{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:16:20Z","timestamp":1790813780806,"version":"4.1.0"},"reference-count":23,"publisher":"Ubiquity Press, Ltd.","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TOHM"],"abstract":"<jats:p>Background: Movement disorders are an uncommon but important manifestation of central nervous system toxoplasmosis. Their phenotypes, lesion patterns, and outcomes have not been systematically characterized.\nMethods: A PRISMA-based systematic review identified all published patient-level reports of central nervous system toxoplasmosis with movement disorders. Eligible case reports and case series confirmed infection via serology, neuroimaging, polymerase chain reaction, or histopathology. Extracted data included demographics, immune status, clinical and neuroimaging features, lesion location, movement disorder type, treatment, outcomes, and proposed mechanisms. Cases were classified as hyperkinetic, hypokinetic, or cerebellar\/ataxia syndromes and summarized descriptively.\nResults: Sixty patients were included: hyperkinetic (n = 42), hypokinetic (n = 9), and ataxia\/cerebellar (n = 9). HIV-related immunosuppression was the predominant risk factor. Reactivation of latent toxoplasmosis was most frequent (40.5%, 55.6%, 88.9%). Hemichorea\/hemiballismus was the leading hyperkinetic phenotype (47.6%), parkinsonism the main hypokinetic form (77.8%), while all ataxia patients exhibited cerebellar signs. Neuroimaging showed basal ganglia involvement in hyperkinetic (47.4%) and hypokinetic (88.9%) cases, whereas ataxia cases consistently demonstrated cerebellar lesions, often with brainstem or hemispheric extension. Standard pyrimethamine\u2013sulfadiazine therapy was used in 59.5%, 33.3%, and 44.4%, respectively. Symptomatic therapy was phenotype-specific: neuroleptics and benzodiazepines for hyperkinetic, levodopa for hypokinetic, and none specified for ataxia. Outcomes varied, with recovery or marked improvement in 57.1%, 33.3%, and 66.7%, and mortality in 33.3%, 33.3%, and 22.2%, respectively. Mechanisms implicated basal ganglia disruption, nigrostriatal degeneration, and cerebellar invasion.\nConclusions: Central nervous system toxoplasmosis-associated movement disorders show distinct phenotype\u2013lesion correlations, with hyperkinetic syndromes most common. Outcomes vary by type, and early recognition with targeted therapy may improve prognosis.<\/jats:p>","DOI":"10.5334\/tohm.1093","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T12:19:41Z","timestamp":1759234781000},"page":"48","source":"Crossref","is-referenced-by-count":1,"title":["Movement Disorders in Toxoplasmosis: A Systematic Review"],"prefix":"10.5334","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0044-7083","authenticated-orcid":false,"given":"Ravindra Kumar","family":"Garg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1483-2233","authenticated-orcid":false,"given":"Shweta","family":"Pandey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8211-1635","authenticated-orcid":false,"given":"Manoj","family":"Agarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0786-9107","authenticated-orcid":false,"given":"Sanjay","family":"Singhal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"issue":"1","key":"key20250930122201_B1","first-page":"e00115","article-title":"Epidemiology, Pathophysiology, Diagnosis, and Management of Cerebral Toxoplasmosis","volume":"34","year":"2020","journal-title":"Clin Microbiol Rev"},{"key":"key20250930122201_B2","article-title":"A review of movement disorders in persons living with HIV","volume":"114","year":"2023","journal-title":"Parkinsonism Relat Disord"},{"key":"key20250930122201_B3","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/B978-0-444-52014-2.00025-2","article-title":"Hyperkinetic movement disorders associated with HIV and other viral infections","volume":"100","year":"2011","journal-title":"Handb Clin Neurol"},{"key":"key20250930122201_B4","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.parkreldis.2018.04.007","article-title":"Cerebellar degeneration and progressive ataxia associated with HIV-virus infection","volume":"54","year":"2018","journal-title":"Parkinsonism Relat Disord"},{"issue":"1","key":"key20250930122201_B5","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1002\/mds.870080119","article-title":"Movement disorders with cerebral toxoplasmosis and AIDS","volume":"8","year":"1993","journal-title":"Mov Disord"},{"key":"key20250930122201_B6","unstructured":"Garg RK, Pandey S, Singhal S. Toxoplasmosis-Associated Extrapyramidal and Movement Disorders: A Systematic Review. PROSPERO 2025 CRD420251119727. Available from https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251119727."