Paroxysmal Nonkinesigenic Dyskinesia with Tremor

Introduction. Paroxysmal nonkinesigenic dyskinesia (PNKD) consists of episodes of chorea, athetosis, or dystonia which are not triggered by movement, with complete remission between episodes. A case of genetically confirmed PNKD with simultaneous tremor has not been previously reported. Case Report....

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Main Author: Robert Fekete
Format: Article
Language:English
Published: Wiley 2013-01-01
Series:Case Reports in Neurological Medicine
Online Access:http://dx.doi.org/10.1155/2013/927587
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author Robert Fekete
author_facet Robert Fekete
author_sort Robert Fekete
collection DOAJ
description Introduction. Paroxysmal nonkinesigenic dyskinesia (PNKD) consists of episodes of chorea, athetosis, or dystonia which are not triggered by movement, with complete remission between episodes. A case of genetically confirmed PNKD with simultaneous tremor has not been previously reported. Case Report. The patient is an 86-year-old right-handed female who presented with episodic stiffness, with onset at age 9. Attacks have a prodrome of difficulty in speaking, followed by abnormal sensation in extremities. Episodes consist of dystonia of trunk associated with upper and lower extremity chorea. There is complete resolution between attacks except for persistent mild head tremor and action tremor of both extremities. Attack frequency and duration as well as tremor amplitude escalated two and a half years ago, in correlation with development of breast carcinoma. Episodes improved after successful cancer treatment, but higher amplitude tremor persisted. There is an autosomal dominant family history of similar episodes but not tremor. Genetic diagnosis was confirmed via A7V mutation of the myofibrillogenesis regulator (MR-1) gene. Conclusion. Exacerbation due to another medical or psychiatric condition should be considered if there is unexpected deterioration in episode frequency or length. PNKD due to MR-1 mutation may exist even in the presence of action tremor.
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spelling doaj-art-7a8954b552604d4aa0209c1f3a35f5de2025-02-03T05:47:58ZengWileyCase Reports in Neurological Medicine2090-66682090-66762013-01-01201310.1155/2013/927587927587Paroxysmal Nonkinesigenic Dyskinesia with TremorRobert Fekete0Department of Neurology, New York Medical College, Munger Pavilion, 4th Floor, 40 Sunshine Cottage Road, Valhalla, NY 10595, USAIntroduction. Paroxysmal nonkinesigenic dyskinesia (PNKD) consists of episodes of chorea, athetosis, or dystonia which are not triggered by movement, with complete remission between episodes. A case of genetically confirmed PNKD with simultaneous tremor has not been previously reported. Case Report. The patient is an 86-year-old right-handed female who presented with episodic stiffness, with onset at age 9. Attacks have a prodrome of difficulty in speaking, followed by abnormal sensation in extremities. Episodes consist of dystonia of trunk associated with upper and lower extremity chorea. There is complete resolution between attacks except for persistent mild head tremor and action tremor of both extremities. Attack frequency and duration as well as tremor amplitude escalated two and a half years ago, in correlation with development of breast carcinoma. Episodes improved after successful cancer treatment, but higher amplitude tremor persisted. There is an autosomal dominant family history of similar episodes but not tremor. Genetic diagnosis was confirmed via A7V mutation of the myofibrillogenesis regulator (MR-1) gene. Conclusion. Exacerbation due to another medical or psychiatric condition should be considered if there is unexpected deterioration in episode frequency or length. PNKD due to MR-1 mutation may exist even in the presence of action tremor.http://dx.doi.org/10.1155/2013/927587
spellingShingle Robert Fekete
Paroxysmal Nonkinesigenic Dyskinesia with Tremor
Case Reports in Neurological Medicine
title Paroxysmal Nonkinesigenic Dyskinesia with Tremor
title_full Paroxysmal Nonkinesigenic Dyskinesia with Tremor
title_fullStr Paroxysmal Nonkinesigenic Dyskinesia with Tremor
title_full_unstemmed Paroxysmal Nonkinesigenic Dyskinesia with Tremor
title_short Paroxysmal Nonkinesigenic Dyskinesia with Tremor
title_sort paroxysmal nonkinesigenic dyskinesia with tremor
url http://dx.doi.org/10.1155/2013/927587
work_keys_str_mv AT robertfekete paroxysmalnonkinesigenicdyskinesiawithtremor