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Neurology India 2020Pediatric movement disorders are heterogeneous and complex disorders with various aetiologies. These are broadly classified as hypo and hyperkinetic disorders. Genetic...
Pediatric movement disorders are heterogeneous and complex disorders with various aetiologies. These are broadly classified as hypo and hyperkinetic disorders. Genetic causes of basal ganglia dysfunction or direct injuries to the basal ganglia mark the genesis of these abnormal movements. The management of pediatric movement disorders is multidisciplinary with pharmacotherapy as the first line of management along with physical therapy. Patients resistant to medications are candidates for invasive neuromodulation which is an upcoming treatment modality in pediatric movement disorders. Deep brain stimulation of basal ganglia and thalamic nuclei are associated with promising symptomatic benefit with reduction in disability and improvement in quality of life of these children. In this article, we have reviewed the management of pediatric movement disorders with emphasis on neuromodulation i.e., deep brain stimulation.
Topics: Basal Ganglia; Child; Deep Brain Stimulation; Dyskinesias; Humans; Movement Disorders; Quality of Life
PubMed: 33318352
DOI: 10.4103/0028-3886.302474 -
Child's Nervous System : ChNS :... Oct 2023Non-spastic movement disorders in children are common, although true epidemiologic data is difficult to ascertain. Children are more likely than adults to have... (Review)
Review
BACKGROUND
Non-spastic movement disorders in children are common, although true epidemiologic data is difficult to ascertain. Children are more likely than adults to have hyperkinetic movement disorders defined as tics, dystonia, chorea/athetosis, or tremor. These conditions manifest from acquired or heredodegenerative etiologies and often severely limit function despite medical and surgical management paradigms. Neurosurgical management for these conditions is highlighted.
METHODS
We performed a focused review of the literature by searching PubMed on 16 May 2023 using key terms related to our review. No temporal filter was applied, but only English articles were considered. We searched for the terms (("Pallidotomy"[Mesh]) OR "Rhizotomy"[Mesh]) OR "Deep Brain Stimulation"[Mesh], dystonia, children, adolescent, pediatric, globus pallidus, in combination. All articles were reviewed for inclusion in the final reference list.
RESULTS
Our search terms returned 37 articles from 2004 to 2023. Articles covering deep brain stimulation were the most common (n = 34) followed by pallidotomy (n = 3); there were no articles on rhizotomy.
DISCUSSION
Non-spastic movement disorders are common in children and difficult to treat. Most of these patients are referred to neurosurgery for the management of dystonia, with modern neurosurgical management including pallidotomy, rhizotomy, and deep brain stimulation. Historically, pallidotomy has been effective and may still be preferred in subpopulations presenting either in status dystonicus or with high risk for hardware complications. Superiority of DBS over pallidotomy for secondary dystonia has not been determined. Rhizotomy is an underutilized surgical tool and more study characterizing efficacy and risk profile is indicated.
Topics: Adult; Adolescent; Humans; Child; Dystonia; Movement Disorders; Tremor; Dystonic Disorders; Neurosurgical Procedures; Globus Pallidus; Deep Brain Stimulation; Treatment Outcome
PubMed: 37522933
DOI: 10.1007/s00381-023-06100-1 -
Journal of Neurology Aug 2019Developing disease modifying therapies for Parkinson's disease (PD) calls for outcome measurement strategies focused on characterizing early stage disease progression....
OBJECTIVES
Developing disease modifying therapies for Parkinson's disease (PD) calls for outcome measurement strategies focused on characterizing early stage disease progression. We explored the psychometric evidence for using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part II (patient motor experience of daily living) and part III (clinician motor examination) in this context.
METHODS
MDS-UPDRS-II and -III data were collected at screening, month 12, and month 24 from 384 early stage PD patients (diagnosis ≤ 2 years; Hoehn and Yahr stage 1/2) in the Parkinson's Progression Markers Initiative (PPMI) study. Psychometric analysis, based on Rasch measurement theory (RMT), was performed on both the original MDS UPDRS-II and -III scales and exploratory content-driven scale structures.
RESULTS
RMT analyses showed neither scale was well targeted to early PD. A marked floor effect appeared for most items and a clear item gap was consistently observed in very mild severity of motor signs and levels of motor impact. The original MDS-UPDRS-II and -III scales also displayed disordered thresholds (9/13 and 20/33 items, respectively), indicating response scales not functioning as expected, and misfit (5/13 and 12/33 items, respectively), flagging areas for potential improvement.
CONCLUSIONS
The MDS-UPDRS-II and -III have psychometric limitations which limits the precision of measurement of motor symptoms and impact in early PD. This can lead to insensitivity in detecting differences and clinical change. Importantly, the diagnostic psychometric evidence provided by the RMT analysis provides a clear starting point for how to improve the quantification of clinically relevant concepts to characterize the course of early PD.
