Diagnosis challenges of child abnormal movement in limited settings countries, the case of a little girl abandoned on the way to care

The technological revolution has upset the landscape of abnormal movements on the semiological, diagnostic and therapeutic level. It is often not easy, on clinical grounds alone, to differentiate tremor, myoclonus, dystonia, chorea, ballism or tic. It is also necessary to have recourse to a sophisticated technical platform which includes routine blood tests but also metabolic or genetic tests in addition to electrophysiology and imaging. In developing countries where resources are low or non-existent, the majority of these examinations remain inaccessible. We report the case of a 12-year-old girl who presents with choreic-type movements and a notion of throat infection days before. A diagnosis of Sydenham's chorea was retained after the ASLO came back positive. Initiated antibiotic therapy brought some improvement before becoming ineffective at the end of treatment. The family remained dissatisfied and the doctor frustrated by the unavailability of certain assessments. What to do or how to support a patient when the only clinic cannot provide all the answers? Even if it is most often chronic illnesses, the weight of such a diagnosis deserves answers that would help the patient and his family to live better with their illnesses.
Keywords: child movement disorder diagnosis challenges