We should be vigilant on some causes like drug-induced movement disorder, some metabolic derangement, infectious inflammatory disorders, and structural lesions that affect predominantly the basal ganglia. I think that some conditions like the functional movement disorder, neurological or immune-mediated movement disorders have become more prevalent in recent years...
We should be vigilant on some causes like drug-induced movement disorder, some metabolic derangement, infectious inflammatory disorders, and structural lesions that affect predominantly the basal ganglia. I think that some conditions like the functional movement disorder, neurological or immune-mediated movement disorders have become more prevalent in recent years. I would like to emphasize these conditions because they should be suspected to be diagnosed. It’s important to recognize them because they all have a specific treatment, for example, immunotherapy for some immune-mediated movement disorders or psychotherapy or physiotherapy for the functional movement disorder. We should make a practical and a stepwise approach to assess the movement disorder in the emergency room. This should be structured as a five-step clinical pyramid. Step one, a general clinical assessment. Step two, the movement disorder history. Step three, we should perform a detailed neurological exam, including an evaluation or a specific evaluation for the movement phenomenology. For instance, it’s a tremor, ataxia, myoclonus, because recognizing the pattern is crucial to narrowing down the causes. Then we move to the ancillary tests. Here we assess the lab work, the neuroimaging, and toxicology. This part would be very important because it allows us to rule out some common causes and confirm the suspected diagnosis. And finally, the diagnosis and treatment phase where we correct the primary underlying disorder and begin with the specific treatment for the movement disorder.
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