Abstract
We prospectively evaluated the clinical features and etiologies of all common categories of movement disorder seen in the emergency room (ER) of an urban university hospital over a period of 12 months. We divided movement disorders according to the presenting phenomenology likely to dominate the clinical presentation, that is, gait disorder, tremor, dystonia, myoclonus, and acute akinetic crisis and classified a specific etiology in the individual phenomenology. In one year, there were 60,002 ER visits; of these, 58 (0.09 %) were diagnosed as a primary movement disorder. The most common clinical presentation was gait disorder (n = 21, 36.2 %), followed by myoclonus (n = 16, 27.6 %), dystonia (n = 10, 17.2 %), tremor (n = 8, 13.8 %), and acute akinetic crisis (n = 3, 5.2 %). Comparing the movement disorders, the mean age of the patients with dystonia was significantly lower than that of patients with other movement disorders (P < 0.001). Of the patients, 37 (63.8 %) had drug-related movement disorders. The contribution of drugs was significantly higher in patients with dystonia compared with the other movement disorders (P < 0.01). Our study showed that a large proportion of the movement disorders seen in the ER are drugrelated. Careful selection of drugs while prescribing would decrease movement disorder-related visits to the ER.
Similar content being viewed by others
References
Bower JH, Maraganore DM, McDonnell SK, Rocca WA (1999) Incidence and distribution of parkinsonism in Olmsted County, Minnesota, 1976– 1990. Neurology 52:1214–1220
Caviness JN, Alving LI, Maraganore DM, Black RA, McDonnell SK, Rocca WA (1999) The incidence and prevalence of myoclonus in Olmsted County, Minnesota. Mayo Clin Proc 74:565–569
Dressler D, Benecke R (2005) Diagnosis and management of acute movement disorders. J Neurol 252:1299–1306
Factor SA, Podskalny GD, Molho ES (1995) Psychogenic movement disorders: frequency, clinical profile, and characteristics. J Neurol Neurosurg Psychiatry 59:406–412
Fahn S, Bressman SB, Marsden CD (1998) Classification of dystonia. Adv Neurol 78:1–10
Fahn S, Marsden CD, Van Woert MH (1986) Definition and classification of myoclonus. Adv Neurol 43:1–5
Fahn S, Williams DT (1988) Psychogenic dystonia. Adv Neurol 50:431–455
Hakim S, Adams RD (1965) The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 2:307–327
Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184
Kipps CM, Fung VS, Grattan-Smith P, de Moore GM, Morris JG (2005) Movement disorder emergencies. Mov Disord 20:322–334
Larsson A, Moonen M, Bergh AC, Lindberg S, Wikkelso C (1990) Predictive value of quantitative cisternography in normal pressure hydrocephalus. Acta Neurol Scand 81:327–332
Lee PH, Kim JS, Shin DH, Yoon SN, Huh K (2006) Cardiac 123I-MIBG scintigraphy in patients with drug induced parkinsonism. J Neurol Neurosurg Psychiatry 77:372–374
Mann SC, Caroff SN, Bleier HR, Welz WK, Kling MA, Hayashida M (1986) Lethal catatonia. Am J Psychiatry 143:1374–1381
Onofrj M, Thomas A (2005) Acute akinesia in Parkinson disease. Neurology 64:1162–1169
Rubino FA (2002) Gait disorders. Neurologist 8:254–262
Sethi KD (2003) Tremor. Curr Opin Neurol 16:481–485
Shalev A, Munitz H (1986) The neuroleptic malignant syndrome: agent and host interaction. Acta Psychiatr Scand 73:337–347
Sugawara M, Watanabe S, Toyoshima I (2006) Prevalence of dystonia in Akita Prefecture in Northern Japan. Mov Disord 21:1047–1049
Wenning GK, Kiechl S, Seppi K, Muller J, Hogl B, Saletu M, Rungger G, Gasperi A, Willeit J, Poewe W (2005) Prevalence of movement disorders in men and women aged 50–89 years (Bruneck Study cohort): a population-based study. Lancet Neurol 4:815–820
Wielinski CL, Erickson-Davis C, Wichmann R, Walde-Douglas M, Parashos SA (2005) Falls and injuries resulting from falls among patients with Parkinson’s disease and other parkinsonian syndromes. Mov Disord 20:410–415
Zijlmans JC, Daniel SE, Hughes AJ, Revesz T, Lees AJ (2004) Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis. Mov Disord 19:630–640
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Yoon, J.H., Lee, P.H., Yong, S.W. et al. Movement disorders at a university hospital emergency room. J Neurol 255, 745–749 (2008). https://doi.org/10.1007/s00415-008-0789-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-008-0789-7