Pediatric emergency medicine trisk 2648 2648
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movements into specific subtypes, based on the character, predominant anatomic
localization, rhythmicity, and frequency, can be useful in deducing the cause of
the disorder. Additionally, the type of movement can suggest the location of CNS
dysfunction ( Table 97.9 ).
CLINICAL PEARLS AND PITFALLS
Tics are the most common movement disorder in children.
Acute dystonia in children is almost always associated with exposure to
an antidopaminergic medication.
Treatment with prednisone can decrease the duration of chorea and
the time to full remission in patients with Sydenham chorea.
Acute Dystonia
Dystonia is marked by involuntary, sustained muscle contractions, typically of the
neck and trunk, that cause twisting movements and abnormal postures. In
generalized dystonia, the head is usually deviated to the side and there is
grimacing of the face. Acute dystonia in children is nearly always the result of
exposure to an antidopaminergic agent such as a neuroleptic, antiemetic, or
metoclopramide. Chronic dystonias are rare but may be seen as an isolated
disorder or as a manifestation of cerebral palsy. Dystonia must be differentiated
from torticollis, an abnormal tilt of the head and neck usually resulting from
irritation or spasm of the sternocleidomastoid muscle (see Chapter 49 Neck
Stiffness ). Another clinically similar condition is Sandifer syndrome, which
describes intermittent arching of the back and neck in infants with
gastroesophageal reflux.
TABLE 97.9
CATEGORIZATION OF MOVEMENT DISORDERS
