Abstract Details

Title Acute Dyskinesias in Non-Ketotic Hyperglycemia (NKH): A Systematic Review of the Literature and Four New Cases

Topic Movement Disorders

Presentation(s) P07 - (-)

Poster/Presentation
Number 216

Objective

Background BACKGROUND: Acute dyskinesia in non-ketotic hyperglycemia was first described by Bedwell in 1960 (Neurology 10:619). A comprehensive and systematic review of this subject has not been reported previously.

Design/Methods DESIGN/METHODS: References for this review were identified by searches of Pub MED from 1960-2012, Boston University Primo by Ex Libris and the Yale University library literature research program.

Results RESULTS: A total of 23 manuscripts were identified encompassing 74 patients (including 4 of our own). The movements were reported as chorea, ballismus and dystonia. Movements were unilateral in 73% of the patients. There was a predominance of females (66%). The blood glucose levels ranged from 202 mg/dL to 1470 mg/dL (average 560 mg/dL). Patients with a modest increase in serum glucose had a pre-existing lesion in the basal ganglia which was shown in neuroimaging. Magnetic resonance imaging was reported in 62 patients (84%). Sixty patients had an abnormal study (97%). The most common form of abnormality in MRI was hyperintesitry of T1 weighted images. The most common site of abnormality was in the putamen, contralateral to the effected side. Two studies reported single photon imaging tomography (SPECT) which showed decreased perfusion in the striatum contralateral to the side of dyskinesia. Abnormal movements disappeared within a week in majority of the patients (59%) after correction of the hyperglycemia. In some patients with preexisting lesions, movements continued beyond two years. The cause of acute dyskinesia in NKH has been attributed to loss of GABAergic and cholinergic neurons in the basal ganglia.

Conclusions CONCLUSIONS: Non-ketotic hyperglycemia is an underdiagnosed cause of acute choreo-ballisic movements. Early detection and aggressive treatment can lead to total resolution of symptoms in the majority of patients.

Authors/Disclosures
Amrita Amanda D. Vuppala, MD (Froedtert Eye Institute) PRESENTER	Dr. Vuppala has nothing to disclose.
	No disclosure on file
	No disclosure on file
Anna Sorokin, MD	No disclosure on file
Bahman Jabbari, MD, FAAN	Dr. Jabbari has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Jabbari has received publishing royalties from a publication relating to health care.

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