Movement Disorders Michael Babcock Summer 2013. Pediatric Neurology Quick Talks. Scenario 2 -6 yo girl -in ED with abnormal sustained twisting posture of L arm and neck -4 recent ER visits for headache with vomiting -has taken headache medicine for the last 5 days -no other medications
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-6 yo girl
-in ED with abnormal sustained twisting posture of L arm and neck
-4 recent ER visits for headache with vomiting
-has taken headache medicine for the last 5 days
-no other medications
-no other significant history
-what is diagnosis?
-what is treatment?Scenarios
RigidityStep 3: Classify
Dystonia – abnormal twisting movement sustained for a long time.
Acute onset is likely medication related – she was recently given headache medication, probably dopamine antagonist like phenergan.
Tx – benedrylStep 4: Diagnose and Step 5: Treatment
Taskforce, “stereotypies are repetitive, simple movements that can be voluntarily suppressed”
Patterned, episodic, repetative, purposeless
These are different from tics
See often in autism, RettOthers
A 10 year old boy presents to the emergency department with a 2 day history of progressive difficulty with speech and coordination. On PE, the restless but otherwise quiet child has a normal mental status and eye movements. His speech is slurred, and he cannot maintain tongue protrusion without an in-and-out darting movement. Continuous flowing and jerky movements occur when he holds his hands outstretched or overhead. Although his grip is strong, he cannot maintain it well because of irregular hand and arm movements. He had a sore throat and fever 2 months ago. You diagnose chorea.
Of the following, the MOST effective treatment for suppressing the chorea for this boy is:
E. TrihexyphenidylPREP Question
-on call neurology