Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital of Rome, Sapienza University, Rome, Italy.
Arch Dis Child. 2018 Aug;103(8):790-794. doi: 10.1136/archdischild-2017-314464. Epub 2018 Mar 8.
Limited data exist on epidemiology, clinical presentation and management of acute hyperkinetic movement disorders (AHMD) in paediatric emergency departments (pED).
We retrospectively analysed a case series of 256 children (aged 2 months to 17 years) presenting with AHMD to the pEDs of six Italian tertiary care hospitals over a 2-year period (January 2012 to December 2013).
The most common type of AHMD was tics (44.5%), followed by tremors (21.1%), chorea (13.7%), dystonia (10.2%), myoclonus (6.3%) and stereotypies (4.3%). Neuropsychiatric disorders (including tic disorders, psychogenic movement disorders and idiopathic stereotypies) were the most represented cause (51.2%). Inflammatory conditions (infectious and immune-mediated neurological disorders) accounted for 17.6% of the cases whereas non-inflammatory disorders (including drug-induced AHMDs, genetic/metabolic diseases, paroxysmal non-epileptic movements and idiopathic AHMDs) accounted for 31.2%. Neuropsychiatric disorders prevailed among preschoolers and schoolers (51.9% and 25.2%, respectively), non-inflammatory disorders were more frequent in infants and toddlers (63.8%), whereas inflammatory conditions were more often encountered among schoolers (73.3%). In 5 out of 36 Sydenham's chorea (SC) cases, tics were the presentation symptom on admission to emergency department (ED), highlighting the difficulties in early diagnosis of SC. Inflammatory disorders were associated with a longer hospital stay and a greater need of neuroimaging test compared with other disorders.
This study provides the first large sample of paediatric patients presenting to the ED for AHMDs, helping to elucidate the epidemiology, aetiology and clinical presentation of these disorders.
儿科急诊科（ped）中急性运动障碍（ahmd）的流行病学、临床表现和治疗方法的数据有限。
我们回顾性分析了 2012 年 1 月至 2013 年 12 月期间，意大利 6 家三级护理医院 ped 收治的 256 例（年龄 2 个月至 17 岁）ahmd 患儿的病例系列。
最常见的 ahmd 类型为抽动症（44.5%），其次为震颤（21.1%）、舞蹈症（13.7%）、肌张力障碍（10.2%）、肌阵挛（6.3%）和刻板动作（4.3%）。神经精神障碍（包括抽动障碍、心因性运动障碍和特发性刻板动作）是最常见的病因（51.2%）。炎症性疾病（感染性和免疫介导的神经障碍）占 17.6%，而非炎症性疾病（包括药物引起的 ahmd、遗传/代谢疾病、发作性非癫痫性运动障碍和特发性 ahmd）占 31.2%。神经精神障碍在学龄前儿童和学龄儿童中更为常见（分别为 51.9%和 25.2%），而非炎症性疾病在婴儿和幼儿中更为常见（63.8%），而炎症性疾病在学龄儿童中更为常见（73.3%）。36 例 Sydenham 舞蹈症（SC）中，有 5 例在急诊科就诊时表现为抽动，这突出了 SC 早期诊断的困难。与其他疾病相比，炎症性疾病与更长的住院时间和更多的神经影像学检查需求相关。
本研究提供了 ped 中首次出现 ahmd 的大量患儿样本，有助于阐明这些疾病的流行病学、病因和临床表现。
