This chapter will outline the clinical features, diagnostic and management strategies, and issues relating to transitional care of pediatric-onset movement disorders and will provide insights important for the recognition of adult-onset expression of disorders more typically considered to be of pediatric onset. In addition, recognition of familial risk and the methods for diagnosis of presymptomatic family members will be presented.
Movement disorders in children are uncommon and thus are challenged by limited experience of pediatric care providers in the accurate diagnosis of etiology, correct characterization of the clinical phenotype, knowledge of pharmacologic interventions, and limited access to, and experience with, neurosurgical options for care. In this chapter, we will highlight movement disorders that have onset in childhood, with an emphasis on disorders that manifest throughout the lifetime.
By definition, movement disorders are conditions that include involuntary movements that are abnormal in initiation, implementation, velocity, frequency, or posture. They are classified broadly into hyperkinetic (dystonia, myoclonus, chorea, dyskinesias, tremor, tics) and hypokinetic (parkinsonism) disorders. Abnormal movements can be difficult to define, and the diagnosis involves pattern recognition and a qualitative appreciation of the movement. The clinician must first describe the phenomenology of the movements before attempting to classify them.