Movement Disorders Emergencies

Abstract

Many acute and potentially life-threatening medical conditions have hyperkinetic or hypokinetic movement disorders as their hallmark. Here we review the clinical phenomenology, and diagnostic principles of neuroleptic malignant syndrome, malignant catatonia, serotonin syndrome, Parkinsonism hyperpyrexia, acute parkinsonism, acute chorea-ballism, drug-induced dystonia, and status dystonicus. In the absence of definitive lab tests and imaging, only a high index of clinical suspicion, awareness of at-risk populations, and variations in clinical presentation can help with diagnosis. We also discuss the principles of management and rationale behind treatment modalities in the light of more recent evidence.

Keywords

neuroleptic malignant syndrome - serotonin syndrome - acute dystonic reaction - oculogyric crisis - Parkinsonism hyperpyrexia - antipsychotics - tardive dyskinesia - acute Parkinsonism - drug-induced dystonia - malignant catatonia

• References

• 1 Delay J, Pichot P, Lemperiere T, Elissalde B, Peigne F. Un neuroleptique majeur non phenothiazinique et non réserpinique, l'halopéridol, dans le traitement des psychoses. Ann Media Psychol (Paris) 1960; 118: 145-152
• 2 Nielsen RE, Wallenstein Jensen SO, Nielsen J. Neuroleptic malignant syndrome-an 11-year longitudinal case-control study. Can J Psychiatry 2012; 57 (08) 512-518
• 3 Strawn JR, Keck Jr PE, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatry 2007; 164 (06) 870-876
• 4 Nakamura M, Yasunaga H, Miyata H, Shimada T, Horiguchi H, Matsuda S. Mortality of neuroleptic malignant syndrome induced by typical and atypical antipsychotic drugs: a propensity-matched analysis from the Japanese Diagnosis Procedure Combination database. J Clin Psychiatry 2012; 73 (04) 427-430
• 5 Shalev A, Hermesh H, Munitz H. Mortality from neuroleptic malignant syndrome. J Clin Psychiatry 1989; 50 (01) 18-25
• 6 Velamoor R. Neuroleptic malignant syndrome: a neuro-psychiatric emergency: recognition, prevention, and management. Asian J Psychiatr 2017; 29: 106-109
• 7 Hall RC, Hall RC, Chapman M. Neuroleptic malignant syndrome in the elderly: diagnostic criteria, incidence, risk factors, pathophysiology, and treatment. Clin Geriatr 2006; 14 (05) 39
• 8 Margetić B, Aukst-Margetić B. Neuroleptic malignant syndrome and its controversies. Pharmacoepidemiol Drug Saf 2010; 19 (05) 429-435
• 9 Ware MR, Feller DB, Hall KL. Neuroleptic malignant syndrome: diagnosis and management. Prim Care Companion CNS Disord 2018; 20 (01) 17r02185
• 10 Stübner S, Rustenbeck E, Grohmann R. , et al. Severe and uncommon involuntary movement disorders due to psychotropic drugs. Pharmacopsychiatry 2004; 37 (Suppl. 01) S54-S64
• 11 Ananth J, Parameswaran S, Gunatilake S, Burgoyne K, Sidhom T. Neuroleptic malignant syndrome and atypical antipsychotic drugs. J Clin Psychiatry 2004; 65 (04) 464-470
• 12 Tse L, Barr AM, Scarapicchia V, Vila-Rodriguez F. Neuroleptic malignant syndrome: a review from a clinically oriented perspective. Curr Neuropharmacol 2015; 13 (03) 395-406
• 13 Gurrera RJ, Caroff SN, Cohen A. , et al. An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method. J Clin Psychiatry 2011; 72 (09) 1222-1228
• 14 Gurrera RJ, Mortillaro G, Velamoor V, Caroff SN. A validation study of the international consensus diagnostic criteria for neuroleptic malignant syndrome. J Clin Psychopharmacol 2017; 37 (01) 67-71
