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We present consensus recommendations for the initial management of acutely worsening dystonia (including pre\u2013status 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\u2010directed 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. \u00a9 2024 International Parkinson and Movement Disorder Society.<\/jats:p>","DOI":"10.1002\/mds.29794","type":"journal-article","created":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T07:25:29Z","timestamp":1713165929000},"page":"1435-1445","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Recommendations for the Management of Initial and Refractory Pediatric Status Dystonicus"],"prefix":"10.1002","volume":"39","author":[{"given":"Lindsey M.","family":"Vogt","sequence":"first","affiliation":[{"name":"Division of Neurology, Department of Pediatrics The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Pediatrics The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"Movement Disorders Program, Department of Neurology, Boston Children's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Tse","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hospital Medicine, Department of Pediatrics Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Quiroz","sequence":"additional","affiliation":[{"name":"Movement Disorders Program, Department of Neurology, Boston Children's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Zaman","sequence":"additional","affiliation":[{"name":"Movement Disorders Program, Department of Neurology, Boston Children's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Pediatrics The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasha","family":"Srouji","sequence":"additional","affiliation":[{"name":"Movement Disorders Program, Department of Neurology, Boston Children's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Tam","sequence":"additional","affiliation":[{"name":"Movement Disorders Program, Department of Neurology, Boston Children's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elicia","family":"Estrella","sequence":"additional","affiliation":[{"name":"Movement Disorders Program, Department of Neurology, Boston Children's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Manzi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Boston Children's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5346-0180","authenticated-orcid":false,"given":"Alfonso","family":"Fasano","sequence":"additional","affiliation":[{"name":"Edmond J. 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