Carlo Dallocchio1, Angela Matinella2, Carla Arbasino1, Natale Arno'1, Margaret Glorioso1, Massimo Sciarretta1, Massimiliano Braga3, Michele Tinazzi4. 1. Department of Medical Area, Neurology Unit, ASST Pavia, Via Volturno, 14, 27058, Voghera, PV, Italy. 2. Department of Medical Area, Neurology Unit, ASST Pavia, Via Volturno, 14, 27058, Voghera, PV, Italy. angelamatinella@gmail.com. 3. Neurology Unit, ASST Vimercate, Vimercate, Italy. 4. Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy.
Abstract
INTRODUCTION: Acute movement disorders (MD) are etiologically heterogeneous entities. Since studies on the relative frequency of different MD and their underlying diseases are limited, we performed a prospective study to investigate the spectrum of various MD and their causes in patients presenting with acute MD in an emergency room (ER) setting. OBJECTIVE: To describe the spectrum and outcomes of acute MD in a prospective cohort and to guide its management. METHODS: We investigated acute MD in 96 consecutive patients admitted to ERs between 2013 and 2017. Time of disease onset, type of MD according to published criteria, diagnostic workup, and outcome were collected. RESULTS: 73.9% of patients had hyperkinetic MD. Tremor was the most common symptom (19.8%), followed by myoclonus (17.7%), dystonia (15.6%), and chorea (11.4%). Other hyperkinetic MD (9.4%) included were gait disorders (imbalance due to involuntary movement), dyskinesia, akathisia, hemiballism, and oculogyric crisis. Hypokinetic MD included acute parkinsonism (15.6%), off-state (4%), akinesia (3%), and rigidity (3%). Co-occurrence of more than one MD was seen in 19.7% of patients. Time delay to medical consultation was between < 24 h and 28 days. Five etiological groups were recognized: drug-induced (29.2%), functional (19.8%), neurodegenerative diseases (15.6%), structural brain damage (11.5%), others (24.0%, metabolic, inflammatory, infective, undetermined). Outcome was better for neurodegenerative diseases and for drug-induced MD. Functional movement disorders (FMD) showed less favorable outcome. CONCLUSIONS: Acute MD is a distinct cause of ER admission, and a variety of treatable diseases may be the underlying cause of this symptom. Uncertain course is more probable in FMD and in structural brain lesions.
INTRODUCTION: Acute movement disorders (MD) are etiologically heterogeneous entities. Since studies on the relative frequency of different MD and their underlying diseases are limited, we performed a prospective study to investigate the spectrum of various MD and their causes in patients presenting with acute MD in an emergency room (ER) setting. OBJECTIVE: To describe the spectrum and outcomes of acute MD in a prospective cohort and to guide its management. METHODS: We investigated acute MD in 96 consecutive patients admitted to ERs between 2013 and 2017. Time of disease onset, type of MD according to published criteria, diagnostic workup, and outcome were collected. RESULTS: 73.9% of patients had hyperkinetic MD. Tremor was the most common symptom (19.8%), followed by myoclonus (17.7%), dystonia (15.6%), and chorea (11.4%). Other hyperkinetic MD (9.4%) included were gait disorders (imbalance due to involuntary movement), dyskinesia, akathisia, hemiballism, and oculogyric crisis. Hypokinetic MD included acute parkinsonism (15.6%), off-state (4%), akinesia (3%), and rigidity (3%). Co-occurrence of more than one MD was seen in 19.7% of patients. Time delay to medical consultation was between < 24 h and 28 days. Five etiological groups were recognized: drug-induced (29.2%), functional (19.8%), neurodegenerative diseases (15.6%), structural brain damage (11.5%), others (24.0%, metabolic, inflammatory, infective, undetermined). Outcome was better for neurodegenerative diseases and for drug-induced MD. Functional movement disorders (FMD) showed less favorable outcome. CONCLUSIONS: Acute MD is a distinct cause of ER admission, and a variety of treatable diseases may be the underlying cause of this symptom. Uncertain course is more probable in FMD and in structural brain lesions.
Entities:
Keywords:
Drug-induced; Emergency; Functional; Movement disorders; Neurodegenerative
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