Abstract
Introduction: Some children treated for cancer become critically ill because of immune suppression and sepsis requiring prolonged intensive care support and assisted ventilation.
Methods: Over a 3-year-period, we have identified six children (four with brain tumors) who developed a generalized movement disorder during a protracted intensive care unit stay. Median age was 2 years (range 1–6 years). Movement disorder developed while receiving multiple medications.
Results: Sedation was achieved with midazolam and opioid infusions. Dystonic posturing of limbs, jaw movements, tongue thrusting, and intermittent eye deviations were present in all. Movements increased if the child was stimulated and an electroencephalogram performed in five children excluded seizures.
Conclusions: This movement disorder should be differentiated from seizures to prevent inappropriate treatment. Exacerbation with stimulation is a clinical clue to the correct diagnosis and an electroencephalogram can help differentiate this movement disorder from seizures.
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References
Potter JM, Reid DB, Shaw RJ, Hackett P, Hickman PE. Myoclonus associated with treatment with high doses of morphine: the role of supplemental drugs. BMJ 1989;299:150–153.
Bergman I, Steeves M, Burckart G, Thompson A. Reversible neurologic abnormalities associated with prolonged intravenous midazolam and fentanyl administration. J Pediatr 1991;119:644–649.
Mott SH, Packer RJ, Vezina LG, et al. Encephalopathy with parkinsonian features in children following bone marrow transplantations and high-dose amphotericin B. Ann Neurol 1995;37:810–814.
Langston JW, Ballard PA, Jr. Parkinson’s disease in a chemist working with 1-methyl-4-phenyl-1,2,5,6-tetrahydropyridine. N Engl J Med 1983;309:310.
Kostic VS, Stojanovic-Svetel M, Kacar A. Symptomatic dystonias associated with structural brain lesions: report of 16 cases. Can J Neurol Sci 1996;23:53–56.
Lane JC, Tennison MB, Lawless ST, Greenwood RS, Zaritsky AL. Movement disorder after withdrawal of fentanyl infusion. J Pediatr 1991;119:649–651.
Petzinger G, Mayer SA, Przedborski S. Fentanyl-induced dyskinesias. Mov Disord 1995;10:679–680.
Cadoni C, Di Chiara G. Reciprocal changes in dopamine responsiveness in the nucleus accumbens shell and core and in the dorsal caudate-putamen in rats sensitized to morphine. Neuroscience 1999;90:447–455.
Takada K, Murai T, Kanayama T, Koshikawa N. Effects of midazolam and flunitrazepam on the release of dopamine from rat striatum measured by in vivo microdialysis. Br J Anaesth 1993;70:181–185.
Schrater PR, Russo AC, Stanton TL, Newman JR, Rodriguez LM, Beckman AL. Changes in striatal dopamine metabolism during the development of morphine physical dependence in rats: observations using in vivo microdialysis. Life Sci 1993;52:1535–1545.
Zetterstrom T, Sharp T, Ungerstedt U. Effect of neuroleptic drugs on striatal dopamine release and metabolism in the awake rat studied by intracerebral dialysis. Eur J Pharmacol 1984;106:27–37.
Shafer A. Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens. Crit Care Med 1998;26:947–956.
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Khan, R.B., Schmidt, J.E. & Tamburro, R.F. A reversible generalized movement disorder in critically III children with cancer. Neurocrit Care 3, 146–149 (2005). https://doi.org/10.1385/NCC:3:2:146
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DOI: https://doi.org/10.1385/NCC:3:2:146