A study involving 428 children and young adults with hereditary spastic paraplegia (HSP) revealed that movement disorders are prevalent in this population. Approximately 27.6% of participants exhibited movement disorders, with dystonia (16.4%) and ataxia (10.0%) being the most common. The research identified specific genotype associations, noting that dystonia was prevalent in those with SPG4, SPG3A, and AP-4-HSP, while parkinsonism was linked to SPG11, and ataxia was found in individuals with SPG15, SPG76, SPG7, SPG5a, and SPG46. The presence of any movement disorder correlated with increased disability, higher motor burden, and a lower quality of life. Dystonia and parkinsonism were associated with worse scores on the SPATAX and Spastic Paraplegia Rating Scale, while ataxia and tremor were linked to better scores. The study concluded that movement disorders in childhood-onset HSP are common and significantly affect clinical outcomes. It emphasized the need for routine screening and tailored management strategies to improve quality of life for affected individuals.