Movement disorder emergencies at a tertiary-care center in West Bengal, India: Spectrum, etiologies, diagnostic implications.

BACKGROUND

Acute-onset movement disorders, often termed movement disorder emergencies, present in emergency and inpatient neurology settings and may arise from diverse causes, including potentially reversible metabolic and medication-related conditions.

OBJECTIVES

We aimed to describe the clinical phenomenology and etiological spectrum of movement disorder emergencies presenting to a tertiary care center.

METHODS

We conducted a prospective, single-center, hospital-based cross-sectional observational study over 12 months (February 2023 to January 2024) at a tertiary-care hospital in Kolkata, Eastern India. Patients aged 12 years or older with a movement disorder onset within 4 weeks were enrolled. Movement disorder presentations were categorized as hyperkinetic, hypokinetic, or mixed.

RESULTS

Eighty patients were included (mean age 48.0 years, standard deviation 18.0; 57.5% male). Hyperkinetic presentations predominated (80.0%), followed by mixed (13.7%) and hypokinetic (6.2%) presentations. The most frequent phenomenologies were hemichorea and myoclonus (18.7% each), followed by acute parkinsonism (17.5%), dystonia (16.2%), and tremor (15.0%). Mean symptom duration at presentation did not differ across movement disorder categories (p = 0.36). The movement disorder category was not associated with sex (p = 0.68), age group (p = 0.39), or timing of presentation (p = 0.632). The leading etiologies were metabolic (26.2%) and drug-induced (25.0%), followed by vascular (15.0%), functional (8.7%), and infectious (6.2%) causes. Functional etiologies presented exclusively with hyperkinetic phenomenology.

CONCLUSIONS

In this tertiary-care cohort, movement disorder emergencies were predominantly hyperkinetic, and metabolic and drug-induced causes accounted for over half of the cases. These findings support an expeditious diagnostic approach that prioritizes rapid metabolic screening, careful medication review, and targeted neuroimaging when clinically indicated.