Movement disorders in childhood: therapeutic update

Mouvements anormaux de l’enfant : nouveautés thérapeutiques

Abnormal movements are not uncommon in childhood. Due to the severity of the abnormal movements or to the functional disability, a medical treatment is often required; the wide range of available pharmacological molecules and the absence of therapeutic consensus highlight the limited efficacy of the medical treatment on dystonic or athetoid movements, or severe tic disorders. The recent identification of the enzymatic defect implicated in metabolic diseases led to the development of specific treatment for newly recognized disorders, with more or less interesting results (creatine ou biotine supplementation). Recent progress in functional neurosurgery opened new fields in the treatment of movement disorders. Intrathecal baclofen was proved effective in the treatment of secondary dystonia, especially in patients with cerebral palsy. Deep brain stimulation is now an established therapy for patients with a generalized dystonic syndrome. Given the successful results of pallidal stimulation in dystonia, the indication of this procedure has been discussed in other types of abnormal movements. [Copyright &y& Elsevier]

Les mouvements anormaux ne sont pas exceptionnels chez l’enfant. Dans bien des cas, l’intensite´ des mouvements anormaux ou la ge`ne fonctionnelle induite conduiront a` un traitement me´dical : la diversite´ des substances pharmocologiques disponibles et l’absence de consensus refle`tent l’efficacite´ souvent limite´e de ces substances, en particulier sur les mouvements dystoniques, l’athe´tose, ou sur les tics se´ve`res. L’identification du de´ficit enzymatique responsable de certains syndromes a permis le de´veloppement de traitements plus spe´cifiques pour certaines maladies nouvellement caracte´rise´es, avec des re´sultats plus ou moins encourageants (supple´mentation en cre´atine, en biotine). Les progre`s les plus re´cents dans le traitement des mouvements anormaux ont e´te´ apporte´s par la neurochirurgie fonctionnelle. Les injections intrathe´cales de baclofe`ne ont montre´ leur efficacite´ chez les patients atteints de dystonie secondaire, notamment ceux entrant dans le cadre d’une infirmite´ motrice ce´re´brale. La stimulation ce´re´brale profonde a comple`tement transforme´ la prise en charge the´rapeutique des patients pre´sentant un syndrome dystonique ge´ne´ralise´. L’efficacite´ de la stimulation bipallidale dans les syndromes dystoniques a conduit a` proposer cette alternative the´rapeutique dans d’autres types de mouvements anormaux se´ve`res. [Copyright 2004 Elsevier]

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