Post-traumatic movement disorders in survivors of severe head injury

The present study investigates the occurrence of post-traumatic movement disorders in survivors of severe head injury. We studied a series of 398 consecutive patients who were admitted to the hospital with a Glasgow Coma Score of 8 or less after they sustained a head trauma. One hundred thirty-four out of 398 patients (34%) died after they were admitted to the hospital or in the further course. A recent follow-up was obtained in 221 of the 264 remaining patients (84%). Follow-up consisted of a three-level assessment, including questionnaires, telephone interviews, and personal examinations. Fifty out of 221 patients (22.6%) had developed movement disorders secondary to the head trauma, which were transient in 23 patients (10.4%) and persistent in 27 patients (12.2%). Forty-two patients (19%) had tremors, nine (4.1%) had dystonia, and seven (3.2%) had other movement disorders. Twelve patients (5.4%) had disabling low-frequency kinetic tremors (2.5 to 4 Hz) or dystonia, or both. Low-frequency kinetic tremors developed with a latency from 2 weeks to 6 months after trauma, and dystonia with a latency from 2 months to 2 years. When compared with patients without movement disorders, this subgroup was characterized by a different distribution profile of Glasgow Coma Scores with a higher proportion of lower scores on admission (p < 0.05). When we compared the initial CT findings, there were highly significant associations between generalized brain edema and the occurrence of any movement disorders, between generalized brain edema and the occurrence of persistent movement disorders, and between generalized brain edema and the occurrence of kinetic tremors and dystonia. We detected similar associations for focal cerebral lesions, but not for subdural and epidural hematomas. In conclusion, transient or persistent movement disorders are common sequelae in survivors of severe head injury. Disabling movement disorders such as kinetic tremors and dystonia, however, occur only in a small group of patients.