CLINICAL SPECTRUM OF SECONDARY PARKINSONISM IN CHILDHOOD - A REVERSIBLE DISORDER

Parkinsonism is an uncommon movement disorder in childhood. Six unusua l cases of acquired parkinsonism in hospitalized children are describe d. Clinical manifestations included an akinetic-rigid syndrome with an d without tremor, the combination of parkinsonism and dystonia, and a parkinsonism-plus syndrome. Altered mental status, mutism, dysphagia, and sialorrhea were frequent associations. Etiologies included hypoxic -ischemic encephalopathy; haloperidol treatment with and without neuro leptic malignant syndrome; toxicity of cytosine arabinoside, cyclophos phamide, amphotericin B, and methotrexate; St. Louis encephalitis and other encephalitides; and a pineal tumor with hydrocephalus. Cranial m agnetic resonance imaging results ranged from normal to profound cereb ral and cerebellar atrophy with chemotherapeutic toxicity. The illness es usually were severe enough to require pharmacotherapy. Incorrect di agnoses of depression or catatonia delayed treatment or aggravated the problem. Acute treatment included amantadine, levodopa/carbidopa with or without selegiline, diphenhydramine, or benztropine. The concentra tion of CSF homovanillic acid was normal in a neuroleptic-associated p atient, but the level was low in an encephalitic patient. All patients demonstrated dramatic improvement, including two who were not treated ; some had complete resolution of symptoms and none required continued antiparkinsonian drugs despite poor scores on the Unified Parkinson's Disease Rating Scale and the Modified Hoehn and Yahr Rating Scales. T he causes of parkinsonism described are more common in a general pedia tric hospital than the parkinsonism associated with the popularized Se gawa syndrome.