Pediatric Movement Disorders - Bradykinesia

Examination

Physical examination of children with bradykinesia is important to determine the severity and location of rigidity, tremor, and bradykinesia. For adults, there is a Unified Parkinson's Disease Rating Scale (UPDRS) that is used to grade the severity and distribution of the disorder; it is often helpful to apply this rating to children with bradykinesia.

Important elements of the child's history include the rate of disease progression, possibility of any triggering event at its onset, possible toxins or medications, and any variation in symptoms during the day. In particular, variation of symptoms or the presence of dystonia suggests the possibility that the child may have dopa-responsive dystonia (DRD). DRD is a metabolically based, neurologic movement disorder that usually responds rapidly to treatment. Although it is rare to find a family history of parkinsonism in childhood-onset bradykinesia, the autosomal recessively inherited "parkin" gene mutation is more likely in families where there is a history of intermarriage within the same family (consanguinity).