Movement Disorders in the Emergency

  • Madhuri Behari
  • Vibhor Pardasani


Movement disorders classically have an insidious onset and slow progression and are usually not associated with emergency situations. Infrequently, there do arise rapidly evolving movement disorders or acute complications of existing movement disorders that need immediate attention and rapid management which can be life-saving [1, 2]. This chapter deals with the clinical presentation, diagnosis and management of some common movement disorders presenting to the emergency department (ED).


  1. 1.
    Poston KL, Frucht SJ. Movement disorder emergencies. J Neurol. 2008;255(Suppl 4):2–13.CrossRefGoogle Scholar
  2. 2.
    Frucht SJ. Movement disorder emergencies. Curr Neurol Neurosci Rep. 2005;5:284–93.CrossRefGoogle Scholar
  3. 3.
    Kipps CM, Fung VS, Grattan–Smith P, et al. Movement disorder emergencies. Mov Disord. 2005;20:322–34.CrossRefGoogle Scholar
  4. 4.
    Fernandez HH, Friedman JH. Acute parkinsonism. In: Frucht SJ, Fahn S, editors. Movement disorder emergencies: diagnosis and treatment. Totowa: Humana Press; 2005. p. 9–28.CrossRefGoogle Scholar
  5. 5.
    Howard RS, Lees AJ. Encephalitis lethargica: a report of four recent cases. Brain. 1987;110:19–33.CrossRefGoogle Scholar
  6. 6.
    Mirsattari SM, Power C, Nath A. Parkinsonism with HIV infection. Mov Disord. 1998;13:684–9.CrossRefGoogle Scholar
  7. 7.
    Pradhan S, Pandey N, Shashank S, et al. Parkinsonism due to predominant involvement of substantianigra in Japanese encephalitis. Neurology. 1999;53:1781–6.CrossRefGoogle Scholar
  8. 8.
    Choi IS. Parkinsonism after carbon monoxide poisoning. Eur Neurol. 2002;48:30–3.CrossRefGoogle Scholar
  9. 9.
    Manji H, Howard RS, Miller DH, et al. Status dystonicus: the syndrome and its management. Brain. 1998;121:243–52.CrossRefGoogle Scholar
  10. 10.
    Fasano A, Ricciardi L, Bentivoglio AR, et al. Status dystonicus: predictors of outcome and progression patterns of underlying disease. Mov Disord. 2012;27:783–8.CrossRefGoogle Scholar
  11. 11.
    Mishra D, Singhal S, Juneja M. Status dystonicus a rare complication of dystonia. Indian Pediatr. 2010;47:883–5.CrossRefGoogle Scholar
  12. 12.
    Svetel M, Sternic N, Pejovic S, Kostic VS. Penicillamine-induced lethal status dystonicus in a patient with Wilson’s disease. Mov Disord. 2001;16:568–9.CrossRefGoogle Scholar
  13. 13.
    Paliwal VK, Gupta PK, Pradhan S. Gabapentin as a rescue drug in D-penicillamine-induced status dystonicus in patients with Wilson disease. Neurol India. 2010;58:761–3.CrossRefGoogle Scholar
  14. 14.
    Apetauerova D, Schirmer CM, Shils JL, Zani J, Arle JE. Successful bilateral deep brain stimulation of the globuspallidusinternus for persistent status dystonicus and generalized chorea. J Neurosurg. 2010;113:634–8.CrossRefGoogle Scholar
  15. 15.
    Muirhead W, Jalloh I, Vloeberghs M. Status dystonicus resembling the intrathecal baclofen withdrawal syndrome: a case report and review of the literature. J Med Case Rep. 2010;4:294.CrossRefGoogle Scholar
  16. 16.
    Vaamonde J, Narbona J, Weiser R, et al. Dystonic storms: a practical management problem. Clin Neuropharmacol. 1994;17:344–7.CrossRefGoogle Scholar
  17. 17.
