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Yeow D, Rudaks LI, Siow SF, Davis RL, Kumar KR. Genetic Testing of Movements Disorders: A Review of Clinical Utility. Tremor Other Hyperkinet Mov (N Y) 2024; 14:2. [PMID: 38222898 PMCID: PMC10785957 DOI: 10.5334/tohm.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024] Open
Abstract
Currently, pathogenic variants in more than 500 different genes are known to cause various movement disorders. The increasing accessibility and reducing cost of genetic testing has resulted in increasing clinical use of genetic testing for the diagnosis of movement disorders. However, the optimal use case(s) for genetic testing at a patient level remain ill-defined. Here, we review the utility of genetic testing in patients with movement disorders and also highlight current challenges and limitations that need to be considered when making decisions about genetic testing in clinical practice. Highlights The utility of genetic testing extends across multiple clinical and non-clinical domains. Here we review different aspects of the utility of genetic testing for movement disorders and the numerous associated challenges and limitations. These factors should be weighed on a case-by-case basis when requesting genetic tests in clinical practice.
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Affiliation(s)
- Dennis Yeow
- Translational Neurogenomics Group, Neurology Department & Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, Australia
- Concord Clinical School, Sydney Medical School, Faculty of Health & Medicine, University of Sydney, Concord, NSW, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- Department of Neurology, Prince of Wales Hospital, Randwick, NSW, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Laura I. Rudaks
- Translational Neurogenomics Group, Neurology Department & Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, Australia
- Concord Clinical School, Sydney Medical School, Faculty of Health & Medicine, University of Sydney, Concord, NSW, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Sue-Faye Siow
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ryan L. Davis
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- Neurogenetics Research Group, Kolling Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney and Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Kishore R. Kumar
- Translational Neurogenomics Group, Neurology Department & Molecular Medicine Laboratory, Concord Repatriation General Hospital, Concord, NSW, Australia
- Concord Clinical School, Sydney Medical School, Faculty of Health & Medicine, University of Sydney, Concord, NSW, Australia
- Rare Disease Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
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Matsuura R, Hamano SI, Hiwatari E, Ikemoto S, Hirata Y, Koichihara R, Kikuchi K. Zonisamide Therapy for Patients With Paroxysmal Kinesigenic Dyskinesia. Pediatr Neurol 2020; 111:23-26. [PMID: 32951651 DOI: 10.1016/j.pediatrneurol.2020.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND We evaluated zonisamide therapy in patients with paroxysmal kinesigenic dyskinesia (PKD). METHODS We analyzed zonisamide therapy in 17 patients with PKD at Saitama Children's Medical Center between November 1994 and April 2020. We collected information regarding family history, previous history, age at onset, age at zonisamide commencement, dyskinesia characteristics, brain magnetic resonance imaging, interictal electroencephalography, treatment lag, zonisamide efficacy, zonisamide dose, serum zonisamide concentration, and adverse effects. We evaluated PKD frequency at six months after zonisamide therapy commencement. RESULTS Fourteen patients met the inclusion criteria. The median age at zonisamide therapy commencement was 12.8 (9.4 to 16.3) years. Zonisamide therapy was effective in 13 of 14 (92.9%) patients: complete remission for more than three months after zonisamide therapy (n = 7), decreased dyskinesia frequency by more than 90% (n = 4), dyskinesia frequency by 75% to 90% (n = 2), and no change of dyskinesia frequency (n = 1). The initial and maintenance zonisamide doses were 2.0 (1.4 to 3.8) and 2.0 (1.5 to 5.9) mg/kg/day, respectively. The median duration between zonisamide therapy commencement and dyskinesia decrease or cessation was 4 (1 to 60) days: 10 of 14 (71.4%) patients responded to zonisamide within one week after zonisamide therapy commencement. Regarding adverse effects, two patients experienced somnolence and one developed reduced perspiration. CONCLUSIONS We suggest that zonisamide monotherapy is effective for patients with PKD as a first-line treatment. We can evaluate the efficacy of zonisamide therapy within one week. Because zonisamide lacks the enzyme-inducing effects of carbamazepine and phenytoin, it may be useful for PKD treatment.
