Contralateral levodopa-induced hemichorea in a patient with severe asymmetric Parkinson’s disease
The motor symptoms of Parkinson’s disease (PD) are predominantly due to progressive degeneration of nigral dopaminergic neurons. In most cases, there is a substantial asymmetry of clinical symptoms from disease onset . Such lack of symmetry in the appearance of symptoms is so conspicuous that it serves as a clinical parameter to differentiate the disease from other neurodegenerative parkinsonian syndromes.
Hemichorea is a hyperkinetic movement disorder that is provoked by unilateral basal ganglia dysfunction, usually manifested by structural lesions or metabolic derangements [2, 3]. Most putatively related anatomical structures are lentiform nucleus, thalamus, and subthalamic nucleus .
PD and hemichorea are similar in terms of asymmetrically malfunctioning brain structures contralateral to clinical manifestations. We observed a PD patient with rare phenomenon of hemichorea.
A 67-year-old female complained of slowly progressive asymmetric...
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (NRF-2017R1D1A1B06028086).
Compliance with ethical standards
The institutional review board at Seoul St. Mary’s Hospital approved this case report (KC18ZESI0477). We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. The patients have consented to the submission of the case report to the journal.
Conflict of interest
The authors declare that they have no competing interest.
Video segment 1. Initially, the patient showed marked asymmetric akinetic rigidity that appeared as dystonic posture. She could not unfold her hand at will or on examiner’s command. She did not demonstrate any sign of tremor. Video segment 2. After uptitrating levodopa dosage, the patient experienced sudden occurrence of right hemichorea. Video segment 3. After reducing the dopamine dosage, the patient’s hemichorea completely resolved. (WMV 46857 KB)