eMedicine Specialties > Neurology > Movement and Neurodegenerative Diseases

Movement Disorders in Individuals with Developmental Disabilities: Differential Diagnoses & Workup

Author: Norberto Alvarez, MD, Assistant Professor, Department of Neurology, Harvard Medical School; Consulting Staff, Department of Neurology, Boston Children's Hospital
Contributor Information and Disclosures

Updated: May 6, 2009

Differential Diagnoses

Cerebral Palsy
Metabolic Disease & Stroke: Hyperglycemia/Hypoglycemia
Chorea in Adults
Metabolic Disease & Stroke: MELAS
Hallervorden-Spatz Disease
Metabolic Disease & Stroke: Propionic Acidemia
Huntington Disease
Myokymia
Hydrocephalus
Hyperammonemia
Inherited Metabolic Disorders

Other Problems to Be Considered

Abetalipoproteinemia
Aicardi syndrome
Alpers disease
Argininosuccinic aciduria
Ataxia telangiectasia
Benign dystonia of infancy
Biotin deficiency
Biotinidase deficiency
Birth asphyxia
Botulinum toxin (BOTOX) - Dystonia treatment
Canavan spongy degeneration
Carbamazepine-associated dystonia
Cerebellar malformations
Cerebral lipidosis
Cerebral malformations
Chorea
Cimetidine-associated dystonia
Diphtheria
Dopamine blockers–associated chorea (eg, phenytoin,
carbamazepine, haloperidol)
Dyspeptic dystonia with hiatal hernia
Dystonia
Encephalitis
Familial progressive myoclonic epilepsy
Glutaric acidemia
Glutaric aciduria type I
Hartnup disease
Hereditary spastic paraplegias
Hyperglycinemia
Hyperkinetic syndrome
Hypoxia-ischemia
Hypoxic-ischemic encephalopathy
Isovaleric acidemia
Lafora body disease
Kernicterus
Maple syrup urine disease (intermittent)
Menkes disease
Metoclopramide-associated dystonia
Mumps encephalitis
Myoclonic encephalopathy of infancy with or without Myoclonus
Neuroblastoma
Neurodevelopmental malformations
Neuronal ceroid-lipofuscinosis
Phenylketonuria
Phenytoin-associated dystonia
Pyridoxine dependency
Rubeola encephalitis
St. Louis encephalitis
Subacute sclerosis panencephalitis
Tay-Sachs disease
Varicella encephalitis

Workup

Laboratory Studies

  • The following is a summary of the guidelines from the American Academy of Neurology and the Child Neurology Society for diagnosis in a child with global developmental delay.
    • Metabolic screening for inborn errors of metabolism
      • Metabolic screening for inborn errors of metabolism is not necessarily indicated in all children if universal newborn screening was performed. However, metabolic screening should be done if the results are not available or if newborn screening was never or might never have been performed.
      • Metabolic screening should also be conducted whenever the history suggests a specific syndrome.
    • Tests of the following:
      • Serum and urine amino acids
      • Urine organic acids
      • Acylcarnitines
      • Mucopolysaccharides
      • Serum glucose
      • Bicarbonate
      • Lactate
      • Pyruvate
      • Ammonia
      • Creatine kinase
    • Genetic consultation followed by specialized genetic testing
      • Routine cytogenetic testing is indicated, even in the absence of dysmorphic or clinical features suggestive of a specific syndrome.
      • Testing for the fragile X mutation may be needed, particularly if the patient has a family history of developmental delay. Clinical preselection may narrow the focus of who should be screened. The yield of positive results is highest in male individuals; however, female individuals are also affected.
      • Testing for the MECP2 gene deletion to diagnose Rett syndrome should be considered in female patients with unexplained moderate-to-severe mental retardation, though this test is most often done if they have some of the phenotype of Rett syndrome.
      • In some children, use of newer molecular techniques (eg, fluorescence in situ hybridization [FISH], measurement of microsatellite markers) to assess for subtelomeric chromosomal rearrangements may be considered.
    • Lead screening: This screening should be done when environmentally indicated.
    • Thyroid screening: Thyroid screening is usually done as a part of newborn screening. However, this test should be considered if other symptoms of hypothyroidism are present.
  • Newborn screening tests for metabolic disorders are common in United States. However, these tests are not uniform and differ in different states. Also, these tests are rarely done in other countries, especially in developing countries.

