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Título

Botulinum toxin as treatment for vascular hemichorea–hemiballism: a case report

RESUMO

Case report: A 55-year-old male patient started with altered sensitivity in the right hemibody seven days before admission, in addition to abnormal movements in the right arm, starting after waking up, with no apparent triggers and which improved during sleep. He had a previous history of unspecified cardiac arrhythmia, with irregular use of propafenone, acetylsalicylic acid and rosuvastatin. Physical examination showed abnormal movements on the right side, sparing the face and worse in the proximal part of the right upper limb, with low frequency, high amplitude, arrhythmic and erratic, characteristics of hemichorea-hemiballismus. Biochemical and serological tests were normal. Brain MRI showed ischemic stroke with areas of subacute ischemia in the occipital lobe and left occipitotemporal transition. Drug treatment was performed with high doses of Haloperidol, Valproic Acid and Clonazepam without satisfactory clinical control. Botulinum toxin type A was applied with 300UI to the right trapezius muscle and 200UI to the right latissimus dorsi muscle, with considerable improvement in movements after thirty days and with preservation of strength in all four limbs. Discussion: Hemichorea-hemiballismus syndrome is one of the main movement disorders caused after a stroke. The main treatments described are typical and atypical antipsychotics, antiepileptics and presynaptic dopamine depletors. The use of botulinum toxin is well established in some hyperkinetic movement disorders such as dystonia, myoclonus and tics; its use in hemichorea-hemiballismus is still poorly studied, with little evidence found in the literature. Our case presented a good response similar to the few cases described in the literature. Final comments: The use of botulinum toxin in the treatment of hemichorea-hemiballismus can be effective in patients who are refractory to drug treatment.

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Área

Doença Cerebrovascular