Dystonic storm: a practical clinical and video review

Area of Science:

• Neurology
• Movement Disorders
• Intensive Care Medicine

Background:

• Dystonic storm is a severe, hyperkinetic movement disorder emergency.
• It presents with rapid exacerbation of dystonia and autonomic instability.
• Prompt recognition and intervention are crucial due to high morbidity and mortality.

Purpose of the Study:

• To outline a management algorithm for dystonic storm.
• To differentiate dystonic storm from other movement disorder emergencies.
• To guide decision-making in the acute and subacute phases of management.

Main Methods:

• Review of clinical features and known triggers of dystonic storm.
• Proposal of a phased management approach (first 24 hours and next 2-4 weeks).
• Identification of early intervention candidates for pallidal deep brain stimulation or intrathecal baclofen.

Main Results:

• Dystonic storm is characterized by fever, tachycardia, tachypnea, hypertension, and autonomic instability.
• Progression to bulbar dysfunction, including dysarthria, dysphagia, and respiratory failure, can occur.
• Triggers like infection or medication changes are identified in about one-third of cases.

Conclusions:

• A structured, time-based management algorithm is proposed for dystonic storm.
• Initial 24-hour management focuses on supportive therapy and identifying candidates for advanced interventions.
• Subsequent management (2-4 weeks) aims for symptomatic control and continued supportive care.