Movement disorders in Children 2022.pdf
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Abnormal movements in children Ataxia Chorea Dystonia
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Movement disorders in Children 2022.pdf
- 1. Movement disorders in Children Types, Clinical Presentation, Diagnosis, Management Prof. Imran Iqbal Fellowship in Pediatric Neurology (Australia) Prof of Paediatrics (2003-2018) Prof of Pediatrics Emeritus, CHICH Prof of Pediatrics, CIMS Multan, Pakistan
- 2. (God Almighty revealed to Prophet Muhammad (PBUH) for all mankind) Alif, Lam, Ra. These are the verses of the clear Book. Indeed, We have sent it down as an Arabic Quran, so that you may understand. We narrate to you, the best of stories The Holy Quran surah Yusuf 12:1 - 3 Al- Quran
- 3. A new Muslim from Tamil Nadu, India says: “You people have Wonderful Amazing Book (Quran) hiding in your homes. World must read this (Quran)”
- 5. CNS disease – Clinical Presentation • Seizures / Convulsions / Fits • Impaired Conscious level • Developmental delay • Intellectual handicap • Neurological Paralysis / Paresis • Neuromuscular disorders • Movement disorders • Headache • Regression of acquired milestones • Behaviour problems
- 6. Movement disorders Ataxia Dystonia Involuntary movements
- 7. ATAXIA (incoordination) in children Clinical Presentation, Types, Causes
- 8. Ataxia Definition • Inability to make smooth, accurate, coordinated movements • Usually due to dysfunction of Cerebellum or its connections
- 9. Ataxia Clinical Presentation • Broad based gait • Falls in walking • Clumsiness of hand movements • Difficult fine movements • Dysmetria (lack of precision in movements) • Intention tremors • Dysarthria • Nystagmus
- 10. Ataxia Clinical Types • Motor Ataxia – (with open eyes) Cerebellum and its connections • Differentiate from: • Sensory Ataxia – (with closed eyes only) Posterior columns (proprioceptive sensations)
- 11. Motor Ataxia Clinical Presentation (Video)
- 12. Sensory Ataxia Romberg sign (Video)
- 13. Acute Ataxia - Etiology (Sudden Onset) • Drugs / Poisoning / Intoxication • Muscle Weakness - (GBS) • Acute Cerebellar Inflammation – Acute Cerebellar Ataxia
- 14. Acute Cerebellar Ataxia • Age – One to three years • Sudden onset of severe ataxia • Post - viral illness (Varicella) • Auto-immune response • Improves spontaneously in weeks to months • Corticosteroids may help in recovery
- 15. Chronic Ataxia - Etiology (Slow Onset) • Brain tumors • Neuroblastoma • Cerebellar malformations • Genetic causes • Friedrich’s Ataxia • Ataxia Telangiectasia
- 16. Friedrich’s Ataxia Dysfunctions • Autosomal Recessive Genetic disease • Ataxia – starts before 10 years of age • Slowly progressive • Spinal Cord - Corticospinal tract, Spinocerebellar Tract and Dorsal columns affected • Cardiomyopathy • Scoliosis • Pes cavus
- 17. Ataxia Telangiectasia • Autosomal Recessive Genetic disease • Ataxia – starts around 2 years of age • Immunodeficiency – frequent sino-pulmonary infections • Telangiectasia (on bulbar conjunctiva) – develop later
- 19. Dystonia (tonic muscle contraction) in children Clinical Presentation, Causes, Management
- 20. Dystonia Clinical Presentation • Involuntary, sustained skeletal muscle contraction • Twisting movements • Abnormal postures • Contraction of agonist and antagonist muscles • Failure to relax • Painful muscle contractions
- 22. Dystonia Etiology – Basal Ganglia • Acute Dystonia – • Drugs – Metoclopramide, Haloperidol • Encephalitis • Chronic Dystonia – • Cerebral Palsy (dyskinetic type) - due to Kernicterus • Wilson disease • Genetic disorders
- 23. Dystonia Management • Muscle relaxants – Baclofen • Sedatives – Diazepam, Clonazepam • Anti-cholinergics - Procyclidine • Dopamine agonists – Levodopa • Paralytics – Botulinum toxin injection
- 24. Involuntary movements in children Types, Clinical Presentation, Causes
- 25. Involuntary movements • Chorea – small amplitude peripheral movement • Athetosis – writhing movement • Tremors – oscillating movement • Tics – habitual repetitive movements • Myoclonus – sudden small jerky movements • Ballismus – large amplitude jerky movement
- 26. Chorea in children Clinical Presentation, Causes, Management
- 27. Chorea • Involuntary movements • Semi-purposive • Random • Variable movements • Movements at rest • Movements usually involve peripheral parts of body • Inability to maintain static posture
- 28. Chorea (Video)
- 30. Chorea Etiology • Rheumatic Fever - Sydenham’s Chorea • SLE • Genetic disorders
- 31. Chorea Management • Sedatives – Diazepam, Clonazepam • Anti-epileptics – Phenobarbitone, SodiumValproate • Anti-Psychotics – Haloperidol, Chlorpromazine
- 32. Tic disorder in children Clinical Presentation, Causes
- 34. Tics (Stereotype Movements) • Motor movements or Vocalisations • Involuntary, abrupt, repetitive, non-rhythmic • Simple or complex • Can be suppressed by voluntary effort • often associated with other Behavior disorders
- 35. Myoclonus in children Clinical Presentation, Types, Causes
- 36. Myoclonus Video
- 37. Myoclonus • Muscle jerks – Involuntary, Sudden, Quick • ETIOLOGY • Physiological myoclonus – in sleep • Essential myoclonus – aggravated by stress • Epilepsy (myoclonic epilepsy) • Acute Encephalopathy • Degenerative Brain disorders • MANGEMENT • No treatment needed for Physiological myoclonus
- 38. Prof Imran Iqbal Fellowship Pediatric Neurology-1991 Royal Children Hospital, Melbourne, Australia