Enterovirus A-71 Associated Parainfectious Movement Disorders in Children.

Background: Pediatric movement disorders can be challenging to characterize, given the phenotypic complexity and broad differential diagnosis. While genetic tests are often part of the diagnostic work-up, it is important to consider acquired causes, which may require specific investigations. Enterovirus A-71 (EV-A71) associated rhombencephalitis frequently presents with movement disorders. We aim to improve the recognition of these phenotypes.

Cases: We describe four patients (aged 21 months-12 years) presenting with movement disorders and a confirmed EV-A71 infection. All patients had myoclonus, one suffered from ataxia. Both focal arm flexion myoclonus and generalized myoclonus were observed. Polymyography demonstrated a subcortical origin. The movement disorders subsided with infection improvement.

Conclusions: Recognition of EV-A71 parainfectious movement disorders in childhood enables clinicians to obtain appropriate, cost-effective diagnostics. When an EV-A71 infection is suspected PCR-diagnostics in stool and nasopharynx material is required. Neuroimaging and polymyography can support the diagnosis.