},{"key":"key20250930122201_B7","first-page":"e291","article-title":"Guidelines for the management of Toxoplasma gondii infection and disease in patients with haematological malignancies and after haematopoietic stem-cell transplantation: guidelines from the 9th European Conference on Infections in Leukaemia, 2022","author":"European Conference on Infections in Leukaemia group","year":"2024"},{"key":"key20250930122201_B8","article-title":"Evolving Concepts in Our Understanding and Treatment of Holmes Tremor, Over 100 Years in the Making","volume":"12","year":"2022","journal-title":"Tremor Other Hyperkinet Mov (N Y)"},{"key":"key20250930122201_B9","unstructured":"The Movement Disorder Society. About Movement Disorders: View clinical information, resources, tools and education about common movement disorders. Downloaded from https:\/\/www.movementdisorders.org\/MDS\/About\/Movement-Disorder-Overviews.htm. Assessed on 31th July, 2025."},{"issue":"2","key":"key20250930122201_B10","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1136\/bmjebm-2017-110853","article-title":"Methodological quality and synthesis of case series and case reports","volume":"23","year":"2018","journal-title":"BMJ Evid Based Med"},{"issue":"1","key":"key20250930122201_B11","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.ajog.2020.04.013","article-title":"Coronavirus disease 2019 during pregnancy: a systematic review of reported cases","volume":"223","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"key20250930122201_B12","article-title":"Cerebral Toxoplasmosis Mimicking a Brain Neoplasm in an Inaugural HIV-Positive Patient: The Importance of Early Decision-Making and Background Assessment in the Emergency Department","volume":"17","year":"2025","journal-title":"Cureus"},{"issue":"15","key":"key20250930122201_B13","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1097\/QAD.0000000000003992","article-title":"Longitudinal study of cognitive function in people with HIV and toxoplasmic encephalitis or latent toxoplasma infection","volume":"38","year":"2024","journal-title":"AIDS"},{"issue":"1","key":"key20250930122201_B14","article-title":"Infection with Toxoplasma gondii triggers coagulation at the blood-brain barrier and a reduction in cerebral blood flow","volume":"22","year":"2025","journal-title":"J Neuroinflammation"},{"issue":"6","key":"key20250930122201_B15","article-title":"Defining neuronal responses to the neurotropic parasite Toxoplasma gondii","volume":"10","year":"2025","journal-title":"mSphere"},{"key":"key20250930122201_B16","article-title":"The cognitive and neurological implications of toxoplasma gondii infection: Evidence from a systematic review and 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tremor: the potential etiologic role of Toxoplasma gondii and Toxocara spp","volume":"35","year":"2025","journal-title":"Int J Environ Health Res"},{"key":"key20250930122201_B21","article-title":"The Cataleptic, Asymmetric, Analgesic, and Brain Biochemical Effects of Parkinson\u2019s Disease Can Be Affected by Toxoplasma gondii Infection","volume":"2020","year":"2020","journal-title":"Biomed Res Int"},{"issue":"5","key":"key20250930122201_B22","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1002\/ana.26777","article-title":"Parkinsonism: A Rare Complication of Cerebral Toxoplasmosis","volume":"94","year":"2023","journal-title":"Ann Neurol"},{"issue":"2","key":"key20250930122201_B23","first-page":"285","article-title":"Presynaptic Hemiparkinsonism Following Cerebral Toxoplasmosis: Case Report and Literature Review","volume":"10","year":"2022","journal-title":"Mov Disord Clin Pract"}],"container-title":["Tremor and Other Hyperkinetic 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