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Mov Disord Clin Pract. 2019 Jul 16;6(6):426-433. doi: 10.1002/mdc3.12806. eCollection 2019 Jul.

Spectrum of Movement Disorders in Patients With Neuroinvasive West Nile Virus Infection.

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Department of Neurology MedStar Georgetown University Hospital Washington DC USA.
Department of Internal Medicine Texas Tech University Health Sciences Center Amarillo TX USA.
Department of Neurology Cleveland Clinic Abu Dhabi United Arab Emirates.



West Nile virus (WNV) is a flavivirus that is recognized as one of the common causes of arboviral neurological disease in the world. WNV infections usually manifest with constitutional symptoms such as fever, fatigue, myalgia, rash, arthralgia, and headache. Neuroinvasive WNV infections are characterized by signs and symptoms suggestive of meningitis, encephalitis, meningoencephalitis, and acute flaccid paralysis. In addition, many patients with neuroinvasive WNV infection develop a wide range of movement disorders. This article aims to comprehensively review the spectrum and natural course of the movement disorders observed in patients with neuroinvasive WNV infections.


A literature search was performed in March 2019 (in PubMed and EMBASE) to identify articles for this review.


Movement disorders observed in the context of WNV infections include tremor, opsoclonus-myoclonus, parkinsonism, myoclonus, ataxia, and chorea. Most often, these movement disorders resolve within a few weeks to months with an indolent course. The commonly observed tremor phenotypes include action tremor of the upper extremities (bilateral > unilateral). Tremor in patients with West Nile meningitis subsides earlier than that in patients with West Nile encephalitis/acute flaccid paralysis. Opsoclonus-myoclonus in WNV infections responds well to intravenous immunoglobulins/plasmapheresis/corticosteroids. Parkinsonism has been reported to be mild in nature and usually lasts for a few weeks to months in the majority of the patients.


A wide spectrum of movement disorders is observed in neuroinvasive WNV infections. Longitudinal studies are warranted to obtain better insights into the natural course of these movement disorders.


West Nile virus; ataxia; chorea; extrapyramidal; movement disorders; myoclonus; opsoclonus; parkinsonism; tremor

[Available on 2020-07-16]

Conflict of interest statement

No specific funding was received for this work. The authors declare that there are no conflicts of interest relevant to this work.

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