Hemidystonia after Pontine Hemorrhage Successfully Treated with Pharmacotherapy and Intensive Rehabilitation: a Case Report
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Dystonia is a movement disorder characterized by involuntary contraction of muscles resulting in repetitive or twisting movements. Dystonia is generally caused by basal ganglia dysfunction. Recent studies have reported an association between dystonia and brainstem disorders. However, the pathological mechanism is uncertain, and detailed management strategies are limited. Here, we report a case of hemidystonia with abnormal posture and impaired proprioception after pontine hemorrhage that was effectively treated with pharmacotherapy combined with early intensive comprehensive rehabilitation. A 45-year-old man presented with abnormal posture and dystonic movement in the right hand and foot after a pontine hemorrhagic stroke. Pharmacotherapy with clonazepam and benztropine was administered, and comprehensive rehabilitation programs were implemented intensively from the early stages of symptom onset. After 3 months, the patient was able to walk independently, go up and down a few stairs without the use of a handrail, and was able to perform activities of daily living with minimal assistance.
Abstract
Dystonia is a movement disorder characterized by involuntary contraction of muscles resulting in repetitive or twisting movements. Dystonia is generally caused by basal ganglia dysfunction. Recent studies have reported an association between dystonia and brainstem disorders. However, the pathological mechanism is uncertain, and detailed management strategies are limited. Here, we report a case of hemidystonia with abnormal posture and impaired proprioception after pontine hemorrhage that was effectively treated with pharmacotherapy combined with early intensive comprehensive rehabilitation. A 45-year-old man presented with abnormal posture and dystonic movement in the right hand and foot after a pontine hemorrhagic stroke. Pharmacotherapy with clonazepam and benztropine was administered, and comprehensive rehabilitation programs were implemented intensively from the early stages of symptom onset. After 3 months, the patient was able to walk independently, go up and down a few stairs without the use of a handrail, and was able to perform activities of daily living with minimal assistance.
참고문헌 (20)
- Albanese A, "Phenomenology and classification of dystonia : a consensus update", Mov Disord, 28, pp.863~873 (2013)
- Chan Wook Park, "A Case of abnormal posture in the left extremities after pontine hemorrhage: Dystonia or pseudodystonia?", Journal Of Movement Disorders, 13(1), pp.62~65 (2020), 대한파킨슨병및이상운동질환학회[DOI]
- Tan EK, "Hemidystonia precipitated by acute pontine infarct", J Neurol Sci, 234, pp.109~111 (2005)
- Loher TJ, "Dystonia associated with pontomesencephalic lesions", Mov Disord, 24, pp.157~167 (2009)
- Balint B, "Dystonia", Nat Rev Dis Primers, 4, pp.25~ (2018)
- Jinnah HA, "The anatomical basis for dystonia: the motor network model", Tremor Other Hyperkinet Mov(N Y), 7, pp.506~ (2017)
- Kim HJ, "Choreodystonia in a patient with hypertrophic olivary degeneration after pontine tegmental hemorrhage", Mov Disord, 23, pp.920~922 (2008)
- Salerno SM, "Dystonia in central pontine myelinolysis without evidence of extrapontine myelinolysis", J Neurol Neurosurg Psychiatry, 56, pp.1221~1223 (1993)
- Goff DC, "The effect of benztropine on haloperidol-induced dystonia, clinical efficacy and pharmacokinetics: a prospective, double-blind trial", J Clin Psychopharmacol, 11, pp.106~112 (1991)
- Cloud LJ, "Treatment strategies for dystonia", Expert Opin Pharmacother, 11, pp.5~15 (2010)
- Chuang C, "The natural history and treatment of acquired hemidystonia : report of 33cases and review of the literature", J Neurol Neurosurg Psychiatry, 72, pp.59~67 (2002)
- Comella CL, "Rating scales for dystonia : a multicenter assessment", Mov Disord, 18, pp.303~312 (2003)
- Umar M, "Effect of botulinum toxin A & task-specific training on upper limb function in post-stroke focal dystonia", J Pak Med Assoc, 68, pp.526~531 (2018)
- Borich M, "Lasting effects of repeated rTMS application in focal hand dystonia", Restor Neurol Neurosci, 27, pp.55~65 (2009)
- Bonouvrié LA, "Intrathecal baclofen treatment in dystonic cerebral palsy : a randomized clinical trial : the IDYS trial", BMC Pediatr, 13, pp.175~ (2013)
- Tassorelli C, "Botulinum toxin and neuromotor rehabilitation : an integrated approach to idiopathic cervical dystonia", Mov Disord, 21, pp.2240~2243 (2006)
- Berman BD, "GABAA receptor availability changes underlie symptoms in isolated cervical dystonia", Front Neurol, 9, pp.188~ (2018)
- Griffin CE 3rd, "Benzodiazepine pharmacology and central nervous systemmediated effects", Ochsner J, 13, pp.214~223 (2013)
- Pisani A, "Re-emergence of striatal cholinergic interneurons in movement disorders", Trends Neurosci, 30, pp.545~553 (2007)
- Lizarraga KJ, "Update on current and emerging therapies for dystonia", Neurodegener Dis Manag, 9, pp.135~147 (2019)