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Prevalence of Movement Disorders in Pediatric Age Group. Int J Health Sci Res

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Prevalence of Movement Disorders in Pediatric Age Group. Int J Health Sci Res International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Prevalence of Movement Disorders in Pediatric Age Group Mahesh Ahirrao1, Prashant Bhadane1, Sanjay Joshi2, Jagdish Pakhare1, Shrikant Patil1 1MD Pediatrics, 2HOD & Professor, Dept. of Pediatrics, A.C.P.M. Medical College, Dhule. Corresponding Author: Prashant Bhadane Received: 23/11/2015 Revised: 24/12/2015 Accepted: 29/12/2015 ABSTRACT The objective of this study outlines the age & sex of distribution, pathophysiology, clinical presentation, various types of movement disorders, their incidence, diagnostic modalities with diagnostic differences and therapy of movement disorders and outcome in children. This prospective study design was done over a period one year. Patients were either admitted in the wards or were attending our special Pediatric neurology clinic at our tertiary referral centre. Total of 64 patients were under 15 years of age. Interventions were done depending on the possible etiology; the patients were subjected to specific investigations. Various modalities of treatment given to our study group were surgical, medical and other therapies. The manuscript does not plan to report the outcome. The results indicated that in our study group, 18 cases (28.08%) showed complete recovery at the end of 3 months while 27 patients (42.18%) had partial improvement. 11 cases (17.18%) had persistence of movements while 5 cases didn’t follow up (7.80%). 3 patients died in our series. The conclusions characteristics of movement disorders in children are different compared to adults. Movement disorders, if diagnosed early and treated promptly have good prognosis. The patients showing complete recovery were generally those with secondary to transient etiologies such as drug toxicity, acute cerebellar ataxia and TBM. Some special circumstances like inborn errors of metabolism and genetic conditions selectively affect the immature developing brain and outcome of the disease. Keywords: Movement Disorders, Pediatric. INTRODUCTION or regions of brain interconnected with the Movement disorders are the basal ganglia. The basal ganglia, a network abnormal or excessive involuntary of nuclei in the forebrain, diencephalon movements that may result in posture, and midbrain. [ 2- 4] Dystonia results from tone, balance, or fine motor control. Most lesions in striatum (putamen or caudate), movement disorders are characterized by globus pallidus, or thalamus. [ 5, 6] These involuntary movements. [ 1] Abnormal may subsequently lead to dysfunction in involuntary movements can be the primary the cerebral cortex and brainstem. [ 7] The presenting feature of a disease or they can underlying systemic disease requires occur as a late manifestation. They are thorough investigation and management frequently observed in many neurological plan to achieve the most favourable illnesses, endocrine conditions, metabolic outcome. Why Movement disorders in disorders, drug toxicities or psychiatric children are different as compared to illnesses and pose a diagnostic challenge adults? : to paediatrician. Most movement disorders A. Several of the movement disorders related to dysfunction of the basal ganglia described in children are characterised International Journal of Health Sciences & Research (www.ijhsr.org) 78 Vol.6; Issue: 1; January 2016 by transient states that last for days, developed countries with a higher weeks or months with complete incidence in underdeveloped areas. [ 14] clinical resolution in most cases. Categorisation of movement Hence the more benign, transient state disorders into various types is done using needs to be differentiated from the amplitude and rhythmicity. Clinical devastating long standing disorders. observation is the mainstay of diagnosis. B. Furthermore, children show Furthermore, many systemic disorders fluctuations in their clinical manifest with several movement disorders manifestations, such as temporary (e.g. tremor, dystonia and rigidity in deterioration in children with dystonia Wilson’s disease) and at any point, one or chorea with intercurrent infections. manifestation may be prominent and may The possibility that PANDAS mask other movements. Additionally, most (pediatric autoimmune children attempt to mask the abnormal neuropsychiatric disorders associated movement by combining them with with streptococcal infections) is also a normal movement patterns, in order to post streptococcal disorder in some has avoid embarrassment. Thus even most been raised. [ 8] experienced observer will at times mistake C. Children often show a latent period of one movement for another or will have presentation for example, onset of