Movement disorders associated with infection

Francisco Cardoso MD PhD (Dr. Cardoso of the Federal University of Minas Gerais received consultation fees from Teva and Zambon and honorariums from Roche, Teva, UCB, and Zambon for speaking engagements.)
Joseph Jankovic MD, editor. (Dr. Jankovic, Director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor College of Medicine, received research funding from Allergan, Allon, Ceregene, Chelsea, EMD Serono, Impax, Ipsen, Lundbeck, Medtronic, Merz, and Teva, and compensation for his services as a consultant or an advisory committee member by Allergan, Auspex, EMD Serono, Lundbeck, Merz, Neurocrine Biosciences, and Teva.)
Originally released October 12, 2000; last updated January 4, 2017; expires January 4, 2020

This article includes discussion of movement disorders associated with infection, rheumatic chorea, and von Economo disease. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

In this article, the author reviews the wide spectrum of movement disorders associated with infectious agents. Although these complications tend to be more frequent in parts of the world plagued by endemic infections, they are also seen in association with sporadic cases of infections. With better control of HIV (human immunodeficiency virus) infection, there has been a decline of movement disorders observed in these patients. There is a comprehensive discussion of Sydenham chorea and other problems related to beta-hemolytic group A streptococcus. New data have fuelled the possibility that streptococcus infection may be associated with neuropsychiatric findings outside the context of Sydenham chorea. Other infections, such as Japanese encephalitis, remain an important cause of movement disorders in some parts of the world. Although it remains unproved and controversial, some experts have proposed that the pathogenesis of Parkinson disease is related to a prion-like behavior of mutated alpha-synuclein.

Key points

 

• Encephalitides of various etiologies can cause movement disorders, mainly parkinsonism and dystonia.

 

• The existence of PANDAS (pediatric auto-immune neuropsychiatric disorders associated with Streptococcus) remains a controversial issue.

 

• The introduction of highly active antiretroviral therapy has resulted in a decline of neurologic complications of HIV infection, including movement disorders.

 

• Almost 50% of patients with Japanese encephalitis, the most common endemic encephalitis worldwide, develop movement disorders.

 

• Sydenham chorea is the most common cause of acute chorea in children worldwide.

Historical note and terminology

Rheumatic chorea was the first described movement disorder related to an infectious agent. Despite the detailed clinical description provided by Thomas Sydenham in 17th century England, its causal relationship with streptococcal infection was only firmly established in the middle of the 20th century (Taranta and Stollerman 1956). The incidence of Sydenham chorea has drastically dropped in North America and Western Europe since 1960. Interest in this condition, however, has been fueled by its persistence as an important health problem in developing countries, as well as by the hypothesis that Streptococcus-induced antibodies targeted at basal ganglia neurons might account for tics and behavioral abnormalities among children (Cardoso 2002a).

Another important landmark in the history of infectious movement disorders was the encephalitis lethargica pandemic, also known as Von Economo disease for the physician who described it. The disease started spontaneously in several different central European cities around 1916. Over the next 11 years, it spread relentlessly around the world, leaving an estimated half million people dead or disabled. From the outset, it became established that a subset of surviving patients developed postencephalitic parkinsonism (von Economo 1931). As mysteriously as it began, this disease virtually disappeared. Curiously, its causative agent remains unknown to date. Even a study employing up-to-date methodology to search for influenza virus in the brain of patients who died of encephalitis lethargica failed to identify any viral gene (Lo et al 2003). It is uncertain whether recent cases with similar clinical pictures represent the same condition described by von Economo.

In the last 2 decades of the 20th century, AIDS was the infectious disease to receive the largest scientific and public attention. It became acknowledged that movement disorders are among the neurologic complications of patients who are HIV positive (Brew 2001). The introduction of highly active antiretroviral therapy has led, however, to a decline in the frequency of occurrence of HIV-related neurologic disorders (Maschke et al 2000; Cardoso 2002b).

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