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Movement disorders in emergency settings: a prospective study

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Abstract

Introduction

Acute movement disorders (MD) are etiologically heterogeneous entities. Since studies on the relative frequency of different MD and their underlying diseases are limited, we performed a prospective study to investigate the spectrum of various MD and their causes in patients presenting with acute MD in an emergency room (ER) setting.

Objective

To describe the spectrum and outcomes of acute MD in a prospective cohort and to guide its management.

Methods

We investigated acute MD in 96 consecutive patients admitted to ERs between 2013 and 2017. Time of disease onset, type of MD according to published criteria, diagnostic workup, and outcome were collected.

Results

73.9% of patients had hyperkinetic MD. Tremor was the most common symptom (19.8%), followed by myoclonus (17.7%), dystonia (15.6%), and chorea (11.4%). Other hyperkinetic MD (9.4%) included were gait disorders (imbalance due to involuntary movement), dyskinesia, akathisia, hemiballism, and oculogyric crisis. Hypokinetic MD included acute parkinsonism (15.6%), off-state (4%), akinesia (3%), and rigidity (3%). Co-occurrence of more than one MD was seen in 19.7% of patients. Time delay to medical consultation was between < 24 h and 28 days. Five etiological groups were recognized: drug-induced (29.2%), functional (19.8%), neurodegenerative diseases (15.6%), structural brain damage (11.5%), others (24.0%, metabolic, inflammatory, infective, undetermined). Outcome was better for neurodegenerative diseases and for drug-induced MD. Functional movement disorders (FMD) showed less favorable outcome.

Conclusions

Acute MD is a distinct cause of ER admission, and a variety of treatable diseases may be the underlying cause of this symptom. Uncertain course is more probable in FMD and in structural brain lesions.

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Authors and Affiliations

  1. Department of Medical Area, Neurology Unit, ASST Pavia, Via Volturno, 14, 27058, Voghera, PV, Italy

    Carlo Dallocchio, Angela Matinella, Carla Arbasino, Natale Arno’, Margaret Glorioso & Massimo Sciarretta

  2. Neurology Unit, ASST Vimercate, Vimercate, Italy

    Massimiliano Braga

  3. Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy

    Michele Tinazzi

Authors
  1. Carlo Dallocchio
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  2. Angela Matinella
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  3. Carla Arbasino
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  4. Natale Arno’
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  5. Margaret Glorioso
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  6. Massimo Sciarretta
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  7. Massimiliano Braga
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  8. Michele Tinazzi
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Contributions

DC, BM, MT—study concept and design

DC, AC, AL, GM, SM—data collection

DC, BM—statistical analysis

DC, BM—analysis and interpretation

DC, MA, AC, BM—critical revision of the manuscript for important intellectual content

DC—study supervision

Corresponding author

Correspondence to Angela Matinella.

Ethics declarations

Data has been acquired according to modern ethical standards and has been approved by the legally appropriated ethical committee.

Conflict of interest

The authors declare that they have no conflict of interest.

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Dallocchio, C., Matinella, A., Arbasino, C. et al. Movement disorders in emergency settings: a prospective study. Neurol Sci 40, 133–138 (2019). https://doi.org/10.1007/s10072-018-3601-1

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  • DOI: https://doi.org/10.1007/s10072-018-3601-1

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