Acute hyperkinetic movement disorders in Italian paediatric emergency departments

Umberto Raucci, Pasquale Parisi, Nicola Vanacore, Giacomo Garone, Claudia Bondone, Antonella Palmieri, Lucia Calistri, Agnese Suppiej, Raffaele Falsaperla, Alessandro Capuano, Valentina Ferro, Antonio Francesco Urbino, Ramona Tallone, Alessandra Montemaggi, Stefano Sartori, Piero Pavone, Margherita Mancardi, Federico Melani, Lucrezia Ilvento, Maria Federica PelizzaAntonino Reale

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: Limited data exist on epidemiology, clinical presentation and management of acute hyperkinetic movement disorders (AHMD) in paediatric emergency departments (pED).METHODS: 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).RESULTS: 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.CONCLUSIONS: 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.
Original languageEnglish
Pages (from-to)790-794
Number of pages5
JournalArchives of Disease in Childhood
Volume103
Issue number8
DOIs
Publication statusPublished - Aug 2018

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Hyperkinesis
Movement Disorders
Chorea
Hospital Emergency Service
Pediatrics
Tics
Epidemiology
Tic Disorders
Inborn Genetic Diseases
Metabolic Diseases
Tremor
Tertiary Healthcare
Nervous System Diseases
Tertiary Care Centers
Neuroimaging
Early Diagnosis
Length of Stay
Pharmaceutical Preparations

Keywords

  • chorea
  • dystonia
  • emergency department
  • movement disorder
  • neurology
  • tics

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Acute hyperkinetic movement disorders in Italian paediatric emergency departments. / Raucci, Umberto; Parisi, Pasquale; Vanacore, Nicola; Garone, Giacomo; Bondone, Claudia; Palmieri, Antonella; Calistri, Lucia; Suppiej, Agnese; Falsaperla, Raffaele; Capuano, Alessandro; Ferro, Valentina; Urbino, Antonio Francesco; Tallone, Ramona; Montemaggi, Alessandra; Sartori, Stefano; Pavone, Piero; Mancardi, Margherita; Melani, Federico; Ilvento, Lucrezia; Pelizza, Maria Federica; Reale, Antonino.

In: Archives of Disease in Childhood, Vol. 103, No. 8, 08.2018, p. 790-794.

Research output: Contribution to journalArticle

Raucci, U, Parisi, P, Vanacore, N, Garone, G, Bondone, C, Palmieri, A, Calistri, L, Suppiej, A, Falsaperla, R, Capuano, A, Ferro, V, Urbino, AF, Tallone, R, Montemaggi, A, Sartori, S, Pavone, P, Mancardi, M, Melani, F, Ilvento, L, Pelizza, MF & Reale, A 2018, 'Acute hyperkinetic movement disorders in Italian paediatric emergency departments', Archives of Disease in Childhood, vol. 103, no. 8, pp. 790-794. https://doi.org/10.1136/archdischild-2017-314464
Raucci, Umberto ; Parisi, Pasquale ; Vanacore, Nicola ; Garone, Giacomo ; Bondone, Claudia ; Palmieri, Antonella ; Calistri, Lucia ; Suppiej, Agnese ; Falsaperla, Raffaele ; Capuano, Alessandro ; Ferro, Valentina ; Urbino, Antonio Francesco ; Tallone, Ramona ; Montemaggi, Alessandra ; Sartori, Stefano ; Pavone, Piero ; Mancardi, Margherita ; Melani, Federico ; Ilvento, Lucrezia ; Pelizza, Maria Federica ; Reale, Antonino. / Acute hyperkinetic movement disorders in Italian paediatric emergency departments. In: Archives of Disease in Childhood. 2018 ; Vol. 103, No. 8. pp. 790-794.
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abstract = "INTRODUCTION: Limited data exist on epidemiology, clinical presentation and management of acute hyperkinetic movement disorders (AHMD) in paediatric emergency departments (pED).METHODS: 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).RESULTS: 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.CONCLUSIONS: 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.",
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T1 - Acute hyperkinetic movement disorders in Italian paediatric emergency departments

AU - Raucci, Umberto

AU - Parisi, Pasquale

AU - Vanacore, Nicola

AU - Garone, Giacomo

AU - Bondone, Claudia

AU - Palmieri, Antonella

AU - Calistri, Lucia

AU - Suppiej, Agnese

AU - Falsaperla, Raffaele

AU - Capuano, Alessandro

AU - Ferro, Valentina

AU - Urbino, Antonio Francesco

AU - Tallone, Ramona

AU - Montemaggi, Alessandra

AU - Sartori, Stefano

AU - Pavone, Piero

AU - Mancardi, Margherita

AU - Melani, Federico

AU - Ilvento, Lucrezia

AU - Pelizza, Maria Federica

AU - Reale, Antonino

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2018/8

Y1 - 2018/8

N2 - INTRODUCTION: Limited data exist on epidemiology, clinical presentation and management of acute hyperkinetic movement disorders (AHMD) in paediatric emergency departments (pED).METHODS: 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).RESULTS: 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.CONCLUSIONS: 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.

AB - INTRODUCTION: Limited data exist on epidemiology, clinical presentation and management of acute hyperkinetic movement disorders (AHMD) in paediatric emergency departments (pED).METHODS: 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).RESULTS: 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.CONCLUSIONS: 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.

KW - chorea

KW - dystonia

KW - emergency department

KW - movement disorder

KW - neurology

KW - tics

U2 - 10.1136/archdischild-2017-314464

DO - 10.1136/archdischild-2017-314464

M3 - Article

VL - 103

SP - 790

EP - 794

JO - Archives of Disease in Childhood

JF - Archives of Disease in Childhood

SN - 0003-9888

IS - 8

ER -