Imaging Studies

  • Neuroimaging studies are indicated in practically every patient with mental retardation with or without a movement disorder.
  • The most common imaging techniques used in the diagnostic evaluation of individuals with mental retardation or developmental disabilities are the CT, MRI, and magnetic resonance arteriography (MRA).
  • Given its unique gray matter–white matter differentiation, MRI is probably the best imaging test in a diagnostic workup.
  • Some conditions in which neuroimaging procedures, and specifically MRI, have proved to be useful include the following:
    • Neuronal migration disorders - Gray matter–white matter heterotopias, schizencephaly, lissencephaly, megalencephaly, polymicrogyria
    • Brain malformations - Arnold-Chiari malformation, Dandy-Walker malformation, hydrocephalus, arachnoid cysts
    • Intrauterine infections - Toxoplasmosis, cytomegalovirus, human herpesviruses (eg, herpes simplex)
    • Vascular disorders - Ischemic brain insults, intracranial bleeding, congenital hemiplegia
    • Disorders of the spine - Spina bifida
    • White matter diseases - Demyelinating disorders such as adrenoleukodystrophy, metachromatic leukodystrophy, and Canavan disease

Other Tests

  • Neurophysiologic studies (eg, electroencephalography, electromyography) are indicated mostly to diagnose and treat associated conditions. However, these tests are considered a component of the routine evaluation of individuals with developmental delay.
  • Hearing and vision testing are usually indicated in many children with developmental delay because the frequent presence of associated sensory deficits.
  • Gait studies help in evaluating patients with CP.

Histologic Findings

From an anatomic perspective, developmental disabilities are heterogeneous conditions.

  • Grossly normal brains are not uncommon, especially in individuals with a mild degree of mental retardation. Grossly abnormal brains almost always are associated with severe mental retardation.
  • No specific histopathology is associated with the abnormal movement disorders found in mental retardation.
  • Brain development is characterized by a succession of well-defined events, including neural induction, proliferation, migration, and cytodifferentiation, all probably under genetic control.
  • Many factors can disrupt this process and lead to obvious brain malformations, such as agyrias, pachygyrias, and varying types of hydrocephalies and microcephalies.
  • Mild forms of neuronal migration disorders (eg, heterotopias, cortical dysplasias) are frequently seen in persons with mental retardation.
  • On occasion, the pathologic changes are subtle and limited to the microscopic level.
  • Dendritic abnormalities are described in a variety of mental retardation disorders.
  • Cytoarchitectonic abnormalities disrupt the brain's circuitry and synaptic organization.
  • Many neuronal abnormalities (eg, in distribution, number, morphology) are described in association with mental retardation; in some cases, these are related to specific syndromes.
  • The subject is complex, but as a matter of example, quantitation of dendritic branches in persons with Down syndrome showed that anomalies are age dependent.
    • Fetuses and neonates have normal dendritic trees.
    • A reduced dendritic tree, aberrant dendritic spines, and decreased spinal density are most common in infants and older individuals.
  • In Rett syndrome, neuronal size is reduced, neuronal density is increased, and the dendritic tree is decreased.
  • In unclassified forms of mental retardation, a reduced dendritic tree, decreased spinal density, and aberrant dendrites and spines are common features.
  • One of the common features in mental retardation is the presence of both cortical and subcortical disturbances in the synaptic relationship or in the circuitry of the cerebral cortex.

More on Movement Disorders in Individuals with Developmental Disabilities

Overview: Movement Disorders in Individuals with Developmental Disabilities
Differential Diagnoses & Workup: Movement Disorders in Individuals with Developmental Disabilities
Treatment & Medication: Movement Disorders in Individuals with Developmental Disabilities
Follow-up: Movement Disorders in Individuals with Developmental Disabilities
References
Further Reading
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References

  1. Coulter DL. Prevention as a form of support: implications for the new definition. Ment Retard. Apr 1996;34(2):108-16. [Medline].

  2. Scott BL, Jankovic J. Delayed-onset progressive movement disorders after static brain lesions. Neurology. Jan 1996;46(1):68-74. [Medline].