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Affiliation(s)
- Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan; Division of Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
| | - Erika Hiwatari
- Department of Pediatrics, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Satoru Ikemoto
- Department of Pediatrics, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, Saitama, Japan
| | - Reiko Koichihara
- Division of Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
| | - Kenjiro Kikuchi
- Division of Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
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Zhang Y, Ren J, Qin Y, Yang C, Zhang T, Gong Q, Yang T, Zhou D. Altered topological organization of functional brain networks in drug-naive patients with paroxysmal kinesigenic dyskinesia. J Neurol Sci 2020; 411:116702. [DOI: 10.1016/j.jns.2020.116702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/06/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
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PRRT2: from Paroxysmal Disorders to Regulation of Synaptic Function. Trends Neurosci 2016; 39:668-679. [DOI: 10.1016/j.tins.2016.08.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 12/19/2022]
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Abstract
OPINION STATEMENT Paroxysmal dyskinesia represents a group of uncommon movement disorders that are characterized by episodes of abnormal movements arising from a baseline of normal or nearly normal movement. Recent advances in the genetics of these disorders have helped provide some unification of classification schemes and better understanding. However, the approach to treatment continues to be based on the phenotype more than the genotype. The treatment approach is primarily based on the factors that precipitate the episodes of abnormal movements. For paroxysmal kinesigenic dyskinesia (PKD) in which the spells are triggered by sudden movement, treatment with anticonvulsants that target voltage-sensitive sodium channels (e.g., carbamazepine or phenytoin) is highly effective. For paroxysmal nonkinesigenic dyskinesia (PNKD), treatment with benzodiazepines is effective in many patients. PNKD episodes are often precipitated by caffeine, ethanol, or sleep deprivation, and lifestyle modifications are often helpful. Paroxysmal exertion-induced dyskinesia (PED) is less likely to respond to medications, but the ketogenic diet or modified Atkins diet may provide benefit. As more knowledge is gained about the underlying biology of these disorders, additional treatments may emerge.
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Chou IC, Lin SS, Lin WD, Wang CH, Chang YT, Tsai FJ, Tsai CH. Successful control with carbamazepine of family with paroxysmal kinesigenic dyskinesia of PRRT2 mutation. Biomedicine (Taipei) 2014; 4:15. [PMID: 25520928 PMCID: PMC4265013 DOI: 10.7603/s40681-014-0015-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/05/2014] [Indexed: 11/30/2022] Open
Abstract
Paroxysmal kinesigenic dyskinesia (PKD), a rare paroxysmal movement disorder often misdiagnosed as epilepsy, is characterized by recurrent, brief dyskinesia attacks triggered by sudden voluntary movement. Pathophysiological mechanism of PKD remains not well understood. Ion channelopathy has been suggested, since the disease responds well to ion channel blockers. Mutations in proline-rich transmembrane protein 2 (PRRT2) were recently identified in patients with familial PKD. To extend these genetic reports, we studied a family with clinical manifestations of familial PKD responding well to low dose carbamazepine. Therapeutic dose ranged from 1.5 to 2.0 mg/ kg/day, below that in seizure control. One insertion mutation c.649_650insC (p.P217fsX7) was identified in three patients of the family. This study avers PRRT2’s high sensitivity for PKD phenotype. Identification of genes underlying pathogenesis will enhance diagnosis and treatment. Function of PRRT2 and its role in PKD warrant further investigation.
