Acute Movement Disorders in Childhood

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.

Dancing Out of Step: A Case of Tuberculous Meningitis Presenting as Childhood Chorea

“…Hyperkinetic MDs are more frequent in pediatrics as compared to hypokinetic MDs. Differentials for the former are dependent on the predominant phenomenology, age at presentation, time frame, and other associated manifestations [1][2][3]. We report an atypical case of subacute pediatric chorea that highlights the importance of prompt diagnosis of a treatable condition.…”

“…Acute to subacute onset pediatric movement disorders (MD) require prompt diagnosis to identify potentially treatable diseases [1,2]. Currently, there is a dearth of data regarding these conditions and there are no available large population studies determining true incidence in children [2]. Hyperkinetic MDs are more frequent in pediatrics as compared to hypokinetic MDs.…”

Overview of management of infection-related movement disorders with focus on specific-infections

“…Flaviviruses (Japanese encephalitis virus (JEV), dengue virus, West Nile virus (WNV)) has a predilection to affect basal ganglia structures resulting in dystonia-parkinsonism [9] , [23] , [24] , [25] , [26] . Herpes simplex virus (HSV), varicella, mumps, measles, enterovirus, Influenza-A, Epstein-Barr virus and other viral infections can cause acute ataxia, OMAS and chorea-dystonic syndromes [10] , [11] , [27] , [28] , [29] . Recently coronavirus disease 2019 (COVID-19) and congenital Zika virus-related MD have also been reported [30] , [31] , [32] .…”

“…Human immunodeficiency virus (HIV) related MD can be directly due to HIV encephalopathy or secondary to opportunistic infections. Other infections that can lead to IRMD are parasitic (cerebral malaria and neurotoxoplasmosis), helminthic (neurocysticercosis), and fungal infections (cryptococcosis and histoplasmosis) [5] , [18] , [29] , [33] , [34] , [35] , [36] , [37] , [38] , [39] . Creutzfeldt-Jacob disease, a neurodegenerative condition caused by an abnormal infectious prion protein, can also manifest with MD, including myoclonus, ataxia and parkinsonism.…”

A Comprehensive Review of Secondary Movement Disorders

“…Post-streptococcal movement disorders (PSMDs) are a group of movement disorders that occur following a streptococcal infection, typically caused by Streptococcus pyogenes. These disorders are thought to result from an autoimmune response triggered by the infection, leading to inflammation and dysfunction in the basal ganglia, a brain region involved in movement control [64].…”