MD phenomenologies, such as acute cerebellar ataxia and opsoclonus-myoclonus-ataxia syndromes (OMAS), suggest a strong possibility of an underlying infectious cause. The underlying pathophysiology is multifaceted, including direct neuronal damage due to neurotropism, granulomas, abscesses causing structural damage, and inflammatory and autoimmune responses triggered by infections. Understanding the prevalence, spectrum, and pattern of these IRMD and common infections that are responsible helps in early diagnosis, and instituting appropriate, timely treatment, thereby improving the overall prognosis and avoiding unnecessary investigations. In this review, we aim to provide a brief overview of common infections associated with MD, common clinical presentations of IRMD, their underlying pathophysiology, and overall approach to their treatment, with a focus on specific treatments of prevalent and treatable IRMD.
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Affiliation(s)
- Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, 560029, Karnataka, India
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