From the Guidelines
The approach to diagnosing and managing movement disorders in children requires a systematic evaluation followed by targeted treatment, prioritizing a detailed history, comprehensive neurological examination, and diagnostic testing such as brain MRI and genetic testing, as recommended by the most recent and highest quality study 1.
Key Components of the Approach
- Initial assessment should include a detailed history focusing on onset, progression, exacerbating factors, and family history, coupled with a comprehensive neurological examination to characterize the movement abnormality.
- Diagnostic testing typically involves brain MRI to identify structural abnormalities, metabolic screening (including copper, ceruloplasmin for Wilson's disease), genetic testing for conditions like DYT1 dystonia or Huntington's disease, and sometimes lumbar puncture to evaluate neurotransmitter disorders.
- Management is disorder-specific, with medications and therapies tailored to the specific movement disorder, such as dystonia, chorea, tic disorders, or Parkinsonism.
Management Strategies
- For dystonia, medications like trihexyphenidyl or baclofen are first-line treatments, with botulinum toxin injections for focal dystonia.
- Chorea may respond to tetrabenazine or antipsychotics like risperidone.
- Tic disorders often benefit from behavioral therapy, with medications like clonidine or risperidone added for severe cases.
- Parkinsonism may require levodopa, with deep brain stimulation considered for drug-resistant cases.
Importance of Multidisciplinary Care
- Regular follow-up is essential to monitor treatment efficacy and side effects.
- Multidisciplinary care, including physical, occupational, and speech therapy, is crucial to maximize function and quality of life.
- Early intervention is vital, as many movement disorders can significantly impact a child's development and daily functioning, as highlighted in 1 and 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Approach to Diagnosing Movement Disorders in Children
- The diagnosis of movement disorders in children can be challenging due to the variability of disease processes and the similarity of symptoms between different disorders 2, 3.
- A practical and phenomenology-oriented framework for diagnosing and managing treatable movement disorders of infancy and early childhood has been proposed, which includes treatments specific to the disease, prevention of progression, hastening recovery, and surveillance and management of associated comorbidities 2.
- The diagnostic approach to pediatric movement disorders involves eight consecutive steps, including recognition of the different movement disorders, identification of a clinical syndrome, consideration of acquired causes, genetic testing, post-sequencing phenotyping, and interpretation of test results 3.
Key Considerations in Diagnosing Movement Disorders in Children
- Accurate history, detailed clinical examination, review of video footage, and neuroimaging and laboratory investigations are essential for elucidating the underlying cause of movement disorders in children 4, 5.
- Recognition of distinctive diagnostic clues in the history and examination can facilitate the diagnosis of potentially treatable disorders 5.
- The clinical spectrum of pediatric movement disorders is broad and heterogeneous, ranging from acute or transient self-limited conditions to conditions that cause profound lifelong motor disability 5.
Psychogenic Movement Disorders in Children
- Psychogenic movement disorders can present with abnormal movements and do not have an identifiable neurologic basis, but rather a psychologic basis 6.
- Elements of history, physical examination, and therapeutic intervention must be combined to construct a clear diagnosis of a psychogenic movement disorder in children 6.
- Prospective trials are needed to provide a solid foundation for better diagnosis and treatment of psychogenic movement disorders in children 6.