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Spectrum and Evolution of Movement Disorder Phenomenology in a Pediatric Powassan Encephalitis Case Series
Kathryn Yang1, Rebecca Lindsay2, Vicente Quiroz1
1Movement Disorders Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Background:
The Powassan virus is a rare neurotropic, tick-borne arbovirus associated with meningoencephalitis. Despite the virus's known predilection for the basal ganglia, there are no reports detailing the spectrum of movement disorders in children with Powassan meningoencephalitis.
Cases:
We present 3 cases of pediatric Powassan encephalitis, highlighting the diverse and evolving movement disorders associated with this disease. We observed subcortical myoclonus and progressive generalized dystonia (patient 1), transient dyskinesias and refractory focal dystonia (patient 2), and generalized dystonia evolving into chorea and lingual dyskinesias (patient 3). One patient exhibited multifocal vasculitis on magnetic resonance imaging angiography, a novel finding.
Conclusions:
Movement disorders were a primary source of the morbidity experienced by pediatric Powassan encephalitis patients throughout their disease course, underscoring the importance of regular monitoring and adaptable treatment strategies in this condition. Larger, prospective studies are necessary to fully delineate the spectrum of associated movement disorders in this rare and severe disease.
Insights
Powassan virus encephalitis in children can cause varied movement disorders, including myoclonus, dystonia, and chorea. Early monitoring and flexible treatments are crucial for managing this rare neurological condition.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Powassan virus is a rare, neurotropic, tick-borne arbovirus causing meningoencephalitis.
- The basal ganglia are a known predilection site for Powassan virus.
- Limited data exists on movement disorders in pediatric Powassan meningoencephalitis.
Purpose of the Study:
- To describe the spectrum of movement disorders in pediatric Powassan encephalitis.
- To highlight the clinical presentation and evolution of these movement disorders.
Main Methods:
- Case series of 3 pediatric patients with Powassan encephalitis.
- Clinical observation of movement disorders.
- Magnetic resonance imaging angiography in one patient.
Main Results:
- Observed diverse movement disorders: myoclonus, dystonia, dyskinesias, and chorea.
- Movement disorders evolved throughout the disease course.
- One patient showed multifocal vasculitis on MRI angiography, a novel finding.
Conclusions:
- Movement disorders are a significant source of morbidity in pediatric Powassan encephalitis.
- Regular monitoring and adaptable treatment strategies are essential.
- Further prospective studies are needed to fully understand associated movement disorders.
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