A reversible generalized movement disorder in critically ill children with cancer.
BACKGROUND
Some children treated for cancer become critically ill because of immune suppression and sepsis requiring prolonged intensive care support and assisted ventilation.


METHODS
Over a 3-year-period, we have identified six children (four with brain tumors) who developed a generalized movement disorder during a protracted intensive care unit stay. Median age was 2 years (range 1-6 years). Movement disorder developed while receiving multiple medications.


RESULTS
Sedation was achieved with midazolam and opioid infusions. Dystonic posturing of limbs, jaw movements, tongue thrusting, and intermittent eye deviations were present in all. Movements increased if the child was stimulated and an electroencephalogram performed in five children excluded seizures.


CONCLUSIONS
This movement disorder should be differentiated from seizures to prevent inappropriate treatment. Exacerbation with stimulation is a clinical clue to the correct diagnosis and an electroencephalogram can help differentiate this movement disorder from seizures.
Khan
Raja B
RB
Divisions of Neurology and Neurooncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA. raja.khan@stjude.org
Schmidt
Jeffrey E
JE
Tamburro
Robert F
RF
D001927:Brain Diseases / Q000503:physiopathology*; D001932:Brain Neoplasms / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D020821:Dystonic Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D009069:Movement Disorders / Q000209:etiology*; D011187:Posture
D006993:Hypnotics and Sedatives; D008874:Midazolam