• 15 Trollor JN, Chen X, Chitty K, Sachdev PS. Comparison of neuroleptic malignant syndrome induced by first- and second-generation antipsychotics. Br J Psychiatry 2012; 201 (01) 52-56
• 16 Philbrick KL, Rummans TA. Malignant catatonia. J Neuropsychiatry Clin Neurosci 1994; 6 (01) 1-13
• 17 Mann SC, Caroff SN, Bleier HR, Welz WK, Kling MA, Hayashida M. Lethal catatonia. Am J Psychiatry 1986; 143 (11) 1374-1381
• 18 Tuerlings JH, van Waarde JA, Verwey B. A retrospective study of 34 catatonic patients: analysis of clinical care and treatment. Gen Hosp Psychiatry 2010; 32 (06) 631-635
• 19 Fink M, Taylor MA. The catatonia syndrome: forgotten but not gone. Arch Gen Psychiatry 2009; 66 (11) 1173-1177
• 20 Francis A. Catatonia: diagnosis, classification, and treatment. Curr Psychiatry Rep 2010; 12 (03) 180-185
• 21 Park J, Tan J, Krzeminski S, Hazeghazam M, Bandlamuri M, Carlson RW. Malignant catatonia warrants early psychiatric-critical care collaborative management: two cases and literature review. Case Rep Crit Care 2017; 2017: 1951965
• 22 Northoff G, Steinke R, Czcervenka C. , et al. Decreased density of GABA-A receptors in the left sensorimotor cortex in akinetic catatonia: investigation of in vivo benzodiazepine receptor binding. J Neurol Neurosurg Psychiatry 1999; 67 (04) 445-450
• 23 Northoff G. What catatonia can tell us about “top-down modulation”: a neuropsychiatric hypothesis. Behav Brain Sci 2002; 25 (05) 555-577 , discussion 578–604
• 24 Carroll BT, Thomas C, Jayanti K. , et al. Treating persistent catatonia when benzodiazepines fail. Curr Psychiatr 2005; 4: 22-33
• 25 American Psychiatric Association. Diagnostic and Statistical Manual Of Mental Disorders (DSM-5). Arlington, VA: American Psychiatric Publishing, Inc.; 2013
• 26 Daniels J. Catatonia: clinical aspects and neurobiological correlates. J Neuropsychiatry Clin Neurosci 2009; 21 (04) 371-380
• 27 Ishida T, Sakurai H, Watanabe K, Iwashita S, Mimura M, Uchida H. Incidence of deep vein thrombosis in catatonic patients: a chart review. Psychiatry Res 2016; 241: 61-65
• 28 Gillman PK. Serotonin syndrome: history and risk. Fundam Clin Pharmacol 1998; 12 (05) 482-491
• 29 Isbister GK, Bowe SJ, Dawson A, Whyte IM. Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose. J Toxicol Clin Toxicol 2004; 42 (03) 277-285
• 30 Gillman PK. A review of serotonin toxicity data: implications for the mechanisms of antidepressant drug action. Biol Psychiatry 2006; 59 (11) 1046-1051
• 31 Frank C. Recognition and treatment of serotonin syndrome. Can Fam Physician 2008; 54 (07) 988-992
• 32 Gordon MF, Leder AN. Serotonin syndrome. In: Frucht SJ. , ed. Movement Disorder Emergencies: Diagnosis and Treatment. 2nd edn. Totowa, NJ: Humana Press; 2013: 217-239
• 33 Wong A. An update on opsoclonus. Curr Opin Neurol 2007; 20 (01) 25-31
• 34 Dunkley EJC, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM 2003; 96 (09) 635-642
• 35 Gillman PK. Triptans, serotonin agonists, and serotonin syndrome (serotonin toxicity): a review. Headache 2010; 50 (02) 264-272
• 36 Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005; 352 (11) 1112-1120
• 37 Sternbach H. The serotonin syndrome. Am J Psychiatry 1991; 148 (06) 705-713
• 38 Sun-Edelstein C, Tepper SJ, Shapiro RE. Drug-induced serotonin syndrome: a review. Expert Opin Drug Saf 2008; 7 (05) 587-596
• 39 Kapur S, Zipursky RB, Jones C, Wilson AA, DaSilva JD, Houle S. Cyproheptadine: a potent in vivo serotonin antagonist. Am J Psychiatry 1997; 154 (06) 884