Topics: Aged; Cohort Studies; Disease Progression; Female; Follow-Up Studies; Humans; Internationality; Longitudinal Studies; Male; Mental Status and Dementia Tests; Middle Aged; Movement Disorders; Parkinson Disease; Societies, Medical
PubMed: 31073716
DOI: 10.1007/s00415-019-09348-3 -
Journal of Neuroscience Methods Feb 2020Hyperkinetic movement disorders include tremors, dystonia, chorea, tics, myoclonus, stereotypies, restless legs syndrome, and various other disorders with abnormal... (Review)
Review
Hyperkinetic movement disorders include tremors, dystonia, chorea, tics, myoclonus, stereotypies, restless legs syndrome, and various other disorders with abnormal involuntary movements. Although several disorders could be included in such a broad spectrum, a limited number of conditions are modeled in non-human primates. These disabling conditions include notably L-dopa-induced dyskinesia in Parkinson's disease, tardive dyskinesia, essential tremor and Huntington's disease. Non-human primate models of these conditions exist. This short opiniated review surveys the current state of use of these models as well as the future developments.
Topics: Animals; Chorea; Dystonia; Movement Disorders; Parkinson Disease; Primates; Tremor
PubMed: 31857131
DOI: 10.1016/j.jneumeth.2019.108551 -
Handbook of Clinical Neurology 2023Botulinum neurotoxins are a group of biological toxins produced by the gram-negative bacteria Clostridium botulinum. After intramuscular injection, they produce... (Review)
Review
Botulinum neurotoxins are a group of biological toxins produced by the gram-negative bacteria Clostridium botulinum. After intramuscular injection, they produce dose-related muscle relaxation, which has proven useful in the treatment of a large number of motor and movement disorders. In this chapter, we discuss the utility of botulinum toxin treatment in three major and common medical conditions related to the dysfunction of the motor system, namely dystonia, tremor, and spasticity. A summary of the existing literature is provided along with different techniques of injection including those recommended by the authors.
Topics: Humans; Botulinum Toxins; Motor Disorders; Dystonia; Dystonic Disorders; Movement Disorders
PubMed: 37620089
DOI: 10.1016/B978-0-323-98817-9.00003-X -
Continuum (Minneapolis, Minn.) Aug 2019This article provides an overview of the clinical features and disorders associated with movement disorders in childhood. This article discusses movement disorder... (Review)
Review
PURPOSE OF REVIEW
This article provides an overview of the clinical features and disorders associated with movement disorders in childhood. This article discusses movement disorder phenomena and their clinical presentation in infants and children and presents a diagnostic approach to suspected genetic disorders with a focus on treatable conditions.
RECENT FINDINGS
Technologic advances in molecular genetic testing over the past decade continue to lead to the discovery of new diseases. This article discusses the clinical presentation and early experience with treatment for several recently described genetic forms of infantile-onset and childhood-onset dystonia and chorea.
SUMMARY
The clinical spectrum of pediatric movement disorders is broad and heterogeneous, ranging from acute or transient self-limited conditions to conditions that cause profound lifelong motor disability. Most movement disorders in childhood are chronic, and the large number of rare, genetic conditions associated with pediatric movement disorders can pose a significant diagnostic challenge. Recognition of distinctive diagnostic clues in the history and examination can facilitate the diagnosis of potentially treatable disorders.
Topics: Child; Child, Preschool; Diet, Ketogenic; Dopamine Agents; Female; Humans; Infant; Levodopa; Movement Disorders
PubMed: 31356295
DOI: 10.1212/CON.0000000000000756 -
Neurology India 2021Lamotrigine (LMT) is a phenyltriazine derivative that was originally described as an antiepileptic drug. (Review)
Review
BACKGROUND
Lamotrigine (LMT) is a phenyltriazine derivative that was originally described as an antiepileptic drug.
OBJECTIVE
This literature review aims to evaluate the clinical epidemiological profile, pathological mechanisms, and management of lamotrigine-associated movement disorders.
METHODS
Relevant reports in six databases were identified and assessed by two reviewers without language restriction. Reports that the individuals only developed tremor or ataxia after LMT use were not included.
RESULTS
In total 48 reports of 108 cases from 19 countries were assessed. The movement disorders associated with LMT found were 29 tics, 21 dyskinesias, 14 myoclonus, 13 parkinsonism, 10 dystonia, and 1 stuttering. The not clearly defined cases included 10 akathisia, 4 myoclonus, 4 cerebellar syndromes, 1 hypertonia, 1 dyskinesia, and an unknown number of dystonia cases. The mean reported age was 33.34 years (range: 1.574 years). The male was the predominant sex and the most common LMT indication was epilepsy. The mean LMT-dose at the movement disorder onset was 228 mg. The time from LMT start to the onset of movement disorder was within 6 months in 81%. The time from LMT withdrawal to complete recovery was within 1 month in 83%. The most common management was LMT withdrawal.
