Movement Disorders in Children: Treatment Algorithm and Surgical Options

Paediatric movement disorders (PMDs) encompass a wide range of diseases resulting from countless aetiologies. These are distinct from their adult counterparts, with a far greater proportion of genetic mutations, perinatal injuries, metabolic disorders, and in many cases, undefined neurodevelopmental abnormalities. Given the complexity of both the diagnostic process and management pathway of PMDs, early identification is critical to guide appropriate intervention in a timely manner. Through early recognition and management, clinicians positively impact neurodevelopment, quality of life, and long-term functional outcomes in children with PMDs.Effective management of PMDs necessitates the cooperation of an extensive multidisciplinary team of healthcare professionals, including neurologists, physiotherapists, occupational therapists, psychologists, and neurosurgeons. Each specialist brings their own perspective and expertise to best manage these complex patients.The initial treatment of paediatric movement disorders is widely centred on pharmacotherapy, with medications guided by underlying aetiology and symptoms. As such, medical management can be seen as treating either the manifestation and symptoms of the movement disorder, or in the case of autoimmune or inflammatory aetiologies, the underlying disease process. As a result, by the time patients have been referred for a neurosurgical opinion they have often trialled a number of different pharmacotherapies.Surgical intervention in paediatric movement disorders is considered when conservative treatment has failed to provide adequate symptom control or when the disorder significantly impairs the child's quality of life. The decision to proceed with surgery is multifaceted, involving careful patient selection, multidisciplinary evaluation, and consideration of the specific movement disorder phenotype.​This chapter integrates contemporary literature to propose a reliable framework with which neurosurgeons can approach paediatric movement disorders, with a specific focus on neurosurgical options, including deep brain stimulation (DBS), pallidotomy, and rhizotomy.