A reversible generalized movement disorder in critically ill children with cancer
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Raja B Khan1, Jeffrey E Schmidt, Robert F Tamburro
1Divisions of Neurology and Neurooncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA. raja.khan@stjude.org
Insights
Critically ill children with cancer may develop a movement disorder during intensive care. This condition, distinct from seizures, presents with specific symptoms and is exacerbated by stimulation.
Area of Science:
- Pediatric critical care medicine
- Pediatric neurology
Background:
- Children with cancer are susceptible to critical illness, often requiring intensive care due to immune suppression and sepsis.
- Prolonged intensive care unit (ICU) stays and assisted ventilation are common in these vulnerable patients.
Observation:
- A generalized movement disorder was observed in six critically ill children during extended ICU stays.
- Four of the affected children had brain tumors, with a median age of 2 years.
Findings:
- The movement disorder involved dystonic posturing, jaw movements, tongue thrusting, and eye deviations.
- Symptoms worsened with stimulation, and electroencephalograms (EEGs) ruled out seizures in five patients.
Implications:
- Differentiating this movement disorder from seizures is crucial to avoid incorrect treatments.
- Increased movement upon stimulation serves as a key diagnostic clue, with EEG aiding in differential diagnosis.
Introduction:
Some children treated for cancer become critically ill because of immune suppression and sepsis requiring prolonged intensive care support and assisted ventilation.
Methods:
Over a 3-year-period, we have identified six children (four with brain tumors) who developed a generalized movement disorder during a protracted intensive care unit stay. Median age was 2 years (range 1-6 years). Movement disorder developed while receiving multiple medications.
Results:
Sedation was achieved with midazolam and opioid infusions. Dystonic posturing of limbs, jaw movements, tongue thrusting, and intermittent eye deviations were present in all. Movements increased if the child was stimulated and an electroencephalogram performed in five children excluded seizures.
Conclusions:
This movement disorder should be differentiated from seizures to prevent inappropriate treatment. Exacerbation with stimulation is a clinical clue to the correct diagnosis and an electroencephalogram can help differentiate this movement disorder from seizures.
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