Postthalamic stroke dystonic choreoathetosis responsive to tetrabenazine

Area of Science:

• Neurology
• Movement Disorders
• Pharmacology

Background:

• Post-stroke choreoathetosis is a rare neurological condition characterized by involuntary, irregular, and jerky movements.
• Lesions in the basal ganglia and/or thalamus are often implicated in the pathogenesis of these movement disorders.

Observation:

• A 48-year-old woman developed progressive choreoathetoid movements post-stroke, initially treated with haloperidol with worsening symptoms.
• Switching to tetrabenazine resulted in rapid remission of involuntary abnormal movements (IAMs), with the Abnormal Involuntary Movement Scale score decreasing from 20 to 1.
• Upon tetrabenazine discontinuation, symptoms recurred, and subsequent re-administration led to symptom remission, indicating a clear therapeutic response.

Findings:

• Tetrabenazine demonstrated significant efficacy in resolving severe choreoathetosis in a post-stroke patient.
• The patient experienced a notable improvement in IAMs after initiating tetrabenazine therapy.
• Recurrence of symptoms upon drug withdrawal and subsequent remission upon re-challenge confirmed tetrabenazine's therapeutic effect.

Implications:

• Tetrabenazine may serve as a valuable therapeutic option for post-stroke choreoathetosis, particularly in cases unresponsive or intolerant to antipsychotic medications.
• This case highlights the potential role of tetrabenazine in managing specific hyperkinetic movement disorders.
• Further research is warranted to establish the risk-benefit profile of tetrabenazine for post-stroke choreoathetosis.