  3. McLaren J, Bryson SE. Review of recent epidemiological studies of mental retardation: prevalence, associated disorders, and etiology. Am J Ment Retard. Nov 1987;92(3):243-54. [Medline].

  4. Kauffman WE. Mental retardation and learning disorders. A neuropathological differentiation. In: Capute AJ, Accardo PJ, eds. Developmental Disabilities in Infancy and Childhood, The Spectrum of Developmental Disabilities. Vol2. 2nd. edition. Baltimore: Paul H. Brooks; 1996:(Chapter 4) 49-70.

  5. Ozand PT, Gascon GG. Organic aciduria: a review, Part I. Journal of Child Neurology. 1991;6:196-219.

  6. Gascon GG, Ozand PT, Brismar J. Movement disorders in childhood organic acidurias. Clinical, neuroimaging, and biochemical correlations. Brain Dev. Nov 1994;16 Suppl:94-103. [Medline].

  7. U.S. Office of Special Education and Rehabilitation Services:. Fifth Annual Report to Congress in the implementation of P.L. 94-142. Washington, DC, Government Printing Office. 1983.

  8. Murphy CC, Yeargin-Allsopp M, Decoufle P, et al. The administrative prevalence of mental retardation in 10-year-old children in metropolitant Atlanta, 1985 through 1987. Am J Public Health. 1995;85:319-323.

  9. Murphy K, Molnar GE, Lankasky K. Medical and functional status of adults with cerebral palsy. Dev Med Chil Neur. 1996;37:1075-1084.

  10. Stone RK, May JE, Alvarez WF, Ellman G. Prevalence of dyskinesia and related movement disorders in a developmentally disabled population. J Ment Defic Res. Feb 1989;33 (Pt 1):41-53. [Medline].

  11. Kuban KC, Leviton A. Cerebral palsy. N Engl J Med. Jan 20 1994;330(3):188-95. [Medline].

  12. Cummins SK, Nelson KB, Grether JK, Velie EM. Cerebral palsy in four northern California counties, births 1983 through 1985. J Pediatr. Aug 1993;123(2):230-7. [Medline].

  13. Rosenbloom L. Dyskinetic cerebral palsy and birth asphyxia. Dev Med Child Neurol. Apr 1994;36(4):285-9. [Medline].

  14. Hallet M, Alvarez N. Attempted rapid elbow flexion movements in patients with athetosis. J Neurol Neurosurg and Psych. 1983;46:745-750.

  15. Yokochi K, Shimabukuro S, Kodama M, et al. Motor function of infants with athetoid cerebral palsy. Dev Med Child Neurol. Oct 1993;35(10):909-16. [Medline].

  16. Pelegano JP, Nowysz S, Goepferd S. Temporomandibular joint contracture in spastic quadriplegia: effect on oral-motor skills. Dev Med Child Neurol. Jun 1994;36(6):487-94. [Medline].

  17. Alvarez N, Larkin C, Roxborough J. Carpal tunnel syndrome in athetoid-dystonic cerebral palsy. Arch Neurol. May 1982;39(5):311-2. [Medline].

  18. Hirose G, Kadoya S. Cervical spondylotic radiculo-myelopathy in patients with athetoid-dystonic cerebral palsy: clinical evaluation and surgical treatment. J Neurol Neurosurg Psychiatry. Aug 1984;47(8):775-80. [Medline].

  19. Losse A, Henderson SE, Elliman D, et al. Clumsiness in children--do they grow out of it? A 10-year follow-up study. Dev Med Child Neurol. Jan 1991;33(1):55-68. [Medline].

  20. Blondis TA. The spectrum of mild neuromotor disabilities. In: Capute AJ, Accardo PJ, eds. Developmental Disabilities in Infancy and Childhood. The Spectrum of Developmental Disabilities. Vol 2. 2nd ed. Baltimore: Paul H. Brooks; 1996:199-208.

  21. Hellgren L, Gillberg C, Gillberg IC, Enerskog I. Children with deficits in attention, motor control and perception (DAMP) almost grown up: general health at 16 years. Dev Med Child Neurol. Oct 1993;35(10):881-92. [Medline].

