1/5. An open trial of clozapine for dystonia.Pharmacologic treatment of severe dystonia is often unsatisfactory. The atypical antipsychotic medication clozapine appears to improve tardive dystonia associated with conventional neuroleptic use. We studied the efficacy of clozapine for severe dystonia in five patients in an open trial. The patient cohort included four with generalized dystonia and one with meige syndrome. All patients were evaluated at baseline and at least weekly while on medication with subjective assessment of response by the patient and physician rating using the Burke-Fahn-Marsden Evaluation Scale for dystonia. All five subjects had significant improvement detected by the Burke-Fahn-Marsden Evaluation Scale as well as subjective improvement while on clozapine. Side effects, such as sedation and orthostatic hypotension, developed in all patients but was only treatment-limiting in one subject who developed persistent symptomatic orthostatic hypotension and tachycardia. Two of the four remaining patients continued clozapine after completion of the study; an additional patient was uncertain if the benefit outweighed the side effects. One patient discontinued treatment because of difficulty obtaining the FDA-required weekly white blood cell counts for patients on clozapine. We conclude that clozapine appears to be effective for generalized and refractory focal dystonia although its use may be limited by the side effects and need for hematologic monitoring.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. gait epilepsy. A case report of gait-induced seizures.reflex epilepsy includes a group of epileptic syndromes in which seizures are induced by a stimulus, either simple (visual, somatosensory, olfactory, auditory) or more complex (e.g., eating, thinking, reading). We document a case of reflex epilepsy in which focal seizures are triggered exclusively by gait. The patient is a young boy whose walking was impaired by abnormal motor phenomena on the left side. These phenomena were elicited by gait and were accompanied by a distinctive ictal pattern with centro-temporal discharges. After comparing this patient with others reported in the literature, we determined that he has an unusual type of reflex epilepsy for which we coined the term "gait epilepsy." This disorder must be considered when physicians are making a differential diagnosis in patients who have symptoms that suggest paroxysmal kinesigenic dystonia (PKD) or selective epileptic gait disorder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. masturbation mimicking paroxysmal dystonia or dyskinesia in a young girl.We present the case of a young girl with periodic posturing during masturbation. The child had been evaluated by several physicians and underwent numerous diagnostic tests before the spells were seen by a physician and determined to be self-stimulatory and not paroxysmal dystonia. masturbation is a normal and common behavior in young children and should be recognized as such. Failure to recognize this behavior can lead to unnecessary and invasive testing.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/5. Case report: dystonia.Following a motor vehicle accident, Ms. G.'s head began intermittently pulling to the right. Within 6 months, the pulling worsened, leaving her head painfully fixated, touching her right shoulder. She was hospitalized for evaluation and numerous drugs were used but unsuccessfully. Baffled, her physician ordered a psychiatric consult. Hysterical conversion reaction was the resultant diagnosis. Ms. G. was treated with thioridazine and chlorpromazine, and psychotherapy was recommended.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Dystonic reaction to a phenothiazine presenting as Bell's palsy.An 11-year-old boy presented to the pediatric ED with signs and symptoms of Bell's palsy, which was believed to be a result of otitis media. He subsequently began to list to the left and could not walk erect. Because of a history of prochlorperazine use for vomiting, a diagnosis of a dystonic reaction to a phenothiazine was made, and the patient was treated with intravenous diphenhydramine. All symptoms resolved, including seventh nerve palsy, within 5 minutes of treatment. Medications are often prescribed by physicians for vomiting without caretakers being aware of the side-effects. Dystonic reactions can be severe and present with myriad neurologic signs and symptoms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |