Acquired reversible pediatric parkinsonism of unknown origin – a case series

Aims: To report several pediatric cases of an acquired reversible parkinsonian movement disorder with unknown etiologies and to extent the clinical spectrum of this movement disorder

Method: Case series from a population-based pediatric hospital

Results: One teenager girl developed a prolonged period of severe parkinsonism after a malignant neuroleptica syndrome following haloperidol-medication against psychosis after LSD-consumption. A trial of L-DOPA led to aggravation of psychosis; her symptoms slowly resolved over weeks with bromocryptin and clozapin treatment. A 3 year old boy showed an acute parkinsonian syndrome after a stressful emergency-intubation due to acute obstruction of upper airways after tonsillectomy/adenotomy that was prompt reversible after a single dose of L-DOPA. Another 11 year old boy with a known behaviour disorder was admitted for progressive weight loss and denial of food. Together with typical symptoms of anorexia he showed persistent rigidity, mutism, hypersalivation and bradykinesia. Imaging, immunological and neurotransmitter studies were normal as well as genetic analysis for the most frequent hereditary childhood parkinson syndromes. Symptoms slowly resolved over weeks with L-DOPA-treatment. Video examples of the clinical pictures are given.

Conclusion: In a population-based neuropediatric setting, parkinsonism can be observed in different clinical situations without clearcut etiology. The case observations imply different mechanism of reversible extrapyramidal dopaminergic dysfunction that sometimes can be corrected by L-DOPA-administration with a dramatic effect.

movement disorder parkinsonism