    Nirenberg MJ, Ford B. Dystonic storm. In: Frucht SJ, editor. Movement disorder emergencies: diagnosis and treatment. 2nd ed. New York: Springer/Human Press; 2013. p. 125–35.CrossRefGoogle Scholar
  18. 18.
    Mariotti P, Fasano A, Contarino MF, et al. Management of status dystonicus: our experience and review of the literature. Mov Disord. 2007;22:963–8.CrossRefGoogle Scholar
  19. 19.
    Jech R, Bares M, Urgosik D, et al. Deep brain stimulation in acute management of status dystonicus. Mov Disord. 2009;24:2291–2.CrossRefGoogle Scholar
  20. 20.
    Zorzi G, Marras C, Nardocci N, et al. Stimulation of the globuspallidusinternus for childhood-onset dystonia. Mov Disord. 2005;20:1194–200.CrossRefGoogle Scholar
  21. 21.
    Sacks OW, Kohl M. L-dopa and oculogyric crises. Lancet. 1970;296:215–6.CrossRefGoogle Scholar
  22. 22.
    Philbrick KL, Rummans TA. Malignant catatonia. J Neuropsychiatry Clin Neurosci. 1994;6:1–13.CrossRefGoogle Scholar
  23. 23.
    Fricchione G, Bush G, Fozdar M, et al. Recognition and treatment of the catatonic syndrome. J Intensive Care Med. 1997;12:135–47.CrossRefGoogle Scholar
  24. 24.
    Fricchione G, Mann SC, Caroff SN. Catatonia, lethal catatonia, and neuroleptic malignant syndrome. Psychiatr Ann. 2000;3:347–55.CrossRefGoogle Scholar
  25. 25.
    Dewey RB, Jankovic J. Hemiballism–hemichorea. Arch Neurol. 1989;46:862–7.CrossRefGoogle Scholar
  26. 26.
    Lee B, Hwang S, Chang G. Hemiballismus-hemichorea in older diabetic women: a clinical syndrome with MRI correlation. Neurology. 1999;52:646–8.CrossRefGoogle Scholar
  27. 27.
    Kurlan R, Como PG, Miller B, et al. The behavioral spectrum of tic disorders: a community based study. Neurology. 2002;59:414–20.CrossRefGoogle Scholar
  28. 28.
    Jankovic J. Tourette’s syndrome. N Engl J Med. 2001;345:1184–92.CrossRefGoogle Scholar
  29. 29.
    Scott B, Jankovic J, Donovan D. Botulinum toxin into vocal cord in the treatment of malignant coprolalia associated with Tourette’s syndrome. Mov Disord. 1996;11:431–3.CrossRefGoogle Scholar
  30. 30.
    Jankovic J. Botulinum toxin in the treatment of dystonic tics. Mov Disord. 1994;9:347–9.CrossRefGoogle Scholar
  31. 31.
    Isono S, Shiba K, Yamaguchi M, et al. Pathogenesis of laryngeal narrowing in patients with multiple system atrophy. J Physiol. 2001;536:237–49.CrossRefGoogle Scholar
  32. 32.
    Hughes RG, Gibbin KP, Lowe J. Vocal fold abductor paralysis as a solitary and fatal manifestation of multiple system atrophy. J Laryngol Otol. 1998;112:177–8.CrossRefGoogle Scholar
  33. 33.
    Caroff SN, Mann SC. Neuroleptic malignant syndrome. Med Clin North Am. 1993;77:185–202.CrossRefGoogle Scholar
  34. 34.
    Velamoor VR, Norman RM, Caroff SN, et al. Progression of symptoms in neuroleptic malignant syndrome. J Nerv Ment Dis. 1994;182:168–73.CrossRefGoogle Scholar
  35. 35.
    Keck PE, Pope HG, Cohen BM, et al. Risk factors for neuroleptic malignant syndrome. Arch Gen Psychiatry. 1989;46:914–8.CrossRefGoogle Scholar
  36. 36.