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Affiliation(s)
- I-Ching Chou
- Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan ; Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Sheng-Shing Lin
- Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan
| | - Wei-De Lin
- Department of Medical Research, China Medical University and Hospital, Taichung, Taiwan ; School of Post Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chung-Hsing Wang
- Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Tzu Chang
- Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan
| | - Fuu-Jen Tsai
- Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan ; Department of Medical Research, China Medical University and Hospital, Taichung, Taiwan ; Department of Pediatrics, China Medical University Hospital, 2 Yuh-Der Road, Taichung 404, Taichung, Taiwan
| | - Chang-Hai Tsai
- Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan ; Asia University, Taichung, Taiwan
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Paroxysmal movement disorders and episodic ataxias. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/b978-0-444-52910-7.00004-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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8
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Localization and mutation detection for paroxysmal kinesigenic choreoathetosis. J Mol Neurosci 2007; 34:101-7. [PMID: 17952630 DOI: 10.1007/s12031-007-9012-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 07/30/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND Paroxysmal kinesigenic choreoathetosis (PKC) is an autosomal-dominant movement disorder characterized by attacks of paroxysmal involuntary movements. To date, the causative gene has not been discovered. PURPOSE The purpose of the study is to localize the causative region and detect the causative mutation. METHODS A PKC family including 16 subjects (5 cases and 11 controls) in Zhejiang Province was recruited. Nine microsatellite markers on chromosome 16 were selected and genotyped. Two-point LOD scores were calculated. After preliminary localization, CACNG3, IL4R and ABCC11 were selected as candidate genes and were detected by polymerase chain reaction-sequencing or PCR-denaturing high performance liquid chromatography (PCR-DHPLC). RESULTS The maximal two-point LOD score was obtained in D16S3081 with 1.21, and haplotype analysis revealed almost all of individuals carrying 5-3-8-3-4-2-5-5-6 in D16S3093/D16S685/D16S690/D16S3081/D16S3080 D16S411/D16S3136/D16S3112/D16S3057 were affected by PKC. There were no causative mutation in CACNG3, IL4R and ABCC11 genes. CONCLUSIONS The culprit gene for PKC was located in approximately 19.34 cM region between 16p12.1-q13, and CACNG3, IL4R and ABCC11 were all ruled out as the cause.
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9
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Golden AS, Haut SR, Moshé SL. Nonepileptic uses of antiepileptic drugs in children and adolescents. Pediatr Neurol 2006; 34:421-32. [PMID: 16765818 DOI: 10.1016/j.pediatrneurol.2005.08.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Revised: 08/02/2005] [Accepted: 08/15/2005] [Indexed: 10/24/2022]
Abstract
Antiepileptic drugs are often prescribed for nonepileptic neurologic and psychiatric conditions. The United States Food and Drug Administration has approved several antiepileptic drugs for the treatment of neuropathic pain, migraine, and mania in adults. For pediatric patients, use of antiepileptic drugs for non-seizure-related purposes is supported mainly by adult studies, open-label trials, and case reports. Summarized here is the published literature for or against the use of antiepileptic drugs for neuropathic pain, migraine, movement disorders, bipolar disorder, aggressive behavior, and pervasive developmental disorders in children and adolescents. Using the American Academy of Neurology's four-tiered classification scheme for a therapeutic article and translation to a recommendation rating, there are no nonepileptic disorders for which antiepileptic drugs have been established as effective for pediatric patients. Valproate and carbamazepine are "possibly effective" in the treatment of Sydenham chorea, and valproate is "probably effective" in decreasing aggressive behavior. Carbamazepine is "probably ineffective" in the treatment of aggression, and lamotrigine is "possibly ineffective" in improving the core symptom of pervasive developmental disorders. Despite the frequent use of antiepileptic drugs in the treatment of juvenile bipolar disorder, migraine, and neuropathic pain, the data are insufficient to make recommendations regarding the efficacy of antiepileptics in these conditions in children and adolescents.
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Affiliation(s)
- Alana S Golden
- Department of Neurology and the Comprehensive Epilepsy Management Center, Bronx, New York, USA.