• 40 Toru M, Matsuda O, Makiguchi K, Sugano K. Neuroleptic malignant syndrome-like state following a withdrawal of antiparkinsonian drugs. J Nerv Ment Dis 1981; 169 (05) 324-327
• 41 Huddleston DE, Factor SA. Parkinsonism-hyperpyrexia syndrome in Parkinson's disease. In: Frucht SJ. , ed. Movement Disorder Emergencies: Diagnosis and Treatment. Totowa, NJ: Humana Press; 2013: 29-41
• 42 Serrano-Dueñas M. Neuroleptic malignant syndrome-like, or--dopaminergic malignant syndrome--due to levodopa therapy withdrawal. Clinical features in 11 patients. Parkinsonism Relat Disord 2003; 9 (03) 175-178
• 43 Takubo H, Harada T, Hashimoto T. , et al. A collaborative study on the malignant syndrome in Parkinson's disease and related disorders. Parkinsonism Relat Disord 2003; 9 (Suppl. 01) S31-S41
• 44 Ueda M, Hamamoto M, Nagayama H. , et al. Susceptibility to neuroleptic malignant syndrome in Parkinson's disease. Neurology 1999; 52 (04) 777-781
• 45 Iwuagwu CU, Riley D, Bonoma RA. Neuroleptic malignant-like syndrome in an elderly patient caused by abrupt withdrawal of tolcapone, a-catechol-o-methyl transferase inhibitor. Am J Med 2000; 108 (06) 517-518
• 46 Oguh O, Videnovic A. Inpatient management of Parkinson disease: current challenges and future directions. Neurohospitalist 2012; 2 (01) 28-35
• 47 Newman EJ, Grosset DG, Kennedy PG. The parkinsonism-hyperpyrexia syndrome. Neurocrit Care 2009; 10 (01) 136-140
• 48 Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992; 55 (03) 181-184
• 49 Kim JS. Involuntary movements after anterior cerebral artery territory infarction. Stroke 2001; 32 (01) 258-261
• 50 Venkatesan A, Frucht S. Movement disorders after resuscitation from cardiac arrest. Neurol Clin 2006; 24 (01) 123-132
• 51 Shprecher D, Mehta L. The syndrome of delayed post-hypoxic leukoencephalopathy. NeuroRehabilitation 2010; 26 (01) 65-72
• 52 Sohn YH, Jeong Y, Kim HS, Im JH, Kim JS. The brain lesion responsible for parkinsonism after carbon monoxide poisoning. Arch Neurol 2000; 57 (08) 1214-1218
• 53 Langston JW. The MPTP story. J Parkinsons Dis 2017; 7 (s1): S11-S19
• 54 Fernandez HH, Friedman JH. Acute parkinsonism. In: Frucht SJ. , ed. Movement Disorder Emergencies: Diagnosis and Treatment. Totowa, NJ: Humana Press; 2013: 9-28
• 55 Jankovic J. Diagnosis and treatment of psychogenic parkinsonism. J Neurol Neurosurg Psychiatry 2011; 82 (12) 1300-1303
• 56 Dewey Jr RB, Jankovic J. Hemiballism-hemichorea. clinical and pharmacologic findings in 21 patients. Arch Neurol 1989; 46 (08) 862-867
• 57 Taranta A, Stollerman GH. The relationship of Sydenham's chorea to infection with group A streptococci. Am J Med 1956; 20 (02) 170-175
• 58 Seckeler MD, Hoke TR. The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin Epidemiol 2011; 3: 67-84
• 59 Burke RJ, Chang C. Diagnostic criteria of acute rheumatic fever. Autoimmun Rev 2014; 13 (4–5): 503-507
• 60 Cardoso F, Eduardo C, Silva AP, Mota CC. Chorea in fifty consecutive patients with rheumatic fever. Mov Disord 1997; 12 (05) 701-703
• 61 Zomorrodi A, Wald ER. Sydenham's chorea in western Pennsylvania. Pediatrics 2006; 117 (04) e675-e679
• 62 Gewitz MH, Baltimore RS, Tani LY. , et al; American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation 2015; 131 (20) 1806-1818
• 63 Dean SL, Singer HS. Treatment of Sydenham's chorea: a review of the current evidence. Tremor Other Hyperkinet Mov (N Y) 2017; 7: 456
• 64 Paz JA, Silva CA, Marques-Dias MJ. Randomized double-blind study with prednisone in Sydenham's chorea. Pediatr Neurol 2006; 34 (04) 264-269
