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Movement Disorders in Children
Rahul Jain1, Sanjay Pandey2, Sanjay Raghav3
1Department of Pediatrics, Lok Nayak Hospital, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India. Correspondence to: Dr Rahul Jain, 7 Nixon Street, Kepnock, Queensland, Australia-4670. drrahuljain1980@gmail.com.
Insights
Pediatric movement disorders, often hyperkinetic, have diverse causes including genetic and acquired conditions. This review simplifies diagnosis and management for common childhood movement disorders like dystonia and chorea.
Area of Science:
- Pediatric Neurology
- Movement Disorders
- Clinical Diagnosis
Background:
- Movement disorders are common in children, posing diagnostic challenges.
- A wide range of etiologies exist, including genetic, infectious, immune-mediated, and drug-induced causes.
- Hyperkinetic disorders are more prevalent than hypokinetic disorders in pediatric populations.
Purpose of the Study:
- To provide an overview of common pediatric movement disorders.
- To present a simplified clinical approach for diagnosis and management.
- To incorporate the latest evidence on classification, features, diagnosis, and treatment.
Main Methods:
- Narrative review based on contemporary evidence and expert experience.
- Medline search for recent advances, consensus, and classification.
- Focus on clinical features, diagnosis, and treatment strategies.
Main Results:
- Movement disorders are broadly classified into hyperkinetic and hypokinetic types.
- Common hyperkinetic disorders include dystonia, chorea, tics, and tremor.
- Diagnosis relies on age of onset, movement characteristics, and associated neurological/systemic features.
Conclusions:
- A synopsis of pediatric movement disorders, updated with current evidence, is presented.
- A simplified diagnostic approach for dystonia and chorea has been developed.
- Management of pediatric movement disorders is complex and evolving.
Context:
Movement disorders represent a common presentation in pediatrics and are often a source of clinical and diagnostic dilemmas. In this review, we provide an overview of common causes along with simplified clinical approach and management options for major movement disorders.
Sources:
This narrative review is based on contemporary evidence and personal experience. Medline was searched for recent advances, current understanding and consensus on classification, clinical features, diagnosis and treatment.
Results:
Movement disorders are classified as hyperkinetic and hypokinetic disorders, the latter being rare in childhood. The hyperkinetic disorders include dystonia, chorea, athetosis, tics and tremor, stereotypies, myoclonus, startle syndromes and functional disorders. Some movement disorders can be benign and developmental. A large proportion of conditions are genetic in origin with a guarded prognosis. Some of the conditions may be post-infectious, immune-mediated or drug induced. Multiple types of movement disorders are present in many conditions. The age at onset, type and distribution of abnormal movements and presence of associated neurological and systemic features help in narrowing the differential diagnosis. The pharmacotherapy of movement disorders is complex and evolving.
Conclusion:
A synopsis of movement disorders presenting in pediatric age has been provided, incorporating the latest evidence. A simplified approach for clinical diagnosis has been developed for dystonia and chorea.
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