Diaphragmatic Flutter: An Unusual Sign of Multifarious Etiologic Entities.

Diaphragmatic flutter (DF) is an unusual movement disorder with involuntary and repetitive contractions of the diaphragm with or without other abdominal muscle involvement. The disorder is known to occur across all ages including newborns. The etiology is diverse and so are the therapeutic options. Reaching an etiological diagnosis is considerably delayed. Response to therapy is variable and is governed by the underlying etiology. We describe three children with diaphragmatic flutter. The etiology was diverse with unrelated pathologies such as hypocalcemia, striatal necrosis, and idiopathic. All three children responded promptly and completely to calcium, high dose thiamine and biotin, and clonazepam, respectively. Our case series underscores the importance of clinical identification of such rare movement disorders. It also emphasizes that directed etiological evaluation may lead to successful amelioration of DF which is otherwise considered refractory to therapy.