Movement disorder paroxysmal movement disorder (PKD) is caused by sudden voluntary movements in which the disease is characterized by flare-ups of chorea that dissipate within minutes and may recur as often as the day. PKD is a neurological condition can be inherited, acquired, or caused by another neurological disorder, and episodes of PKD can occur multiple times per day and have multiple triggers.
Attacks can occur anywhere from once per year to hundreds of times per day while voluntary movements such as getting in and out of a car or changing from sitting to standing are common causes. In an interview with HT Lifestyle, Dr Pankaj Agarwal, Senior Consultant – Neurologist, Head of Movement Disorders Clinic and Head – DBS program at Global Hospital in Mumbai, emphasized causes of paroxysmal dyskinesia and states, “Variations (also known as mutations) in the PRRT2 gene can cause familial paroxysmal dyskinesia. The protein of this gene regulates communication between nerve cells (neurons) in the brain. PRRT2 gene variants produce less of the PRRT2 protein leading to abnormal nerve signaling. People with familial paroxysmal dyskinesia have episodes of jerking or shaking movements that are triggered by sudden actions, such as getting up quickly or being startled.”
Revealing that symptoms are generally unilateral, he says, “They can be alternating or even bilateral. The extremities are most commonly affected, but the neck, face, and trunk can also be affected. Jaw dystonia or facial spasms can cause dysarthria. After an attack, there is a period of resistance during which sudden movement may not trigger the attack. Continuity is maintained.”
Speaking of treatment for paroxysmal dyskinesia, he shares: “Treatment of paroxysmal dyskinesia must be individualized and may require trying multiple alternatives before reduce or eliminate symptoms. Both the physician and the patient must be patient. Oral medications are often used as the mainstay of treatment. Anticonvulsants such as phenytoin, primidone, valproate, carbamazepine, phenobarbital, and diazepam work well for people with paroxysmal dyskinesia (PKD).
He added, “Anticholinergics, levodopa, flunarizine and tetrabenazine are among the drugs that may be beneficial. Haloperidol has shown inconclusive results. Clonazepam, haloperidol, alternate-day oxazepam, and anticholinergics may help treat paroxysmal nonmotor dyskinesia (PNKD). In most situations, anticonvulsants are useless. The key is to avoid triggering variables like alcohol and coffee.”
