Abstract
Background Movement disorders are broad group of acute and chronic neurological conditions in children and it has been increasingly recognized worldwide because of disturbance of activities of daily living and quality of life. Because of diagnostic and therapeutic challenges for movement disorders, phenomenology plays the key role in diagnosis of specific movement disorders and also helps in identifying the underlying causes.
Objectives The objectives of study are to classify the types of movement disorders, to identify the underlying cause and to assess the short term outcomes of children with movement disorders.
Methods Cross sectional descriptive study was conducted in all children with movement disorders attending hospital during one year period. Phenomenology of movement disorders were classified by visual pattern recognition or recorded home based videos using smartphone. Relevant clinical examination and laboratory investigations including EEG and imaging were done. Underlying causes and short term outcomes were found out.
Results Of 102 patients, types of movement disorders were dystonia (n=39) followed by chorea and athetosis (n=32), tics (n=12), tremor (n=8), stereotypes (n=5), myoclonus (n=4) and bradykinesia (n=2). Sixty per cent of the cases were older than 5 years of age. Nearly 60% of children were male. Age of onset of movement disorders more than 5 years of age is 46% of children.The median duration of abnormal movements were 345 days. The main causes of dystonia were birth asphyxia (n=13) and infection (n=9). The major causes for chorea and athetosis were infection (n=12) and kernicterus (n=12). Common cause of infections were encephalitis Among study population, 74% of dystonic children, 53% chorea and athetosis, 25% of tics, 62.5% of tremor, 50% of myoclonus and bradykinesia were improved. Twenty-six percent of dystonia, 31% of chorea and athetosis, 75% of tics, 37.5% children with tremor and 50% of myoclonus had persistent symptoms. Only 16% of chorea and athetosis and 50% of bradykinesia had completely recovered. Dystonia with underlying CNS infection, chorea and athetosis due to Syndeham’s Chorea and Wilson disease, tics, tremor due to drug-induced cases, autoimmune encephalitis and paroxysmal tremor and myoclonus of infectious encephalitis and autoimmune encephalitis were improved. Dystonia and choreo-athetosis due to cerebral palsy, all cases of sterotypes,tremor due to ALL with CNS metastasis and neurometabolic disease were persisted.
Conclusions Phenomenology plays the key role in diagnosis of specific movement disorders and also helps in identifying the underlying causes. Understanding to phenomenology and clinical profile of movement disorder in children is very crucial for correct diagnosis and management. This study pointed out that childhood movement disorders are common and most of the common movement disorders are preventable or treatable cause such as neuroinfections, immune aetiologies, hypoxic injury at birth, kernicterus and drug induced movement orders. Because of diverse aetiologies pose a diagnostic challenge to pediatrician, emphasis on phenomenology plays a role. Focusing on those factors, diagnosis approach of pediatric movement disorders can be simplified.
