Department of Pediatrics, Lok Nayak Hospital, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India. Correspondence to: Dr Rahul Jain, 7 Nixon Street, Kepnock, Queensland, Australia-4670.
Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India.
Indian Pediatr. 2021 Sep 15;58(9):861-870. Epub 2021 May 20.
Movement disorders represent a common presentation in pediatrics and are often a source of clinical and diagnostic dilemmas. In this review, we provide an overview of common causes along with simplified clinical approach and management options for major movement disorders.
This narrative review is based on contemporary evidence and personal experience. Medline was searched for recent advances, current understanding and consensus on classification, clinical features, diagnosis and treatment.
Movement disorders are classified as hyperkinetic and hypokinetic disorders, the latter being rare in childhood. The hyperkinetic disorders include dystonia, chorea, athetosis, tics and tremor, stereotypies, myoclonus, startle syndromes and functional disorders. Some movement disorders can be benign and developmental. A large proportion of conditions are genetic in origin with a guarded prognosis. Some of the conditions may be post-infectious, immune-mediated or drug induced. Multiple types of movement disorders are present in many conditions. The age at onset, type and distribution of abnormal movements and presence of associated neurological and systemic features help in narrowing the differential diagnosis. The pharmacotherapy of movement disorders is complex and evolving.
A synopsis of movement disorders presenting in pediatric age has been provided, incorporating the latest evidence. A simplified approach for clinical diagnosis has been developed for dystonia and chorea.
运动障碍在儿科中较为常见，且常导致临床和诊断上的困境。在本次综述中，我们就主要运动障碍的常见病因、简化的临床处理方法和治疗选择进行概述。
本综述基于现有证据和个人经验。检索 Medline 以获取近期进展、目前对分类、临床特征、诊断和治疗的理解和共识。
运动障碍分为锥体外系运动障碍和锥体系运动障碍，后者在儿童中较为少见。锥体外系运动障碍包括肌张力障碍、舞蹈病、手足徐动症、抽动症和震颤、刻板动作、肌阵挛、惊吓综合征和功能性运动障碍。一些运动障碍可能是良性和发育性的。很大一部分疾病具有遗传基础，预后一般。一些疾病可能是感染后、免疫介导或药物诱导的。许多疾病存在多种类型的运动障碍。发病年龄、异常运动的类型和分布以及是否存在相关的神经和系统特征有助于缩小鉴别诊断的范围。运动障碍的药物治疗较为复杂且在不断发展。
本文对儿科运动障碍的表现进行了概述，纳入了最新的证据。针对肌张力障碍和舞蹈病，我们制定了简化的临床诊断方法。
