Emerging therapies for childhood-onset movement disorders

PURPOSE OF REVIEW

We highlight novel and emerging therapies in the treatment of childhood-onset movement disorders. We structured this review by therapeutic entity (small molecule drugs, RNA-targeted therapeutics, gene replacement therapy, and neuromodulation), recognizing that there are two main approaches to treatment: symptomatic (based on phenomenology) and molecular mechanism-based therapy or 'precision medicine' (which is disease-modifying).

RECENT FINDINGS

We highlight reports of new small molecule drugs for Tourette syndrome, Friedreich's ataxia and Rett syndrome. We also discuss developments in gene therapy for aromatic l-amino acid decarboxylase deficiency and hereditary spastic paraplegia, as well as current work exploring optimization of deep brain stimulation and lesioning with focused ultrasound.

SUMMARY

Childhood-onset movement disorders have traditionally been treated symptomatically based on phenomenology, but focus has recently shifted toward targeted molecular mechanism-based therapeutics. The development of precision therapies is driven by increasing capabilities for genetic testing and a better delineation of the underlying disease mechanisms. We highlight novel and exciting approaches to the treatment of genetic childhood-onset movement disorders while also discussing general challenges in therapy development for rare diseases. We provide a framework for molecular mechanism-based treatment approaches, a summary of specific treatments for various movement disorders, and a clinical trial readiness framework.

The spectrum of movement disorders in young children with ARX-related epilepsy-dyskinesia syndrome

Children with developmental and epileptic encephalopathies often present with co-occurring dyskinesias. Pathogenic variants in ARX cause a pleomorphic syndrome that includes infantile epilepsy with a variety of movement disorders ranging from focal hand dystonia to generalized dystonia with frequent status dystonicus. In this report, we present three patients with severe movement disorders as part of ARX-associated epilepsy-dyskinesia syndrome, including a patient with a novel pathogenic missense variant (p.R371G). These cases illustrate diagnostic and management challenges of ARX-related disorder and shed light on broader challenges concerning epilepsy-dyskinesia syndromes.

Recommendations for the Management of Initial and Refractory Pediatric Status Dystonicus

Status dystonicus is the most severe form of dystonia with life-threatening complications if not treated promptly. We present consensus recommendations for the initial management of acutely worsening dystonia (including pre-status dystonicus and status dystonicus), as well as refractory status dystonicus in children. This guideline provides a stepwise approach to assessment, triage, interdisciplinary treatment, and monitoring of status dystonicus. The clinical pathways aim to: (1) facilitate timely recognition/triage of worsening dystonia, (2) standardize supportive and dystonia-directed therapies, (3) provide structure for interdisciplinary cooperation, (4) integrate advances in genomics and neuromodulation, (5) enable multicenter quality improvement and research, and (6) improve outcomes. © 2024 International Parkinson and Movement Disorder Society.

Clinical effect of a Mexican sanguinaria extract (Polygonum aviculare L.) on gingivitis

It is well known that gingivitis is a bacterially-elicited inflammation of the marginal gingiva. A number of chemical agents have been evaluated over the years with regard to their antimicrobial effects in the oral cavity; however, all are associated with side effects that prohibit regular long-term use. Therefore, the effectiveness of a natural Mexican Sanguinaria extract (Polygonum aviculare L.) against gingivitis, was assessed in 60 male dentistry students between the ages of 18 and 25 years. Over a period of 2 weeks, these students used the Sanguinaria extract (1 mg/ml) in oral rinse twice daily as a unique oral health measurement (no tooth-brushing was allowed). The O'Leary Plaque Index and the Löe and Silness Gingivitis Index were recorded at baseline (day 0) in all the subjects. Also, a complete prophylaxis was performed after both indices were obtained. The antibacterial and antiinflammatory effects of the extract were evaluated on days 7, 11 and 14. The results showed that the Mexican Sanguinaria extract in oral rinse significantly decreased gingivitis from day 0 (-x=1. 056) to day 14 (-x=1.011) (P</=0.05). In contrast, a significant increase in dental plaque was observed from day 0 (-x=91.38) to day 14 (-x=98.69) (P</=0.05); however, the consistency of this plaque permitted its mechanical flushing easily. From this study, it is concluded that the Mexican Sanguinaria extract in oral rinse can be employed supportively in the therapy of gingivitis.

[Uterine defibrillation in uterine inertia. Report of 2 cases]

The uterine atony are the most common cause of postpartum hemorrhage. Manual compression and pharmacologic methods are usually used with a successful result. When pharmacologic methods fail to control hemorrhage from atony, surgical measures should be undertaken to arrest the bleeding before it becomes life-threatening. We presents the utilization of electrical uterine defibrillation in two cases with acute hemorrhage confirming the effectivity of the proceeding.