  22. Baumeister AA, Todd ME, Sevin JA. Efficacy and specificity of pharmacological therapies for behavioral disorders in persons with mental retardation. Clin Neuropharmacol. Aug 1993;16(4):271-94. [Medline].

  23. Murti Rao J, Cowie VA, Mathew B. Tardive dyskinesia in neuroleptic medicated mentally handicapped subjects. Acta Psychiatrica Scand. 1987;76:507-513.

  24. Granger DA, Yurkunski JM, Miller NH, et al. Systematic dyskinesia examination of profoundly mentally retarded persons: cooperation and assessment. Am J Ment Defic. Sep 1987;92(2):155-60. [Medline].

  25. Rogers D, Karki C, Bartlett C, et al. The motor disorders of mental handicap. An overlap with the motor disorders of severe psychiatric illness. Br J Psychiatry. Jan 1991;158:97-102. [Medline].

  26. Matson JL, Mayville EA, Bielecki J, et al. Tardive dyskinesia associated with metoclopramide in persons with developmental disabilities. Res Dev Disabil. May-Jun 2002;23(3):224-33. [Medline].

  27. Suzuki T, Koizumi J, Moroji T, et al. Clinical characteristics of the Pisa syndrome. Acta Psychiatr Scand. Dec 1990;82(6):454-7. [Medline].

  28. Gross EJ, Hull HG, Lytton GJ, et al. Case study of neuroleptic-induced akathisia: important implications for individuals with mental retardation. Am J Ment Retard. Jul 1993;98(1):156-64. [Medline].

  29. Ganesh S, Murti Rao JM, Cowie VA. Akathisia in neuroleptic medicated mentally handicapped subjects. J Ment Defic Res. Aug 1989;33 (Pt 4):323-9. [Medline].

  30. Correll CU, Leucht S, Kane JM. Lower risk for tardive dyskinesia associated with second-generation antipsychotics: a systematic review of 1-year studies. Am J Psychiatry. Mar 2004;161(3):414-25. [Medline].

  31. Boyd RD. Neuroleptic malignant syndrome and mental retardation: review and analysis of 29 cases. Am J Ment Retard. Jul 1993;98(1):143-55. [Medline].

  32. Asconape J, Diedrich A, DellaBadia J. Myoclonus associated with the use of gabapentin. Epilepsia. Apr 2000;41(4):479-81. [Medline].

  33. Lancman ME, Asconape JJ, Penry JK. Choreiform movements associated with the use of valproate. Arch Neurol. Jul 1994;51(7):702-4. [Medline].

  34. Magalhaes MH, Kawamura JY, Araujo LC. General and oral characteristics in Rett syndrome. Spec Care Dentist. Jul-Aug 2002;22(4):147-50. [Medline].

  35. Rojahn J. Self-injurious and stereotypic behavior of noninstitutionalized mentally retarded people: prevalence and classification. Am J Ment Defic. Nov 1986;91(3):268-76. [Medline].

  36. Dura JR, Mulick JA, Rasnake LK. Prevalence of stereotypy among institutionalized nonambulatory profoundly mentally retarded people. Am J Ment Defic. Mar 1987;91(5):548-9. [Medline].

  37. Bodfish JW, Crawford TW, Powell SB, et al. Compulsions in adults with mental retardation: prevalence, phenomenology, and comorbidity with stereotypy and self-injury. Am J Ment Retard. Sep 1995;100(2):183-92. [Medline].

  38. Lund J. Behavioural symptoms and autistic psychosis in the mentally retarded adult. Acta Psychiatr Scand. Apr 1986;73(4):420-8. [Medline].

  39. Berkson G, Rafaeli-Mor N, Tarnovsky S. Body-rocking and other habits of college students and persons with mental retardation. Am J Ment Retard. Mar 1999;104(2):107-16. [Medline].

  40. Fee VE, Matson JL. Definition, classification and taxonomy. In: Luiselli JK, Matson JL, Singh NN, eds. Self Injurious Behavior. Analysis, Assessment, and Treatment. New York: Springer-Verlag; 1992:3-20.

