Movement disorders in children: a case-based approach

Administrator: Biju Hameed, UK

Dr Biju Hameed
Great Ormond Street Hospital, London
biju.hameed@gmail.com
Movement disorders in Cerebral Palsy
Movement disorders in cerebral palsy (CP) consist of a spectrum of abnormal muscle tone patterns and movement types. The approach to tone management has traditionally focused on spasticity as a phenomenon at the expense of other forms of hypertonia and dyskinesia. This has resulted in the impact upon function including activity and participation being overlooked. This has partly been due to lack of accurate assessment and descriptors for the condition. Dyskinesia is not always accurately identified in children with CP and there is no consensus among clinicians and researchers regarding tools to identify and measure the degree of dyskinesia. Identification and classification of these abnormal movements in cerebral palsy is important since they have a profound impact on motor function. This segment in the proposed symposia would aim to discuss the prevalence of movement disorders in Cerebral Palsy, new & emerging terminologies for classifying movement patterns and review the evidence-based identification along with recent advances in the assessment and management of movement disorders in children with cerebral palsy.

Dr Sangeetha Yoganathan
Department of Neurological Sciences, Christian Medical College, Vellore- 632004, Tamil Nadu, India
doc_ys@yahoo.co.in
Movement disorders in Inborn Errors of Metabolism
Inborn errors of metabolism (IEMs) are rare heterogeneous group of disorders that often manifests with neurological and non-neurological symptoms. Movement disorders are one of the common neurological symptoms in children with IEMs. Movement disorders contribute substantially to the morbidity in inborn errors of metabolism and can have a significant impact on quality of life. However they are poorly defined and a phenomenology-based approach, based on the predominant movement disorder, can facilitate a differential diagnosis and can guide biochemical, molecular, and imaging testing. Clinicians should never miss treatable inborn errors of metabolism manifesting with complex movement disorders that includes neurotransmitter disorders, organic aciduria, cerebral creatine deficiency syndromes, certain lysosomal storage disorders, GLUT1 transporter defects and metal storage disorders. Some of the mitochondrial energy metabolism defects also exhibit movement disorders. Dr. Yoganathan will discuss about the clinical and imaging phenotypes, biochemical and molecular diagnosis and management of various treatable IEMs manifesting with movement disorders using a illustrative case-based approach.
 

Dr Belen Perez Duenas
Primary dystonia and other treatable genetic movement disorders
belen.perez@vhir.org
Primary dystonia and other treatable genetic movement disorders
Dystonia is one the common movement disorders characterised by repetitive twisting posture resulting from co-contraction of agonist and antagonist muscles. The etiologies of dystonia are heterogeneous. The dystonia may be classified based on the age at onset symptoms, topography, temporal pattern, etiology and associated features. Based on the etiology, dystonia may be classified in to primary (primary pure, primary plus and primary paroxysmal), secondary and heredodegenerative while based on the temporal pattern, dystonia may be classified in to persistent, paroxysmal, action-specific and dystonia with diurnal fluctuation. Based on the topography, dystonia may be categorized in to focal, segmental, multifocal, hemidystonia and generalized. The recognition of clinical phenotypes of primary dystonia and other treatable monogenic movement disorders becomes crucial for early diagnosis and management. Dr. Belen will discuss about the clinical spectrum of various types of primary dystonia that have onset in childhood, imaging findings and their genotypes and management using illustrative cases. Establishing a precise diagnosis of primary dystonia and other monogenic disorders has important implications for appropriate treatment, identification of prognosis and genetic counselling.
 

Dr Shekeeb Mohammad
The Children’s hospital at Westmead, Australia
shekeeb.mohammad@sydney.edu.au
Immune-mediated movement disorders
The spectrum of immune-mediated movement disorders in children consists of rheumatic chorea, opsoclonus-myoclonus ataxia syndrome, movement disorders associated with autoimmune encephalitis, movement disorders in systemic autoimmune disorders and pediatric acute neuropsychiatric syndrome. Autoimmune neurological syndromes, including movement disorders have also been described in children and young adults after COVID-19 infections. Some of these disorders are still quite common while many others are rare. However, these disorders are often eminently treatable. Dr. Shekeeb will systematically discuss the immunopathogenesis, clinical patterns, radiological findings, laboratory diagnosis and management options of various immune-mediated movement disorders in children using a case-based and algorithmic approach. A pragmatic therapeutic approach will be outlined summarising the latest evidence for disorder specific immune therapies as well as for use of symptomatic medications for movement disorders and other neuropsychiatric, sleep and behavioural symptoms in these disorders. This segment will provide a guide to clinical nuances in the use of various existing and novel immune therapies such as different steroid regimens, intravenous Immunoglobulin, monoclonal antibodies as well as emerging therapies.