title: Management of status dystonicus in children. Cases report and review.
abstract: Status dystonicus (SD) is a medical emergency weighed by a relevant morbidity and mortality. It mainly affects patients with primary or secondary dystonia and is often triggered by events such as fever, infections, exposure medications or their abrupt cessation. We report on three patients presenting with SD. Two of them were affected by a static encephalopathy and the other one by a neurodegenerative disorder such as megalencephalic leukoencephalopathy with subcortical cysts (MLC). To our knowledge this is the first patient affected by MLC presenting with SD. All our patients underwent continuous infusion of midazolam, in association with pimozide and trihexyphenidyl, which led to complete resolution of muscular spasms in two patients. In the other one a complete cessation of dystonic spasms was obtained after intrathecal baclofen. From a therapeutic point of view there are no evidence-based management guidelines in SD. The approach is empiric and based on very limited anecdotal reports. On the basis of our observations and an extensive review of the literature we delineated a possible therapeutic strategy of SD in children.
authors.affiliation: Department of Pediatrics, Obstetrics, Gynecology, and Reproductive Medicine, Pediatric Neurology Unit, S. Maria alle Scotte Hospital, University of Siena, 53100 Siena, Italy. grosso@unisi.it
authors.forename: Salvatore
authors.initials: S
authors.lastname: Grosso
authors.forename: Alberto
authors.initials: A
authors.lastname: Verrotti
authors.forename: Mario
authors.initials: M
authors.lastname: Messina
authors.forename: Michele
authors.initials: M
authors.lastname: Sacchini
authors.forename: Paolo
authors.initials: P
authors.lastname: Balestri
mesh_terms: D000293:Adolescent; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001418:Baclofen / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D019090:Case Management; D002648:Child; D003560:Cysts / Q000473:pathology; D004421:Dystonia / Q000628:therapy*; D004569:Electroencephalography; D005260:Female; D006257:Head / Q000473:pathology; D020279:Hereditary Central Nervous System Demyelinating Diseases / Q000473:pathology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use; D056784:Leukoencephalopathies / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D010868:Pimozide / Q000627:therapeutic use; D013035:Spasm / Q000188:drug therapy; D013747:Tetrabenazine / Q000627:therapeutic use; D014282:Trihexyphenidyl / Q000627:therapeutic use
chemical_list: D018726:Anti-Dyskinesia Agents; D006993:Hypnotics and Sedatives; D009125:Muscle Relaxants, Central; D010868:Pimozide; D014282:Trihexyphenidyl; D001418:Baclofen; D008874:Midazolam; D013747:Tetrabenazine