  41. Troster H. Prevalence and functions of stereotyped behaviors in non-handicapped children in residential care. J Abnorm Child Psychol. Feb 1994;22(1):79-97. [Medline].

  42. Harris KM, Mahone EM, Singer HS. Nonautistic motor stereotypies: clinical features and longitudinal follow-up. Pediatr Neurol. Apr 2008;38(4):267-72. [Medline].

  43. Aman MG. Efficay for psychotropic drugs for reducing self-injurious behavior inthe developmental disabilities. Annals of Clinical Psychiatry. 1993;5:171-188.

  44. Sandman CA, Barron JL, Chicz-DeMet A, DeMet EM. Plasma B-endorphin levels in patients with self-injurious behavior and stereotypy [see comments]. Am J Ment Retard. Jul 1990;95(1):84-92. [Medline].

  45. Symons FJ, Sutton KA, Walker C, Bodfish JW. Altered diurnal pattern of salivary substance P in adults with developmental disabilities and chronic self-injury. Am J Ment Retard. Jan 2003;108(1):13-8. [Medline].

  46. Symons FJ, Thompson A, Rodriguez MC. Self-injurious behavior and the efficacy of naltrexone treatment: a quantitative synthesis. Ment Retard Dev Disabil Res Rev. 2004;10(3):193-200. [Medline].

  47. Sandman CA, Barron JL, Crinella FM, et al. Influence of naloxone on brain and behavior of a self-injurious woman. Biol Psychiatry. Jul 1987;22(7):899-906. [Medline].

  48. Taylor DV, Hetrick WP, Neri CL, et al. Effect of naltrexone upon self-injurious behavior, learning and activity: a case study. Pharmacol Biochem Behav. Sep 1991;40(1):79-82. [Medline].

  49. Zingarelli G, Ellman G, Hom A, et al. Clinical effects of naltrexone on autistic behavior. Am J Ment Retard. Jul 1992;97(1):57-63. [Medline].

  50. Willemsen-Swinkels SH, Buitelaar JK, Nijhof GJ, et al. Failure of naltrexone hydrochloride to reduce self-injurious and autistic behavior in mentally retarded adults. Double-blind placebo-controlled studies. Arch Gen Psychiatry. Sep 1995;52(9):766-73. [Medline].

  51. Kern L, Bailin D, Mauk JE. Effects of a topical anesthetic on non-socially maintained self-injurious behavior. Dev Med Child Neurol. Nov 2003;45(11):769-71. [Medline].

  52. Bukelis I, Porter FD, Zimmerman AW, et al. Smith-Lemli-Opitz syndrome and autism spectrum disorder. Am J Psychiatry. Nov 2007;164(11):1655-61. [Medline].

  53. Sikora DM, Pettit-Kekel K, Penfield J, Merkens LS, Steiner RD. The near universal presence of autism spectrum disorders in children with Smith-Lemli-Opitz syndrome. Am J Med Genet A. Jul 15 2006;140(14):1511-8. [Medline].

  54. Tierney E, Nwokoro NA, Porter FD, et al. Behavior phenotype in the RSH/Smith-Lemli-Opitz syndrome. Am J Med Genet. Jan 15 2001;98(2):191-200. [Medline].

  55. Haas D, Garbade SF, Vohwinkel C, et al. Effects of cholesterol and simvastatin treatment in patients with Smith-Lemli-Opitz syndrome (SLOS). J Inherit Metab Dis. Jun 2007;30(3):375-87. [Medline].

  56. Hall SS, Lightbody AA, Reiss AL. Compulsive, self-injurious, and autistic behavior in children and adolescents with fragile X syndrome. Am J Ment Retard. Jan 2008;113(1):44-53. [Medline].

  57. Hall S, Thorns T, Oliver C. Structural and environmental characteristics of stereotyped behaviors. Am J Ment Retard. Nov 2003;108(6):391-402. [Medline].

  58. Jacquemont S, Hagerman RJ, Leehey M, et al. Fragile X premutation tremor/ataxia syndrome: molecular, clinical, and neuroimaging correlates. Am J Hum Genet. Apr 2003;72(4):869-78. [Medline].

  59. Hagerman RJ, Leavitt BR, Farzin F, et al. Fragile-X-associated tremor/ataxia syndrome (FXTAS) in females with the FMR1 premutation. Am J Hum Genet. May 2004;74(5):1051-6. [Medline].

