Objective: To report and describe movement disorders, clinical and investigative features of children with a clinical diagnosis of autoimmune diseases.

Background: Movement disorders (Md) are often a prominent feature of different autoimmune diseases in children, they are important to recognize and diagnose, as early therapy can shorten disease duration and improve outcome. Depending on the etiology we can divide the autoimmnune conditions as associated to: multisystem diseases such as Systemic lupus erythematosus (SLE), Antiphospholipid syndrome (APL) and Hashimoto’s encephalopathy (HE); post-streptococcal infection such as Neuropsychiatric disorder associated with streptococcal infection (PANDAS) and Sydenham chorea; and of paraneoplastic origin such as anti-N-methyl D-aspartate receptor (NMDAR) encephalitis and Opsoclonus myoclonus syndrome (OMS).

Methods: Retrospective and descriptive study based on review of clinical records of patients with Md secondary to autoimmune disease diagnosed and controlled in our center.

Results: 27 patients were identified, 16 women and 11 men. Md debuted between 7 days and 16 years of age. The autoimmune diseases reported were: 12 patients with OMS (12 with opsoclonus, 7 myoclonus and 10 ataxia, 6 with neuroendocrine tumor), 11 with Sydenham chorea (2 with hemicorea and 9 with generalized chorea), 2 patients with NMDAR encephalitis (1 patient with dystonia and linguistic dyskinesias and 1 with dystonia and myoclonus), 1 patient with tics secondary to PANDAS, 1 with left hemicorea secondary to APL and 1 with left hemicorea associated to SLE. 12 of the 27 patients presented psychiatric syntoms, irritability was the most common manifestation (9/12). 20 patients received treatment with immunosuppressive therapy, most of them with substantial improvement.

Conclusions: Autoimmune disease in children may present with different Md. In our group OMS and Sydenham corea were the most frequent conditions. Neuropsychiatric symptoms commonly coexist. It is important to identify Md as an early manifestation that can help for an early diagnosis and prompt treatment.

References: Lim M, Gorman M. Autoimmune neurologic disorders in children. Handb Clin Neurol. 2016;133:485-510. Hacohen Y, Wright S, Waters P et al. (2013). Paediatric autoimmune encephalopathies: clinical features, laboratory investigations and outcomes in patients with or withou antibodies to known central nervous system autoantigens. J Neurol Neurosurg Psychiatry 84: 748–755.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/movement-disorders-in-children-with-autoimmune-diseases/