Objective: The study objective was to assess the clinico-epidemiological aspects of patients attending the Emergency with movement disorder as the primary symptom.

Background: Available literature mostly include movement disorder emergencies,as opposed to any patient attending Emergency with movement disorder as the predominant symptom.Herein we analyse 19 such patients.

Method: A prospective observational study was conducted at the Emergency of Medical College,Kolkata.All patients attending Emergency with movement disorder as the predominant presentation were included.Detailed history,clinical phenomenology,etiological diagnosis and therapeutic response after one month were noted.Treatment response was assessed subjectively into four groups:

No symptomatic benefit and or worsening

<50% benefit

>50% benefit

Complete resolution

Results: Altogether 19 patients were enrolled.Hyperkinetic disorders were more common(68.42%).15.79% patients each had hypokinetic and mixed(both hypo and hyperkinetic)disorders.Amongst the hyperkinetic group,Diabetic chorea was the commonest(61.54%).Others included status dystonicus in PKAN, laryngeal dystonia in MSA, ataxia with ocular movement abnormalities in Wenicke’s encephalopathy, drug induced Rabbit syndrome and Oculogyric crisis and 2 patients of bizzare generalized movements which were diagnosed as Functional Neurological Disorder. Among the hypokinetic disorders,we had 2 patients of malignant catatonia and 1 patient of NMS.All three cases of mixed movement disorders were drug induced.2 patients had parkinsonism with craniocervical dyskinesia and 1 patient had parkinsonism with oculogyric crisis.Levosulpride was most commonly associated.Majority(72.22%) of patients had a greater than 50% symptomatic improvement.16.67% patients had complete recovery and 11.11% had less than 50% improvement.2 patients of Diabetic striatopathy and 1 patient of Autoimmune encephalitis had complete resolution.The only two cases having suboptimal improvement were both Functional Neurological Disorders.

Conclusion: Patients presenting to the Emergency with movement disorders vary widely in phenomenology.Hyperkinetic disorders are the commonest.Drug induced movement disorders followed by Diabetic striatopathy are the most common etiologies.Drugs can cause a mixed phenotype.Efficient diagnosis and prompt treatment results in a usually favorable outcome except in cases of Functional Neurological Disorders.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/movement-disorders-in-the-emergencynew-insights/