  60. Finucane BM, Konar D, Haas-Givler B, et al. The spasmodic upper-body squeeze: a characteristic behavior in Smith- Magenis syndrome. Dev Med Child Neurol. Jan 1994;36(1):78-83. [Medline].

  61. Harris J. Lesch-Nyhan disease. 2005. Neurology Medlink. Available at http://www.medlink.com.

  62. Taira T, Kobayashi T, Hori T. Disappearance of self-mutilating behavior in a patient with lesch-nyhan syndrome after bilateral chronic stimulation of the globus pallidus internus. Case report. J Neurosurg. Feb 2003;98(2):414-6. [Medline].

  63. Temudo T, Oliveira P, Santos M, et al. Stereotypies in Rett syndrome: analysis of 83 patients with and without detected MECP2 mutations. Neurology. Apr 10 2007;68(15):1183-7. [Medline].

  64. Einspieler C, Kerr AM, Prechtl HF. Abnormal general movements in girls with Rett disorder: the first four months of life. Brain Dev. Nov 2005;27 Suppl 1:S8-S13. [Medline].

  65. Goyal M, O'Riordan MA, Wiznitzer M. Effect of topiramate on seizures and respiratory dysrhythmia in Rett syndrome. J Child Neurol. Aug 2004;19(8):588-91. [Medline].

  66. Zivkovic SA, Costa G, Bond G, Abu-Elmagd KM. Treatment of tardive dyskinesia with levetiracetam in a transplant patient. Acta Neurol Scand. May 2008;117(5):351-3. [Medline].

  67. Macedo CR, Silva AB, Machado MA, Saconato H, Prado GF. Occlusal splints for treating sleep bruxism (tooth grinding). Cochrane Database Syst Rev. Oct 17 2007;CD005514. [Medline].

  68. Barron J, Sandman CA. Relationship of sedative-hypnotic response to self-injurious behavior and stereotypy by mentally retarded clients. Am J Ment Defic. Sep 1983;88(2):177-86. [Medline].

  69. Cauwels RG, Martens LC. Self-mutilation behaviour in Lesch-Nyhan syndrome. J Oral Pathol Med. Oct 2005;34(9):573-5. [Medline].

  70. Crichton JU, Mackinnon M, White CP. The life-expectancy of persons with cerebral palsy. Dev Med Child Neurol. Jul 1995;37(7):567-76. [Medline].

  71. Cummins SK, Nelson KB, Grether JK, Velie EM. Cerebral palsy in four northern California counties, births 1983 through 1985. J Pediatr. Aug 1993;123(2):230-7. [Medline].

  72. Dabrowski E, Smathers SA, Ralstrom CS, et al. Botulinum toxin as a novel treatment for self-mutilation in Lesch-Nyhan syndrome. Dev Med Child Neurol. Sep 2005;47(9):636-9. [Medline].

  73. Gillberg C, Terenius L, Lonnerholm G. Endorphin activity in childhood psychosis. Spinal fluid levels in 24 cases. Arch Gen Psychiatry. Aug 1985;42(8):780-3. [Medline].

  74. Gillberg IC, Gillberg C. Children with preschool minor neurodevelopmental disorders. IV: Behaviour and school achievement at age 13. Dev Med Child Neurol. Feb 1989;31(1):3-13. [Medline].

  75. Green BH, Dewey ME, Copeland JR, et al. Prospective data on the prevalence of abnormal involuntary movements among elderly people living in the community. Acta Psychiatr Scand. Jun 1993;87(6):418-21. [Medline].

  76. Grosso S, Franzoni E, Coppola G, et al. Efficacy and safety of levetiracetam: an add-on trial in children with refractory epilepsy. Seizure. Jun 2005;14(4):248-53. [Medline].

  77. Jankovic J, Caskey TC, Stout JT, Butler IJ. Lesch-Nyhan syndrome: a study of motor behavior and cerebrospinal fluid neurotransmitters. Ann Neurol. May 1988;23(5):466-9. [Medline].

