Levodopa treatment of late onset extrapyramidal movements in a child after high voltage electrocution

We present the case of a 12-year-old girl with abnormal extrapyramidal movements associated with basal ganglia lesions after electrical injury. After her injury, our patient initially did well and recovered from acute cardiovascular and hemodynamic instability, and the results of her neurological examination, head computed tomography scan, and electroencephalogram were normal on discharge from hospital. Two weeks after discharge, she developed extrapyramidal movements, and head magnetic resonance imaging showed areas of bilateral, symmetrical enhanced associated with signal intensity in the basal ganglia, hypoxic encephalopathy, and cerebral edema that may have occurred secondary to the cardiopulmonary arrest that she suffered immediately after her accident. The symptoms disappeared after low dose levodopa was instituted and have not recurred during the 15 months of treatment. Injury and death from electric current, although rare, are not uncommon and occur mostly as a result of accidental contact with a live wire. This is the first case report documenting the use of levodopa for extrapyramidal movements secondary to high-tension electrocution.