Infection-associated dystonia: A narrative review

Abstract

Infectious diseases are common in tropical countries, and varied complications associated with such diseases are frequently encountered. Movement disorders are a complication of infectious diseases, and the spectrum of movement disorders differs between tropical countries and other countries. We screened three electronic databases for cases of dystonia presenting as a manifestation of infections diseases and selected cases and series describing chorea associated with infections. The studies were identified and data regarding the study design, sample size, neurological assessment, and diagnostic workup, including brain imaging and cerebrospinal fluid analysis were extracted. After a detailed review of 139 selected articles, 39 articles were referred to in the final manuscript of this narrative review. Dystonia is most commonly associated with Japanese encephalitis than other central nervous system infections. The hypothesized mechanisms of infection-related dystonia are vasculopathy, space-occupying lesions, autoimmune reactions, inflammation, or via anti-dopaminergic drug therapy. The infections presenting with dystonia include tuberculosis, Japanese encephalitis, streptococcal infections, varicella-zoster virus, subacute sclerosing panencephalitis, dengue, and neurocysticercosis. In this narrative review, we discuss the different types of central nervous system infections that present with dystonia.