Back to Search Start Over

Botulinum neurotoxin as early treatment in acute-onset lesional hemiballism.

Authors :
Di Rauso G
Orlandi N
Jacopetti M
Bigliardi G
Antonelli F
Meletti S
Rispoli V
Source :
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology [Neurol Sci] 2024 Jul; Vol. 45 (7), pp. 3509-3511. Date of Electronic Publication: 2024 Mar 28.
Publication Year :
2024

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.<br />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.<br />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.<br />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.<br />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.<br /> (© 2024. Fondazione Società Italiana di Neurologia.)

Details

Language :
English
ISSN :
1590-3478
Volume :
45
Issue :
7
Database :
MEDLINE
Journal :
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Publication Type :
Academic Journal
Accession number :
38548894
Full Text :
https://doi.org/10.1007/s10072-024-07465-0