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Acute hyperkinetic movement disorders in Italian paediatric emergency departments
  1. Umberto Raucci1,
  2. Pasquale Parisi2,
  3. Nicola Vanacore3,
  4. Giacomo Garone4,
  5. Claudia Bondone5,
  6. Antonella Palmieri6,
  7. Lucia Calistri7,
  8. Agnese Suppiej8,
  9. Raffaele Falsaperla9,
  10. Alessandro Capuano10,
  11. Valentina Ferro1,
  12. Antonio Francesco Urbino5,
  13. Ramona Tallone6,
  14. Alessandra Montemaggi11,
  15. Stefano Sartori8,
  16. Piero Pavone9,
  17. Margherita Mancardi12,
  18. Federico Melani13,
  19. Lucrezia Ilvento13,
  20. Maria Federica Pelizza8,
  21. Antonino Reale1
  1. 1 Pediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
  2. 2 Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sant’Andrea Hospital of Rome, Sapienza University, Rome, Italy
  3. 3 National Centre for Epidemiology, Surveillance, and Health Promotion, National Institute of Health, Rome, Italy
  4. 4 University Department of Pediatrics (DPUO), University of Rome Tor Vergata, Bambino Gesù Children’s Hospital, Rome, Italy
  5. 5 Department of Pediatric Emergency, Regina Margherita Children’s Hospital–AOU Città della Salute e della Scienza di Torino, Turin, Italy
  6. 6 Department of Pediatric Emergency, IRCCS Giannina Gaslini, Genova, Italy
  7. 7 Department of Pediatric Emergency, Anna Meyer Children’s Hospital, Florence, Italy
  8. 8 Pediatric Neurology Unit, Department of Woman’s and Child’s Health, University of Padua, Padova, Italy
  9. 9 General Paediatrics Operative Unit, University Hospital Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
  10. 10 Division of Neurology, Bambino Gesù Children’s Hospital, Rome, Italy
  11. 11 Department of Pediatrics, Anna Meyer Children’s Hospital, Florence, Italy
  12. 12 Unit of Child Neuropsychiatry, Head-Neck and Neuroscience Department, Giannina Gaslini Institute, Genoa, Italy
  13. 13 Pediatric Neurology and Neurogenetics Unit and Laboratories, Neuroscience Department, Meyer Children’s Hospital, University of Florence, Florence, Italy
  1. Correspondence to Dr Umberto Raucci, Pediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Rome 00165, Italy; umberto.raucci{at}


Introduction Limited data exist on epidemiology, clinical presentation and management of acute hyperkinetic movement disorders (AHMD) in paediatric emergency departments (pED).

Methods We retrospectively analysed a case series of 256 children (aged 2 months to 17 years) presenting with AHMD to the pEDs of six Italian tertiary care hospitals over a 2-year period (January 2012 to December 2013).

Results The most common type of AHMD was tics (44.5%), followed by tremors (21.1%), chorea (13.7%), dystonia (10.2%), myoclonus (6.3%) and stereotypies (4.3%). Neuropsychiatric disorders (including tic disorders, psychogenic movement disorders and idiopathic stereotypies) were the most represented cause (51.2%). Inflammatory conditions (infectious and immune-mediated neurological disorders) accounted for 17.6% of the cases whereas non-inflammatory disorders (including drug-induced AHMDs, genetic/metabolic diseases, paroxysmal non-epileptic movements and idiopathic AHMDs) accounted for 31.2%. Neuropsychiatric disorders prevailed among preschoolers and schoolers (51.9% and 25.2%, respectively), non-inflammatory disorders were more frequent in infants and toddlers (63.8%), whereas inflammatory conditions were more often encountered among schoolers (73.3%). In 5 out of 36 Sydenham’s chorea (SC) cases, tics were the presentation symptom on admission to emergency department (ED), highlighting the difficulties in early diagnosis of SC. Inflammatory disorders were associated with a longer hospital stay and a greater need of neuroimaging test compared with other disorders.

Conclusions This study provides the first large sample of paediatric patients presenting to the ED for AHMDs, helping to elucidate the epidemiology, aetiology and clinical presentation of these disorders.

  • movement disorder
  • emergency department
  • child
  • neurology
  • chorea
  • tics
  • dystonia

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  • Contributors UR and PP conceptualised and designed the study, coordinated and supervised data collection, interpreted the data, drafted the initial manuscript, provided critical review and revision of the manuscript, and wrote the final manuscript. NV performed statistical analysis, interpreted the data, contributed to conceptualising the study and participated in the design of the study, and reviewed and revised the initial manuscript. GG and VF contributed to conceptualising the study and participated in the design of the study, collected and interpreted the data, and reviewed and revised the initial manuscript. CB, AP, LC, AS, RF, AC, AFU, RT, AM, SS, PP, MM, FM, LI and MFP contributed to conceptualising the study, collected the data, and reviewed and revised the initial manuscript. AR contributed to conceptualising the study, provided study supervision, and reviewed and revised the initial manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Local Ethical Committee of each participating centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.