Movement disorders

 DO

• Discuss the possibility of filming movement disorders with parents to support diagnosis.
• Consult with a (paediatric) neurologist readily to make the diagnosis.

• Consider additional diagnostics (including MRI) depending on the situation and condition of the child.

 DO

• Explain movement disorders to child and/or parents.
• Consult with a paediatric neurologist readily about possible treatment options.

 DO

• Rule out medication as a possible cause of movement disorders.

• Check for movement disorder luxating factors such as physical discomfort, constipation, bladder retention, inadequate rest, pain and anxiety.
• Consider low-level consultation with a (paediatric) physical therapist, occupational therapist or paediatric rehabilitation physician.
• Consider using assistive devices to help the child sit, stand or lie down as optimally as possible.

• In acute status dystonicus, consider biperiden. For other acute movement disorders, consult readily with a paediatric neurologist with expertise in movement disorders.
• In dystonia, consider treatment with baclofen (see also: spasticity), clonazepam, trihexyphenidyl or gabapentin.
• In focal dystonia, consider botulinum toxin A injections in consultation with a paediatric rehabilitation physician (see also: spasticity).
• In persistent status dystonia, consider a deep-brain stimulator (surgical).

 DO

• Evaluate the effect and side effects of the treatment instituted at the appropriate time, and adjust treatment as needed. Involve child and family in this process.