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Sechi G, Corda D, Deiana GA, Contu S, Rosati G. Carbamazepine, clonazepam and focal reflex proprioceptive seizures. Clin Neuropharmacol 2004; 26:327-30. [PMID: 14646614 DOI: 10.1097/00002826-200311000-00013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We studied a 34-year-old man with focal tonic-clonic seizures sometimes elicited by some active postures of the right hand and evolving at times to secondary generalization. Treatment with carbamazepine (CBZ) in combination with parenteral diazepam induced both a dramatic increase of focal reflex proprioceptive seizures and choreoathetoid dyskinesias in the affected hand. CBZ was withdrawn and clonazepam (CZP) given 2 mg daily, with complete relief of seizures and choreoathetoid dyskinesias. CZP had a suppressive effect on seizures for over 15 years, without development of tolerance.
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Affiliation(s)
- GianPietro Sechi
- Department of Neurology, University of Sassari, Neurological Clinic, Viale S. Pietro 10, 07100-Sassari, Italy.
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11
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Abstract
Paroxysmal dyskinesias are rare movement disorders. The onset of paroxysmal dyskinesias in childhood are typically idiopathic (sporadic or familial), whereas those in adulthood are usually secondary to an identifiable cause. Paroxysmal dyskinesias are classified according to precipitating factors, and these include paroxysmal kinesigenic dyskinesia, paroxysmal nonkinesigenic dyskinesia, paroxysmal exertion-induced dyskinesia, and paroxysmal hypnogenic dyskinesia. The pathophysiology remains unknown; however, there is increasing evidence that channelopathies may play a role, which explains the response to anticonvulsant medications in certain kindreds. Pharmacologic treatment with anticonvulsant medications, clonazepam, tetrabenazine, trihexyphenidyl, or levodopa is reviewed herewith. Paroxysmal dyskinesias go by many names, but a rational classification does exist. Of those that respond to medications, the majority of paroxysmal dyskenesias respond to anticonvulsant medications. Channelopathies have been implemented as a cause in paroxysmal dyskinesias.
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Affiliation(s)
- Tony M. McGrath
- Department of Pediatrics, Division of Child Neurology, University of Alabama at Birmingham, CHB 314, 1600 7th Avenue South, Birmingham, AL 35233, USA.
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12
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Abstract
Chorea and athetosis are rare presenting symptoms in childhood. Chorea can be a presenting symptom in a number of hereditary diseases, including neurodegenerative diseases, paroxysmal diseases, and metabolic diseases. In these situations, family history, associated symptoms, and other physical findings will often enable a correct diagnosis. Benign childhood chorea is probably a genetically heterogeneous group of disorders, generally without other symptoms. Clinical aspects of these disorders are reviewed here.
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MESH Headings
- Athetosis/diagnosis
- Athetosis/genetics
- Brain Diseases, Metabolic, Inborn/diagnosis
- Brain Diseases, Metabolic, Inborn/genetics
- Brain Diseases, Metabolic, Inborn/pathology
- Child
- Chorea/diagnosis
- Chorea/genetics
- Chorea/pathology
- Ethics, Clinical
- Heredodegenerative Disorders, Nervous System/diagnosis
- Heredodegenerative Disorders, Nervous System/genetics
- Heredodegenerative Disorders, Nervous System/pathology
- Humans
- Prognosis
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13
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Bonev VI, Gledhill RF. Paroxysmal kinesigenic choreoathetosis because of cryptogenic myelitis. Remission with carbamazepine and the pathogenetic role of altered sodium channels. Eur J Neurol 2002; 9:517-20. [PMID: 12220384 DOI: 10.1046/j.1468-1331.2002.00440.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lesions of the spinal cord causing paroxysmal kinesigenic choreoathetosis are rare and most of the reported cases have been because of multiple sclerosis. We now describe this movement disorder occurring in a patient who developed a myelitis of unknown aetiology. A typically striking remission followed treatment with carbamazepine. It is suggested that the effect of the drug and the disorder itself may both be explained on the basis of altered sodium channels.
