Most
movement disorders, reflecting degenerative disorders, develop in a slowly progressive fashion. Some
movement disorders, however, manifest with an acute onset. We wish to give an overview of the management and
therapy of those acute-onset
movement disorders.Drug-induced
movement disorders are mainly caused by
dopamine-receptor blockers (
DRB) as used as
antipsychotics (
neuroleptics) and
antiemetics. Acute dystonic reactions usually occur within the first four days of treatment. Typically, cranial pharyngeal and cervical muscles are affected.
Anticholinergics produce a prompt relief.
Akathisia is characterized by an often exceedingly bothersome feeling of
restlessness and the inability to remain still. It is a common side effect of
DRB and occurs within few days after their initiation. It subsides when
DRB are ceased.
Neuroleptic Malignant Syndrome is a rare, but life-threatening adverse reaction to
DRB which may occur at any time during
DRB application. It is characterised by
hyperthermia, rigidity, reduced consciousness and autonomic failure. Therapeutically immediate
DRB withdrawal is crucial. Additional
dantrolene or
bromocriptine application together with symptomatic treatment may be necessary.
Paroxysmal dyskinesias are childhood onset disorders characterised by dystonic postures,
chorea,
athetosis and ballism occurring at irregular intervals. In
Paroxysmal Kinesigenic Dyskinesia they are triggered by rapid movements, startle reactions or
hyperventilation. They last up to 5 minutes, occur up to 100 times per day and are highly sensitive to
anticonvulsants. In Paroxysmal Non-Kinesiogenic
Dyskinesia they cannot be triggered, occur less frequently and last longer. Other
paroxysmal dyskinesias include hypnogenic
paroxysmal dyskinesias, paroxysmal exertional
dyskinesia, infantile paroxysmal dystonias,
Sandifer's syndrome and symptomatic
paroxysmal dyskinesias. In Hereditary
Episodic Ataxia Type 1 attacks of
ataxia last for up to two minutes, may be accompanied by
dysarthria and
dystonia and usually respond to
phenytoin. In Type 2 they can last for several hours, may be accompanied by
vertigo,
headache and malaise and usually respond to
acetazolamide. Symptomatic episodic
ataxias can occur in a number of metabolic disorders, but also in
multiple sclerosis and
Behcet's disease.