Movement Disorders Emergencies

Renato P. Munhoz; Laura M. Scorr; Stewart A. Factor

Disclosures

Curr Opin Neurol. 2015;28(4):406-412. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Although movement disorders are traditionally viewed as chronic diseases that are followed electively, a growing number of these patients present with acute, severe syndromes or complications of their underlying neurological problem. Identifying and managing movement disorders emergencies is challenging, even for the specialist. This review summarizes evidence outlining the clinical presentation of acute, life-threatening movement disorders.

Recent findings We review the most significant aspects in the most common movement disorders emergencies, including acute complications related to Parkinson's disease and parkinsonism, serotonergic, and neuroleptic malignant syndromes, chorea, ballismus, dystonia, myoclonus, and tics.

Summary The increasing amount of information delineating the descriptions of movement disorders emergencies provides means for more effective prevention, identification, and management for the nonspecialist. Although the commonest of these syndromes eventually have a good outcome, serious conditions such as neuroleptic malignant syndrome and status dystonicus may induce substantial rates of morbidity and mortality. This review re-emphasizes the need for their prompt identification and management.

Introduction

Movement disorders encompass disabling syndromes typically viewed as a realm of inexorably progressive chronic disorders that are, in most cases, followed and treated in ambulatory care settings. More recently, this view has been challenged by the growing body of literature as well as clinical experience showing that movement disorders can also present acute and more aggressively.[1] The concept of movement disorders emergencies has been coined to address such situations, as a neurological disorder evolving acute or subacutely, in which the clinical presentation is dominated by movement disorders and in which failure to accurately diagnose and manage the patient may result in significant morbidity or even mortality. Here, we used these criteria to concisely review diagnostic approaches to movement disorders emergencies by identifying the phenomenology according to the predominant abnormal movement pattern, describing common causes and therapeutics.

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