    Mann SC, Caroff SN, Fricchione G, et al. Central dopamine hypoactivity and the pathogenesis of the neuroleptic malignant syndrome. Psychiatr Ann. 2000;30:363–74.CrossRefGoogle Scholar
  37. 37.
    Davis JM, Caroff SN, Mann SC. Treatment of neuroleptic malignant syndrome. Psychiatr Ann. 2000;30:325–31.CrossRefGoogle Scholar
  38. 38.
    Caroff SN, Mann SC, Keck PE Jr. Specific treatment of the neuroleptic malignant syndrome. Biol Psychiatry. 1998;44:378–81.CrossRefGoogle Scholar
  39. 39.
    Mizuno Y, Takubo H, Mizuta E, et al. Malignant syndrome in Parkinson’s disease: Cconcept and review of the literature. Parkinsonism Relat Disord. 2003;9(Suppl 1):S3–9.CrossRefGoogle Scholar
  40. 40.
    Harada T, Mitsuoka K, Kumagai R, et al. Clinical features of malignant syndrome in Parkinson’s disease and related neurological disorders. Parkinsonism Relat Disord. 2003;9(Suppl 1):S15–23.CrossRefGoogle Scholar
  41. 41.
    Ikebe S, Harada T, Hashimoto T, et al. Prevention and treatment of malignant syndrome in Parkinson’s disease: a consensus statement of the malignant syndrome research group. Parkinsonism Relat Disord. 2003;9(Suppl 1):S47–9.CrossRefGoogle Scholar
  42. 42.
    Mackay FJ, Dunn NR, Mann RD. Antidepressants and the serotonin syndrome in general practice. Br J Gen Pract. 1999;49:871–4.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Dunkley EJ, Isbister GK, Sibbritt D, et al. The hunter serotonin toxicity criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003;96:635–42.CrossRefGoogle Scholar
  44. 44.
    Isbister GK, Whyte IM. Serotonin toxicity and malignant hyperthermia: role of 5-HT2 receptors. Br J Anaesth. 2002;88:603–4.CrossRefGoogle Scholar
  45. 45.
    Radomski JW, Dursun SM, Revely MA, et al. An exploratory approach to the serotonin syndrome; an update of clinical phenomenology and revised diagnostic criteria. Med Hypotheses. 2000;55:218–24.CrossRefGoogle Scholar
  46. 46.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text Revision. Washington DC: American Psychiatric Association; 2000.Google Scholar
  47. 47.
    Ayers JL, Dawson KP. Acute dystonic reactions in childhood to drugs. N Z Med J. 1980;92:464–5.PubMedGoogle Scholar
  48. 48.
    Raja M, Azzoni A. Novel antipsychotics and acute dystonic reactions. Pharmacol Biochem Behav. 2000;67:497–500.CrossRefGoogle Scholar
  49. 49.
    Sachdev PS. Neuroleptic-induced movement disorders: an overview. Psychiatr Clin North Am. 2005;28:255–74.CrossRefGoogle Scholar
  50. 50.
    Keepers GA, Casey DE. Clinical management of acute neuroleptic-induced extrapyramidal syndromes. In: Masserman JH, editor. Current psychiatric therapies. New York: Grune & Stratton; 1986. p. 139–57.Google Scholar
  51. 51.
    Miller CH, Fleischhacker WW. Managing antipsychotic-induced acute and chronic akathisia. Drug Saf. 2000;22:73–81.CrossRefGoogle Scholar
  52. 52.
    Hu S, Frucht S. Emergency treatment of movement disorders. Curr Treat Options Neurol. 2007;9:103–14.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  • Madhuri Behari
    • 1
  • Vibhor Pardasani
    • 2
  1. 1.Consultant Neurologist, Fortis Hospital, Vasant KunjNew DelhiIndia
  2. 2.Department of NeurologySeven Hills HospitalMumbaiIndia

Personalised recommendations