Recommendations for the Management of Initial and Refractory Pediatric Status Dystonicus

Lindsey M Vogt; Kathryn Yang; Gabriel Tse; Vicente Quiroz; Zainab Zaman; Laura Wang; Rasha Srouji; Amy Tam; Elicia Estrella; Shannon Manzi; Alfonso Fasano; Weston T Northam; Scellig Stone; Mahendranath Moharir; Hernan Gonorazky; Brian McAlvin; Monica Kleinman; Kerri L LaRovere; Carolina Gorodetsky; Darius Ebrahimi-Fakhari

doi:10.1002/mds.29794

Recommendations for the Management of Initial and Refractory Pediatric Status Dystonicus

Mov Disord. 2024 Sep;39(9):1435-1445. doi: 10.1002/mds.29794. Epub 2024 Apr 15.

Authors

Lindsey M Vogt¹, Kathryn Yang^{1

2}, Gabriel Tse³, Vicente Quiroz², Zainab Zaman², Laura Wang¹, Rasha Srouji², Amy Tam², Elicia Estrella², Shannon Manzi⁴, Alfonso Fasano^{5

6}, Weston T Northam⁷, Scellig Stone⁷, Mahendranath Moharir¹, Hernan Gonorazky¹, Brian McAlvin⁸, Monica Kleinman⁸, Kerri L LaRovere⁹, Carolina Gorodetsky^{1

5}, Darius Ebrahimi-Fakhari^{2

9}

Affiliations

¹ Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
² Movement Disorders Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³ Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA.
⁴ Department of Pharmacy, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
⁶ Krembil Brain Institute, University of Toronto, Toronto, Ontario, Canada.
⁷ Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁸ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁹ Neurocritical Care Consult Service, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 38619077
DOI: 10.1002/mds.29794

Abstract

Status dystonicus is the most severe form of dystonia with life-threatening complications if not treated promptly. We present consensus recommendations for the initial management of acutely worsening dystonia (including pre-status dystonicus and status dystonicus), as well as refractory status dystonicus in children. This guideline provides a stepwise approach to assessment, triage, interdisciplinary treatment, and monitoring of status dystonicus. The clinical pathways aim to: (1) facilitate timely recognition/triage of worsening dystonia, (2) standardize supportive and dystonia-directed therapies, (3) provide structure for interdisciplinary cooperation, (4) integrate advances in genomics and neuromodulation, (5) enable multicenter quality improvement and research, and (6) improve outcomes. © 2024 International Parkinson and Movement Disorder Society.

Keywords: childhood‐onset movement disorders; clinical pathway; deep brain stimulation; dystonia; status dystonicus.

Publication types

Review

MeSH terms

Child
Disease Management
Dystonia / diagnosis
Dystonia / therapy
Dystonic Disorders* / diagnosis
Dystonic Disorders* / therapy
Humans