Objective: The objective of our study is to report the clinical and imaging profile of a cohort of pediatric patients with movement disorders (MDs) associated with infectious encephalitis (IE).

Background: Acute-onset MDs are an increasingly recognized neurological emergency in children. Various etiological factors have been described, leading to secondary MDs. IE has been found to cause more MDs than previously acknowledged.

Method: This is a retrospective study 2010-2022, conducted at the Pediatric Neurology Department at National Institute of Neurology Mongi Ben Hmida, including patients fulfilling the criteria for probable IE according to the diagnostic criteria established at the international consensus conference in 2013. Patients with MDs were identified.

Results: MDs were reported in 17 out of 60 patients diagnosed with IE. The mean age at presentation was 9.12 ± 5.11 years. The mean latency of onset of MDs after the beginning of IE symptoms was 7 ± 3 days, with 3 patients experiencing them at the onset. The phenomenology of MD was: (1) Pure dystonia (35.3%), generalized in 3/6 cases and segmental in 3/6 cases. (2) Pure chorea (17.6%) generalized in 2/3 cases and focal in 1/3 cases. (3) Tremor (5.8%). (4) Tics (17,6%), simple in 2/3 cases and complex in1/3 cases. (5) Parkinsonism (23,5%), symmetrical in 1/4 cases and asymmetrical in 3/4 cases. The identified infectious agents were as follows: Herpes Simplex Virus (HSV) (17.6%), West Nile virus (11.7%), Human Immunodeficiency Virus (HIV) (11.7%), unknown (58.8%). Brain magnetic resonance imaging (MRI) was abnormal in 64.7 % of our patients. A correlation was observed between thalamic lesions and MDs (p=0.009). The outcome was favorable with the disappearance of MDs in 14 patients (82.3%), with an average delay of 7 ± 2 days from the start of treatment. Symptoms persisted in 3 patients (17.6%). One death has occurred.

Conclusion: IE often results in a spectrum of MDs, ranging from slowness and rigidity to hyperkinetic movements. Dystonia emerged as the most common MD observed in our series. The thalamus was the most involved structure.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/movement-disorders-associated-with-infectious-encephalitis-in-pediatric-patients/