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Affiliation(s)
- V I Bonev
- Department of Neurology, Medical University of Southern Africa and Ga-Rankuwa Hospital, South Africa
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14
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Abstract
The inherited movement disorders comprise a rapidly growing category of human disease. Advances in genetics have led to the identification of the gene mutation in Huntington's disease and three different gene mutations, which may lead to Parkinson's disease. In addition, gene mutations have been identified in less common movement disorders including Wilson's disease, Hallervorden-Spatz syndrome, paroxysmal kinesogenic choreoathetosis, neuroacanthocytosis, and some forms of dystonia. This article summarizes what is known about the genetic mutations that cause these movement disorders, as well as the clinical features of each disease and the symptomatic treatments currently available.
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Affiliation(s)
- Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Chatterjee A, Louis ED, Frucht S. Levetiracetam in the treatment of paroxysmal kinesiogenic choreoathetosis. Mov Disord 2002; 17:614-5. [PMID: 12112221 DOI: 10.1002/mds.10118] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Anticonvulsants are frequently used in the treatment of paroxysmal kinesiogenic choreoathetosis (PKC). Although they are often extremely effective in eliminating paroxysmal movements, short- and long-term side-effects may limit their use in young patients. Levetiracetam (Keppra), a novel antiepileptic drug approved for the treatment of partial seizures is well tolerated in patients with epilepsy. We report on the use of levetiracetam in the treatment of PKC. Levetiracetam was effective in eliminating paroxysmal events and should be considered as an alternative to standard antiepileptic medications in this disorder.
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Affiliation(s)
- Anjan Chatterjee
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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16
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Abstract
This group of disorders is characterized by periodic sudden events of involuntary movement. The clinical range of these involuntary movements is wide including tonic spasms, choreiform and athetoid movements and sustained dystonic postures. Confusion with reflex forms of epilepsy has been common in the past, but in general, paroxysmal dyskinesias are not associated with alterations in consciousness or epileptiform activity on electroencephalogram. The underlying basis of the paroxysmal dyskinesia is under active investigation as is their relationship to epilepsy and other paroxysmal disorders.
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Affiliation(s)
- Paul S. Fishman
- Department of Neurology, University of Maryland School of Medicine, 22 Greene Street, Box 281, Baltimore, MD 21201, USA
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Hattori H, Fujii T, Nigami H, Higuchi Y, Tsuji M, Hamada Y. Co-segregation of benign infantile convulsions and paroxysmal kinesigenic choreoathetosis. Brain Dev 2000; 22:432-5. [PMID: 11102728 DOI: 10.1016/s0387-7604(00)00178-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report seven families and two sporadic cases in which benign infantile convulsions and paroxysmal kinesigenic choreoathetosis were co-segregated. Clinical investigations included physical and neurological examinations, blood electrolyte values, interictal and ictal electroencephalograms, and computed tomography or magnetic resonance imaging of the brain. The family pedigree was confirmed and the clinical history of the relatives was obtained. Seventeen individuals developed infantile convulsions followed by paroxysmal dyskinesias during childhood or adolescence. Six had only infantile convulsions, and two had only paroxysmal dyskinesias. The seizures never persisted into childhood or recurred in adulthood. The seizure type was a complex partial seizure, with or without secondary generalization, in nine of 14 patients. Paroxysmal dyskinesias, a subgroup of paroxysmal kinesigenic choreoathetosis, occurred for less than 5 min. The attacks of dyskinesias began at age 5-12 years in most patients, and tended to remit in adulthood. The mode of inheritance was apparently autosomal dominant in four of the families (17 affected individuals), who were diagnosed with ICCA syndrome (infantile convulsions and paroxysmal choreoathetosis). However, the condition occurred only among siblings in three families (six patients), and sporadically in two patients, suggesting genetic heterogeneity in this distinct co-segregation.
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Affiliation(s)
- H Hattori
- Department of Pediatrics, Kyoto University School of Medicine, Kyoto, Japan.
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18
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Abstract
The paroxysmal dyskinesias are a subset of the hyperkinetic movement disorders characterized by their episodic nature. Classification based on precipitating factors is helpful in considering treatment and prognosis. The clinical similarities with partial seizures are discussed. An approach to differential diagnosis, diagnostic evaluation, and treatment options are presented.
