Movement Disorders

Overview & Types of Pediatric Movement Disorders - Motion Mayhem

Pediatric Movement Disorders involve involuntary movements or postures, reflecting abnormal quality or quantity of movement, often due to basal ganglia dysfunction.

• Classification:
  • Hyperkinetic (excessive movement):
    • Chorea: Rapid, irregular, flowing, non-stereotyped "dance-like" movements.
    • Athetosis: Slow, writhing, sinuous movements, predominantly distal.
    • Dystonia: Sustained or intermittent muscle contractions causing abnormal postures or repetitive movements.
    • Tics: Sudden, brief, repetitive, non-rhythmic, stereotyped movements (motor) or sounds (vocal).
    • Tremor: Rhythmic, oscillatory movement of a body part.
    • Myoclonus: Sudden, brief, shock-like muscle jerks.
    • Stereotypies: Repetitive, patterned, often rhythmic, fixed movements or postures.
  • Hypokinetic (paucity of movement): Bradykinesia, rigidity (less common in children).

⭐ Tics are the most common movement disorder in children, often transient and benign (e.g., transient tic disorder).

Tics & Tourette Syndrome - Twitchy Tales

• Tics: Sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations.
  • Motor: Simple (blinking, head jerk); Complex (jumping, facial gestures).
  • Vocal: Simple (sniffing, throat clearing); Complex (words, echolalia, coprolalia).
• Tourette Syndrome (TS):
  • DSM-5 Criteria: ≥2 motor tics & ≥1 vocal tic, for >1 year, onset <18 years.
  • Common comorbidities: ADHD (50-70%), OCD (30-50%). 📌 "OCD & ADHD go To-gether".

  ⭐ Typical age of onset for Tourette Syndrome is between 4-6 years, peaking at 10-12 years.

• Management:
  • Behavioral: Habit Reversal Training (HRT), psychoeducation.
  • Pharmacotherapy (for impairing tics):
    • Alpha-2 agonists (Clonidine, Guanfacine) - 1st line.
    • Antipsychotics (Risperidone, Haloperidol) - for severe cases.

Chorea & Dystonia in Children - Dance & Stance Storms

Chorea ("Dance")

• Definition: Involuntary, rapid, irregular, non-stereotyped, "dance-like" movements.
• Sydenham's Chorea:
  • Etiology: Post-streptococcal (Group A β-hemolytic) infection; autoimmune.
  • Key Signs: Milkmaid's grip (irregular hand grip), pronator sign (forearm pronates with arms extended), jack-in-the-box tongue (darting protrusion).
  • Associated with Rheumatic Fever.

Dystonia ("Stance Storms")

• Definition: Sustained or intermittent muscle contractions causing abnormal, often twisting/repetitive movements or postures.
• Acute Dystonic Reactions:
  • Triggers: Dopamine receptor blockers (e.g., metoclopramide, haloperidol, phenothiazines).
  • Features: Torticollis, oculogyric crisis, opisthotonus, trismus.
  • Treatment: Parenteral anticholinergics (e.g., benztropine) or antihistamines (e.g., diphenhydramine).

⭐ Acute dystonic reactions are dramatically reversed by parenteral benztropine or diphenhydramine.

Briefly: Other causes include Wilson's disease, Huntington's (chorea); cerebral palsy, genetic dystonias (dystonia).

Other Key Pediatric Movement Disorders - Oddball Oscillations

• Myoclonus: Sudden, brief, shock-like involuntary jerks.
  • Benign Neonatal Sleep Myoclonus (BNSM): During sleep, resolves by 3-6 months. Non-epileptic.
• Stereotypies: Repetitive, rhythmic, fixed, patterned movements.
  • Common in typical development (e.g., hand flapping) & ASD (more complex/persistent).

  ⭐ Stereotypies are typically rhythmic, repetitive, fixed movements that can be stopped with distraction, unlike tics which are suppressible but often have a premonitory urge.

• Tremor: Rhythmic, oscillatory involuntary movement.
  • Types: Rest, postural, action/kinetic.
  • Common causes: Enhanced physiological, essential, drug-induced.
• Wilson's Disease: Copper metabolism disorder.
  • Neuro: Dystonia, tremor (wing-beating), dysarthria.
  • Key: Kayser-Fleischer (KF) rings.

High‑Yield Points - ⚡ Biggest Takeaways

• Sydenham's chorea: Post-streptococcal; involuntary movements, emotional lability; part of Jones criteria.
• Tourette syndrome: Multiple motor & ≥1 vocal tics (>1 year, onset <18 yrs); high ADHD/OCD comorbidity.
• Cerebral Palsy: Spastic most common; dyskinetic CP from basal ganglia injury (e.g., kernicterus).
• Wilson's disease: Copper accumulation; K-F rings, hepatic & neuro (dystonia, tremor) signs.
• Acute dystonia: Often drug-induced (e.g., metoclopramide); treat with anticholinergics.
• Ataxia-Telangiectasia: AR; cerebellar ataxia, telangiectasias, immunodeficiency, ↑ AFP.