Movement disorder emergencies

Kipps, Christopher M., Fung, Victor S.C., Grattan-Smith, Padraic, Moore, Gregory M. and Morris, John G.L. (2005) Movement disorder emergencies. Movement Disorders, 20 (3), 322-334. (doi:10.1002/mds.20325).

Abstract

Movement disorders may present acutely, and failure to recognize and exclude important differential diagnoses can result in significant morbidity or mortality. Unfortunately, much of the literature pertaining to this topic is scattered and not easily accessible. This review aims to address this deficit. Movement disorder emergencies are discussed according to their most likely mode of presentation. Diagnostic considerations and early management principles are reviewed, along with appropriate pathophysiology where relevant. © 2004 Movement Disorder Society

A movement disorder emergency (MDE) has been defined by Fahn and Frucht1 as “… any neurological disorder evolving acutely or subacutely, in which the clinical presentation is dominated by a primary movement disorder, and in which failure to accurately diagnose and manage the patient may result in significant morbidity or even mortality.” Much of the literature dealing with MDE is scattered and not readily accessible. In this article we review the clinical presentation, diagnosis, and management of MDE. The pathophysiology of various MDE is discussed only when directly relevant to these issues.

We have divided MDE according to the phenomenology that is likely to dominate the clinical presentation. In each section, diseases that are monophasic and that develop acutely or subacutely are mentioned first, followed by chronic diseases that can manifest acute exacerbations or relapses. For the purposes of this review, only those conditions that are likely to present to the accident and emergency or intensive care unit and for which treatment has to be instituted within hours or days will be considered in detail. Some treatable disorders that present in childhood are also discussed.

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Contributors

Author: Christopher M. Kipps

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