  78. Kalachnik JE, Hanzel TE, Harder SR, et al. Antiepileptic drug behavioral side effects in individuals with mental retardation and the use of behavioral measurement techniques. Ment Retard. Dec 1995;33(6):374-82. [Medline].

  79. Kokkonen J, Saukkonen AL, Timonen E, et al. Social outcome of handicapped children as adults. Dev Med Child Neurol. Dec 1991;33(12):1095-100. [Medline].

  80. Newell KM, Ko YG, Sprague RL, et al. Onset of dyskinesia and changes in postural task performance during the course of neuroleptic withdrawal. Am J Ment Retard. Jul 2002;107(4):270-7. [Medline].

  81. Reese ME, Msall ME, Owen S, et al. Acquired cervical spine impairment in young adults with cerebral palsy. Dev Med Child Neurol. Feb 1991;33(2):153-8. [Medline].

  82. Richman DM, Lindauer SE. Longitudinal assessment of stereotypic, proto-injurious, and self-injurious behavior exhibited by young children with developmental delays. Am J Ment Retard. Nov 2005;110(6):439-50. [Medline].

  83. Schretlen DJ, Ward J, Meyer SM, et al. Behavioral aspects of Lesch-Nyhan disease and its variants. Dev Med Child Neurol. Oct 2005;47(10):673-7. [Medline].

  84. Stone RK, Alvarez WF, Ellman G. Lifetime antipsychotic-drug exposure, dyskinesia and related movement disorders in the developmentally disabled. Pharmacol Biochem Behav. Dec 1989;34(4):759-63. [Medline].

  85. Thirumalai SS. Fragile X syndrome. Available at: www.medlink.com. [Medline].

  86. Walia KS, Khan EA, Ko DH, et al. Side effects of antiepileptics-a review. Pain Practice. Vol 4. Issue 3:2004: 194-203.

  87. Wszola BA, Newell KM, Sprague RL. Risk factors for tardive dyskinesia in a large population of youths and adults. Exp Clin Psychopharmacol. Aug 2001;9(3):285-96. [Medline].

  88. Youssef HA, Waddington JL. Calcium metabolism and abnormal involuntary movements (tardive dyskinesia) in psychosis. Acta Psychiatr Scand. Oct 1988;78(4):523-5. [Medline].

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Further Reading

Clinical guidelines

Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Ashwal S, Russman BS, Blasco PA, Miller G, Sandler A, Shevell M, Stevenson R. Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2004 Mar 23;62(6):851-63. [77 references] PubMed

Practice parameter: evaluation of the child with global developmental delay: report of the Quality Standards Subcommittee of the American Academy of Neurology and The Practice Committee of the Child Neurology Society. Shevell M, Ashwal S, Donley D, Flint J, Gingold M, Hirtz D, Majnemer A, Noetzel M, Sheth RD. Practice parameter: evaluation of the child with global developmental delay: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2003 Feb 11;60(3):367-80. [123 references] PubMed

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Keywords

mental retardation, MR, cerebral palsy, CP, Down syndrome, delayed-onset movement disorder, mild neuromotor disabilities, tardive dyskinesia, TD, bruxism, stereotypies, autism, drug-induced movement disorder, Smith-Magenis syndrome, Lesch-Nyhan syndrome, Prader-Willi syndrome, obsessive-compulsive disorder, Rett syndrome, pyramidal cerebral palsy, extrapyramidal cerebral palsy, developmental disability, movement disability, limited intellectual capacity, limited intellect, biomedical mental retardation, social mental retardation, behavioral mental retardation, educational mental retardation, self-injurious behavior, SIB

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Contributor Information and Disclosures

Author

Norberto Alvarez, MD, Assistant Professor, Department of Neurology, Harvard Medical School; Consulting Staff, Department of Neurology, Boston Children's Hospital
Norberto Alvarez, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

Medical Editor

Rodrigo O Kuljis, MD, Esther Lichtenstein Professor of Psychiatry and Neurology, Director, Division of Cognitive and Behavioral Neurology, Department of Neurology, University of Miami School of Medicine
Rodrigo O Kuljis, MD is a member of the following medical societies: American Academy of Neurology and Society for Neuroscience
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Nestor Galvez-Jimenez, MD, MSc, MHA, Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida
Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
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