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Affiliation(s)
- B L Schlaggar
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Nagamitsu S, Matsuishi T, Hashimoto K, Yamashita Y, Aihara M, Shimizu K, Mizuguchi M, Iwamoto H, Saitoh S, Hirano Y, Kato H, Fukuyama Y, Shimada M. Multicenter study of paroxysmal dyskinesias in Japan--clinical and pedigree analysis. Mov Disord 1999; 14:658-63. [PMID: 10435504 DOI: 10.1002/1531-8257(199907)14:4<658::aid-mds1016>3.0.co;2-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
To investigate the clinical features of paroxysmal dyskinesias and carry out a pedigree analysis, we conducted a multicenter survey in Japan. A questionnaire was mailed to 229 medical institutions. A total of 150 patients with paroxysmal kinesigenic choreoathetosis (PKC), including 53 sporadic cases and 97 affected individuals from 32 pedigrees, were identified. The mean age of onset of PKC was 8.8 years, and 80% of the cases were men. Of the 32 pedigrees with familial occurrence, 18 (56%) were compatible with an autosomal-dominant inheritance (AD) with complete penetrance, and seven (22%) had AD with incomplete penetrance; the remaining seven were sibling recurrence cases with apparently healthy parents. In six of seven familial cases with incomplete penetrance, the disease gene was thought to be transmitted by clinically unaffected females. Paroxysmal dystonic choreoathetosis (PDC) was found in five cases, including two sporadic cases and three affected individuals from two pedigrees; the mean age of onset was 0.6 years, and a male predominance was noted (male:female = 4:1). There was one case of paroxysmal hypnogenic dyskinesia and one case of paroxysmal exertion-induced dyskinesia. There is an unexplained male predominance for paroxysmal dyskinesias. When the genetic defect of patients with paroxysmal dyskinesias is identified, the pathophysiology of the disease will become more clear.
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Affiliation(s)
- S Nagamitsu
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Kurume City, Japan
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Tan LC, Tan AK, Tjia H. Paroxysmal kinesigenic choreoathetosis in Singapore and its relationship to epilepsy. Clin Neurol Neurosurg 1998; 100:187-92. [PMID: 9822839 DOI: 10.1016/s0303-8467(98)00038-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To study the clinical characteristics of paroxysmal kinesigenic choreoathetosis (PKC) in our local population and its relationship to epilepsy. METHODS We reviewed retrospectively 15 patients who were managed by neurologists in our department from 1982 to 1996. The literature was also reviewed to study the association between PKC and epilepsy. RESULTS In our study, all the cases were idiopathic. The male to female ratio was 14:1 with all major races represented. Sixty percent of our patients suffered dystonic posturing rather than chorea, during the attacks. Twenty-one percent had a family history of a similar disorder which appeared to be of autosomal dominant inheritance. The sporadic form (79%) predominated in Singapore. One had a history of febrile fits while two had a history of epilepsy. We reviewed the available literature and found five other patients with idiopathic PKC also suffering from epilepsy. Of the 83 patients reviewed, 8% had epilepsy. This further strengthens the relationship between the two conditions. All our patients responded well to phenytoin at doses between 100 and 400 mg/day. CONCLUSION PKC affected all three major races in our population with a high male to female ratio of 14:1. Seventy-nine percent of our cases were sporadic and 60% suffered dystonic posturing during attacks. Of the cases reviewed, 8% of patients with idiopathic PKC also had epilepsy.
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Affiliation(s)
- L C Tan
- Department of Neurology, Tan Tock Seng Hospital, Singapore
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Dure LS, Mussell HG. Paroxysmal dyskinesia in a patient with pseudohypoparathyroidism. Mov Disord 1998; 13:746-8. [PMID: 9686786 DOI: 10.1002/mds.870130424] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- L S Dure
- Department of Pediatrics, University of Alabama at Birmingham, USA
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