Choreiform

The most serious and frequent adverse reactions seen witii levodopa include choreiform movements... 

Dyskinesias are involuntary choreiform movements, usually involving the neck, trunk, and extremities. They are usually associated with peak striatal dopamine levels. Less commonly, dyskinesias also can develop during the rise and fall of L-dopa effects (the dyskinesias-improvement-dyskinesias or diphasic pattern of response. 

Choreiform movements are purposeless, involuntary movements such as flexing and extending of fingers, raising and lowering of shoulders or grimacing. 

Tardive dyskinesia is a condition that sometimes results from chronic neuroleptic treatment lasting from months to years (Baldessarini 1996 Stahl et al. 1982). It occurs in 15-25% of treated chronic psychotic patients and is characterized by repetitive, athetoid writhing and stereotyped choreiform movements of the face, eyes, mouth, extremities, and trunk. Discontinuation of neuroleptic medication allows the symptoms to gradually decline, but sometimes they can persist indefinitely. The pathophysiology of tardive dyskinesia is poorly understood, but it appears to involve supersensitive postsynaptic dopamine receptors in the basal ganglia. 

Severe intoxication has resulted in prostration, tachycardia, blood pressure flucmations, con-vulsive seizures, choreiform movements, and psychosis. Recovery may be complete, but permanent residual effects such as ataxia, optic atrophy, tremor, mental abnormalities, and footdrop have been reported. fti cases of fatal intoxication, typical autopsy findings include pulmonary edema, necrosis of the liver, nephritis, and degenerative changes in peripheral axons. ... 

Unlabeled Uses Treatment of choreiform movement of Huntington s disease... 

Studies at the National Institutes of Health (NIH) have detailed the clinical characteristics of patients in the PANDAS subgroup (Swedo et al., 1998). The rate of neuropsychiatric comorbidity in this population is quite striking. Twenty of the 50 children (40%) met DSM-IV criteria for ADHD and/or oppositional defiant disorder (ODD), 18 (36%) for major depressive disorder, 14 (28%) for overanxious disorder, and 10 (20%) for separation anxiety disorder. Six children (12%) were enuretic, often episodically and closely correlated with periods of OCD and tic exacerbations. Depressive symptoms, ADHD, and separation anxiety disorder also waxed and waned in concert with the OCD/ tic symptoms. In addition, exacerbations of OCD and tics were accompanied frequently by the acute onset of choreiform movements (clinically distinct from chorea), emotional lability and irritability, tactile/sensory defensiveness, motoric hyperactivity, messy handwriting, and symptoms of separation anxiety (Perlmutter et al., 1998 Becker et al., 2000). 

Choreiform or athetoid movements of the extremities and/or truncal areas... 

An acute overdose of CBZ can produce significant neurological symptoms. Diplopia may be a useful clinical indicator of developing toxicity, since severity is not necessarily correlated with plasma levels. Life-threatening seizures and coma may occur when levels exceed 20 to 25 pg/ml. Lower levels can produce drowsiness, ataxia, blurred vision, dysarthria, choreiform movements, or behavioral changes (374374 and 375). Gastric lavage, hemoperfusion, and plasmapheresis may be beneficial, especially in more serious cases (77, 376). 

Mecamylamine, unlike the quaternary amine agents and trimethaphan, crosses the blood-brain barrier and readily enters the CNS. Sedation, tremor, choreiform movements, and mental aberrations have been reported as effects of mecamylamine. 

The choreiform movements and behaviors can be only partially controlled by phenothiazines or butyrophenone neuroleptics. 

Worse yet, if these D2 receptors in the nigrostriatal DA pathway are blocked chronically (Fig. 11—5), they can produce a hyperkinetic movement disorder known as tardive dyskinesia. This movement disorder causes facial and tongue movements such as constant chewing, tongue protrusions, and facial grimacing, as well as limb movements, which can be quick, jerky or choreiform (dancing). Tardive dyskinesia is thus caused by long-term administration of conventional antipsychotics and is... 

Use of androgenic steroids is likely to produce a sensation of energy and euphoria, but also with a tendency to sleeplessness and irritability (1). More extreme changes in mental state can result in extreme swings in mood, ranging from depression to aggressive elation. An unusual complication in one case was a toxic confusional state and choreiform movements caused by an anabolic steroid (SED-12, 1038) (29), but it may have been due to the non-specific results of endocrine stress in a susceptible individual. 

Tilzey A, Heptonstall J, Hamblin T. Toxic confusional state and choreiform movements after treatment with anabolic steroids. BMJ (Chn Res Ed) 1981 283(6287) 349-50. 

Involuntary movement disorders also respond well to this class of drugs. These include restless leg syndrome, akathisia associated with neuroleptic use, choreiform disorders, and myoclonus. 

Abnormal involuntary movements appear in approximately 50% of patients within the first few months of the commencement of L-dopa therapy, these effects being correlated with the dose of the drug and the degree of clinical improvement. The frequency of the abnormal involuntary movements increases with the duration of administration and can reach 80% of patients after 1 year of therapy. Such abnormal movements are presumed to be due to postsynaptic dopamine receptor hyperactivity and include buccolingual movements, grimacing, head-bobbing, and various choreiform and dystonic movements of the extremities. Tolerance does not appear to develop to these effects and there is no known treatment apart from reducing the dose of L-dopa, a situation which inevitably leads to the likelihood of a return of the Parkinsonian symptoms. 

Croteau D, Owainati A, Dalmau J, Rogers LR. Response to cancer therapy in a patient with a paraneoplastic choreiform disorder. Neurology 2001 57(4) 719-722. 

Multiple involuntary movements, consisting of jaw grinding, oral dyskinesias, bilateral hand rolling, vermiform tongue movements, and bilateral choreiform movements of the digits, have been described in an 11-year-old boy taking thioridazine 150 mg/day and methylphenidate 10 mg bd (36). The methylphenidate was discontinued and within 4 weeks his movement disorder had completely disappeared. 

A 22-year-old man who had had ADHD since the age of 8 years took methylphenidate, and had an adequate response for 14 years (52). However, his symptoms worsened and he switched from methylphenidate to mixed amfetamine salts 20 mg bd. A month later he continued to have difficulty in focusing on tasks, and the dosage was eventually increased to 45 mg tds over several weeks, with symptomatic improvement. However, 5 days later, he awoke feeling nauseated and agitated and had choreiform movements of his face, trunk, and limbs. He had also taken escitalopram 10 mg/day for anxiety and depression for 2 months before any changes in his ADHD medications. He was treated with intravenous diphenhydramine, lora-zepam, and diazepam without improvement in the chorea. Amfetamine was withdrawn and 3 days later his chorea abated. He restarted methylphenidate and the movement disorders did not recur. 

Methadone can cause movement disorders characterized by tremor, choreiform movements, and a gait abnormality (26). 

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