Abstract
Background
Hemiballism (HB) and hemichorea (HC) are the most frequent secondary movement disorders, usually caused by cerebrovascular diseases. In only a minority of cases, these involuntary movements are not self-limited, and they may severely compromise patients’ quality of life, so that symptomatic treatments are required. Typical and atypical neuroleptics as well as tetrabenazine are considered therapies of choice. However, anecdotal reports of antiseizures medications and botulinum neurotoxin injection effectiveness have been described.
Methods
We described a case of severely disabling acute-onset lesional HB/HC, where high dosage of first- and second-line therapies was contraindicated due to patient’s comorbidities.
Results
After botulin neurotoxin (BoNT) injections in his left upper limb muscles (biceps brachii, triceps brachii, teres major, and deltoid), the patient experienced gradual reduction of hyperkinetic movements. The gradual discontinuation of topiramate (TPM) did not worsen the clinical picture.
Discussion
The reduction of hyperkinetic movements led to rhabdomyolysis resolution as well as cutaneous injuries healing with renal function improvement, so that the patient was able to be eligible for rehabilitation, which was prevented by HB/HC itself. The clinical improvement was consistent with BoNT pharmacokinetic. The administration of BoNT early after the onset of lesional HB/HC remarkably modified the clinical management and drove toward comorbidities resolution and rehabilitation.
Conclusion
The present case highlights the effectiveness of unconventional therapeutic options in disabling acute onset lesional HB/HC when first-line therapies are contraindicated. Particularly, this report may encourage BoNT application in the early stage of movement disorder emergencies.
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Data Availability
Any further information or data would be available through a reasonable request to the corresponding author.
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(1) Patient care; (2) manuscript preparation: A. Writing of the first draft, B. review and critique.
G.D.R: 1, 2A, and 2B.
N.O.: 1, 2B
M.J.: 1, 2B
G.B.: 1, 2B
F.A.: 1, 2B
S.M.: 1, 2B
V.R.: 1, 2A, and 2B.
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Di Rauso, G., Orlandi, N., Jacopetti, M. et al. Botulinum neurotoxin as early treatment in acute-onset lesional hemiballism. Neurol Sci 45, 3509–3511 (2024). https://doi.org/10.1007/s10072-024-07465-0
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DOI: https://doi.org/10.1007/s10072-024-07465-0