• 65 Ghika-Schmid F, Ghika J, Regli F, Bogousslavsky J. Hyperkinetic movement disorders during and after acute stroke: the Lausanne Stroke Registry. J Neurol Sci 1997; 146 (02) 109-116
• 66 Alarcón F, Zijlmans JC, Dueñas G, Cevallos N. Post-stroke movement disorders: report of 56 patients. J Neurol Neurosurg Psychiatry 2004; 75 (11) 1568-1574
• 67 Chung SJ, Im JH, Lee MC, Kim JS. Hemichorea after stroke: clinical-radiological correlation. J Neurol 2004; 251 (06) 725-729
• 68 Ryan C, Ahlskog JE, Savica R. Hyperglycemic chorea/ballism ascertained over 15 years at a referral medical center. Parkinsonism Relat Disord 2018; 48: 97-100
• 69 Chen C, Zheng H, Yang L, Hu Z. Chorea-ballism associated with ketotic hyperglycemia. Neurol Sci 2014; 35 (12) 1851-1855
• 70 Oh SH, Lee KY, Im JH, Lee MS. Chorea associated with non-ketotic hyperglycemia and hyperintensity basal ganglia lesion on T1-weighted brain MRI study: a meta-analysis of 53 cases including four present cases. J Neurol Sci 2002; 200 (1–2): 57-62
• 71 Miyasaki JM, Aldakheel A. Movement disorders in pregnancy. Continuum (Minneap Minn) 2014; 20 (1 Neurology of Pregnancy): 148-161
• 72 Committee on Drugs. American Academy of Pediatrics. Use of psychoactive medication during pregnancy and possible effects on the fetus and newborn. Pediatrics 2000; 105 (4, Pt 1): 880-887
• 73 Zesiewicz TA, Sullivan KL. Drug-induced hyperkinetic movement disorders by nonneuroleptic agents. Handb Clin Neurol 2011; 100: 347-363
• 74 Zádori D, Veres G, Szalárdy L, Klivényi P, Vécsei L. Drug-induced movement disorders. Expert Opin Drug Saf 2015; 14 (06) 877-890
• 75 Ayd Jr FJ. A survey of drug-induced extrapyramidal reactions. JAMA 1961; 175 (12) 1054-1060
• 76 Pierre JM. Extrapyramidal symptoms with atypical antipsychotics : incidence, prevention and management. Drug Saf 2005; 28 (03) 191-208
• 77 Burkhard PR. Acute and subacute drug-induced movement disorders. Parkinsonism Relat Disord 2014; 20 (Suppl. 01) S108-S112
• 78 Diederich NJ, Goetz CG. Drug-induced movement disorders. Neurol Clin 1998; 16 (01) 125-139
• 79 Robottom BJ, Shulman LM, Weiner WJ. Drug-induced movement disorders: emergencies and management. Neurol Clin 2012; 30 (01) 309-320 , x
• 80 Flaherty JA, Lahmeyer HW. Laryngeal-pharyngeal dystonia as a possible cause of asphyxia with haloperidol treatment. Am J Psychiatry 1978; 135 (11) 1414-1415
• 81 Manji H, Howard RS, Miller DH. , et al. Status dystonicus: the syndrome and its management. Brain 1998; 121 (Pt 2): 243-252
• 82 Fasano A, Ricciardi L, Bentivoglio AR. , et al. Status dystonicus: predictors of outcome and progression patterns of underlying disease. Mov Disord 2012; 27 (06) 783-788
• 83 Allen NM, Lin JP, Lynch T, King MD. Status dystonicus: a practice guide. Dev Med Child Neurol 2014; 56 (02) 105-112
• 84 Rosebush PI, Anglin RE, Richards C, Mazurek MF. Neuroleptic malignant syndrome and the acute phase response. J Clin Psychopharmacol 2008; 28 (04) 459-461
• 85 Katus LE, Frucht SJ. Management of serotonin syndrome and neuroleptic malignant syndrome. Curr Treat Options Neurol 2016; 18 (09) 39
• 86 Wild EJ, Tabrizi SJ. The differential diagnosis of chorea. Pract Neurol 2007; 7 (06) 360-373
• 87 Miyasaki JM. Chorea caused by toxins. Handb Clin Neurol 2011; 100: 335-346
• 88 Allen NM, Lin JP, Lynch T. , et al. Status dystonicus: a practice guide. Dev Med Child Neurol 2014; Feb; 56 (02) 105-112