CONCLUSIONS
In the literature, the majority of the cases did not give a clear picture of the individual, and the times of movement disorder onset and recovery are not described. We believe that before withdrawal LMT, a dose adjustment based on the benefits and adverse events with careful evaluation case-by-case can be done.
Topics: Anticonvulsants; Ataxia; Epilepsy; Humans; Infant; Lamotrigine; Male; Movement Disorders
PubMed: 34979637
DOI: 10.4103/0028-3886.333440 -
Tremor and Other Hyperkinetic Movements... 2021Movement disorders are increasingly described in hospitalized and milder cases of SARS-CoV-2 infection, despite a very low prevalence compared to the total patients. (Review)
Review
INTRODUCTION
Movement disorders are increasingly described in hospitalized and milder cases of SARS-CoV-2 infection, despite a very low prevalence compared to the total patients.
METHODS
We reviewed the scientific literature published in English, spanning from the initial descriptions of COVID-19 until January 25, 2021, in the PubMed/MEDLINE database.
RESULTS
We identified 93 new-onset movement disorders cases (44 articles) from 200 papers screened in the database or reference lists. Myoclonus was present in 63.4% (n = 59), ataxia in 38.7% (n = 36), action/postural tremor in 10.8% (n = 10), rigid-akinetic syndrome in 5.38% (n = 5), oculomotor abnormalities in 20.4% (n = 19), catatonia in 2.1% (n = 2), dystonia in 1.1% (n = 1), chorea in 1.1% (n = 1), functional (psychogenic) movement disorders in 3.2% (n = 3) of the reported COVID-19 cases with any movement disorder. Encephalopathy was a common association (n = 37, 39.78%).
DISCUSSION
Comprehensive neurophysiological, clinical, and neuroimaging descriptions of movement disorders in the setting of SARS-CoV-2 infection are still lacking, and their pathophysiology may be related to inflammatory, postinfectious, or even indirect mechanisms not specific to SARS-CoV-2, such as ischemic-hypoxic brain insults, drug effects, sepsis, kidney failure. Cortical/subcortical myoclonus, which the cited secondary mechanisms can largely cause, seems to be the most common hyperkinetic abnormal movement, and it might occur in association with encephalopathy and ataxia.
CONCLUSION
This brief review contributes to the clinical description of SARS-CoV-2 potential neurological manifestations, assisting clinical neurologists in identifying features of these uncommon syndromes as a part of COVID-19 symptomatology.
HIGHLIGHTS
- Movement disorders are probably uncommon neurological manifestations in SARS-CoV-2 infection;- Myoclonus is the most reported movement disorder associated with COVID-19, its clinical complications or pharmacological management;- The pathophysiology is yet not well-understood but can include systemic inflammation, autoimmune mechanisms, or hypoxia.
Topics: COVID-19; Humans; Movement Disorders
PubMed: 34277139
DOI: 10.5334/tohm.595 -
Acta Neurologica Belgica Jun 2021The concept of functional movement disorders has evolved considerably over the past few decades. More specifically, the views on the relation with psychological... (Review)
Review
The concept of functional movement disorders has evolved considerably over the past few decades. More specifically, the views on the relation with psychological stressors or personality disorders have substantially changed, emphasizing a shift from the previously dominant dualistic scheme. This evolution is reflected in adaptations to diagnostic criteria and management approaches. Functional movement disorders which arise in a close temporal relationship with a peripheral trauma are specifically challenging with respect to diagnosis and treatment, but similar considerations seem to apply. The relationship of functional disorders with trauma appears to be much closer than is often thought. Clinical and pathophysiological research has identified shared factors underlying functional posttraumatic as well as primary movement disorders. These evolving insights impact on discussions in terms of litigation for compensation after trauma. The literature is reviewed and the consequences for argumentation in litigation are outlined, including ethical and legal considerations. Finally, we formulate a number of recommendations.
Topics: Humans; Jurisprudence; Movement Disorders; Stress Disorders, Post-Traumatic
PubMed: 33772740
DOI: 10.1007/s13760-021-01660-y -
Seminars in Neurology Apr 2020Movement disorders in childhood can be difficult to diagnose early. Disease processes present variably and can mimic each other. It is particularly important to remain... (Review)
Review
Movement disorders in childhood can be difficult to diagnose early. Disease processes present variably and can mimic each other. It is particularly important to remain vigilant for the subset of these movement disorders that are treatable. These disorders can be managed with (1) treatments specific to the disease that substantially reduce symptoms; (2) treatments that can prevent progression; (3) treatments that can hasten recovery; or (4) surveillance and management of the associated, sometimes life-threatening, comorbidities. Here, we present a practical and phenomenology-oriented framework for diagnosing and managing these treatable movement disorders of infancy and early childhood.
Topics: Child, Preschool; Humans; Infant; Movement Disorders
PubMed: 32079029
DOI: 10.1055/s-0040-1702938