difficulty conceptualizing the nature of an dystonia in a child with cerebral palsy abnormal movement. Videotaping, at is much later than its other clinical home or in clinics / hospital, proves manifestations. [ 9] extremely beneficial. A movement disorder is a broad The spectrum of pathophysiology term which encompasses the of movement disorders in children range extrapyramidal disorders along with from structural abnormalities, genetics, disorders of incoordination and even neuroimmunologic basis to psychogenic corticospinal tract dysfunction including causes. Structural abnormalities or lesions spasticity. They are usually associated of the central nervous system and of basal with abnormalities of basal ganglia. ganglial connecting structures may be Movement disorders in children are delineated in some cases of abnormal broadly classified into hypokinetic and involuntary movements with the help of hyperkinetic disorders. [ 10] Hypokinetic neuroimaging. Recent studies have found movement disorders are characterised by that movement disorders have genetic paucity of movement such as akinesia or basis (Huntington’s disease) or a bradykinesia in which purposeful motor neuroimmunologic basis (e.g. Sydenham’s activity is absent or reduced for example, chorea, Tourette syndrome). [ 15, 16] A Parkinson’s disease. Hyperkinetic psychogenic especially in preschool and movement disorders are those in which an school going children. excessive amount of spontaneous motor The workup can range from simple activity is seen or in which abnormal blood count, ESR to metabolic work up involuntary movements occur. such as measurement of electrolytes, Hyperkinetic movements are further calcium, glucose etc. Suspected drug classified into rhythmical (e.g. tremors) toxicities need measurement of drug and non rhythmical (rapid such as tics, levels. Neuroimaging especially MRI is chorea, ballismus and myoclonus or slow very useful. PET and SPECT scans such as athetosis and dystonia). [ 11] drastically revolutionised the early Cerebral palsy is categorized into spastic, diagnosis, detection of underlying extra-pyramidal or dyskinetic, and mixed. etiology, follow up and prognostication. If [ 12, 13] Perinatal asphyxia in term infants all the above tests are inconclusive, then in accounts for less than 15% of CP in such cases, genetic studies are advised. International Journal of Health Sciences & Research (www.ijhsr.org) 79 Vol.6; Issue: 1; January 2016 Various treatment options in such infection, exposure to medication, koch’s cases include drugs such as neuroleptics, contact etc. benzodiazepines and β-blockers. They are The description of the movement started with mild drugs and in smaller disorder as told by the parents and as doses and titrated according to the observed in wards was the basis for response. [ 15, 17, 18] classifying them. We undertook this study to A thorough clinical examination determine the prevalence of movement was performed with detailed disorders in different age and sex group, to anthropometric measurements. Abnormal evaluate their underlying illnesses, to facies, neurocutaneous markers, eye and study neuroimaging findings of these ear abnormalities were looked for. Vital patients and treatment outcome. parameters of patients were recorded. A Aims and Objectives: detailed neurological examination was 1) To estimate the prevalence of done with special attention of higher movement disorders in different age functions, cranial nerve examination, and sex group. motor and sensory system, cerebellar signs 2) To determine the spectrum of and gait. Abnormal movements were involuntary movements in children. aggravated by asking to perform special 3) To evaluate underlying etiologies of tasks relating to the type of involuntary movement disorders. movement. 4) To study the patterns of clinical Depending on the possible presentations of children with etiology, the patients were subjected to movement disorders. specific investigations. These are from 5) To correlate neuroimaging findings in ESR, complete blood count, metabolic patients with movement disorders. parameters like RBS, calcium, magnesium, 6) To study efficacy of various treatment x-ray chest, EEG, MT, neuroimaging options for children with abnormal (CT/MRI), 24hr urinary copper, serum movements and to determine their ceruloplasmin, IQ/DQ, BERA, serum drug outcome. levels etc. Statistical data were compared using chi- MATERIALS AND METHODS square test and the chi-square test of This prospective study was done goodness of fit. over a period one year and included 64 P<0.001 was statistically highly patients under 15 years of age who were significant. either admitted in the wards or were P<0.05 was considered statistically attending our special Pediatric neurology significant. clinic at our tertiary referral center. P>0.05 was considered statistically
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