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Chapter 27 - Movement disorders emergencies

from Section V - Systemic complications of movement disorders

Published online by Cambridge University Press:  05 April 2014

By
Ritesh A. Ramdhani  and
Steven J. Frucht
Edited by
Werner Poewe  and
Joseph Jankovic
Ritesh A. Ramdhani
Affiliation:
Movement Disorders Division, Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
Steven J. Frucht
Affiliation:
Movement Disorders Division, Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
Werner Poewe
Affiliation:
Medical University Innsbruck
Joseph Jankovic
Affiliation:
Baylor College of Medicine, Texas
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Summary

Introduction

A movement disorder emergency is defined as any movement disorder that evolves or clinically worsens over hours to days. It can occur with hypokinetic as well as hyperkinetic conditions. The systemic and neurological sequelae can originate from the inherent disease process, excessive movements, or a combination of both. Failure to recognize and efficiently manage these patients carries a significant risk of morbidity and mortality.

We review the six major categories of movement disorder emergencies: parkinsonism, dystonia, chorea, myoclonus, tics, and emergencies associated with deep brain stimulation.

Acute parkinsonism

Acute parkinsonism, or non-neurodegenerative parkinsonism, develops suddenly over hours to days. Unlike idiopathic Parkinson’s disease (PD), symptoms are usually symmetric, with prominent bradykinesia and rigidity. Dopamine-blocking medications are the most common precipitants. Consideration of rarer etiologies such as toxins and chemotherapy, structural lesions, and rapid dystonia-parkinsonism, viral encephalitis, and neuroleptic malignant syndrome is predicated in the clinical context (Table 27.1).

Drug-induced parkinsonism

Drug-induced parkinsonism (DIP) is commonly caused by medications that affect dopamine efficacy either by blocking its receptors or depleting its stores (i.e. neuroleptics, antiemetics). As many as 60 percent of patients develop symptoms within one month of initiating these medications, and 90 percent by the third month (Quinn 1995). Its incidence increases with age and it tends to have a bimodal distribution, with an initial peak in adolescence and a second peak after the sixth decade (Susatia and Fernandez 2009). Women are twice as likely as men to be affected, and the risk of developing it correlates with the potency of the drug (Ayd 1961).

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Movement Disorders in Neurologic and Systemic Disease , pp. 419 - 441
Publisher: Cambridge University Press
Print publication year: 2014

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  • Movement disorders emergencies
    • By Ritesh A. Ramdhani, Movement Disorders Division, Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA, Steven J. Frucht, Movement Disorders Division, Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
  • Edited by Werner Poewe, Joseph Jankovic, Baylor College of Medicine, Texas
  • Book: Movement Disorders in Neurologic and Systemic Disease
  • Online publication: 05 April 2014
  • Chapter DOI: https://doi.org/10.1017/CBO9781139175845.028
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  • Movement disorders emergencies
    • By Ritesh A. Ramdhani, Movement Disorders Division, Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA, Steven J. Frucht, Movement Disorders Division, Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
  • Edited by Werner Poewe, Joseph Jankovic, Baylor College of Medicine, Texas
  • Book: Movement Disorders in Neurologic and Systemic Disease
  • Online publication: 05 April 2014
  • Chapter DOI: https://doi.org/10.1017/CBO9781139175845.028
Available formats
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  • Movement disorders emergencies
    • By Ritesh A. Ramdhani, Movement Disorders Division, Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA, Steven J. Frucht, Movement Disorders Division, Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
  • Edited by Werner Poewe, Joseph Jankovic, Baylor College of Medicine, Texas
  • Book: Movement Disorders in Neurologic and Systemic Disease
  • Online publication: 05 April 2014
  • Chapter DOI: https://doi.org/10.1017/CBO9781139175845.028
Available formats
×