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Acute focal dystonia induced by a tricyclic antidepressant in a patient with Wilson disease: a case report
Affiliations- II Klinika Neurologii, Instytut Psychiatrii i Neurologii w Warszawie
- Zakład Farmakologii Klinicznej i Doświadczalnej, Warszawski Uniwersytet Medyczny
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Abstract
The authors present the case of a 19-year-old patient with Wilson disease (WD) who developed symptoms of acute focal dystonia of the left hand (a ‘starfish’ hand presentation) shortly after treatment with the tricyclic antidepressant clomipramine. The diagnosis of WD was made 8 months earlier based on abnormal copper metabolism parameters and was confirmed by genetic testing. Initially, the patient presented with akathisia, sialorrhea, oromandibular dystonia (occasionally grimacing) and slight dysarthria. The patient's symptoms diminished after treatment with d-penicillamine was initiated. No further deterioration was observed after copper-chelating therapy was started.
The authors diagnosed acute focal dystonia induced by clomipramine.
Botulinum toxin and intensive rehabilitation was initiated; complete regression of hand dystonia was observed. Based on the case, the authors suggest that care should be exercised with regard to starting medications that could potentially impact the extrapyramidal system in WD patients.
Abstract
The authors present the case of a 19-year-old patient with Wilson disease (WD) who developed symptoms of acute focal dystonia of the left hand (a ‘starfish’ hand presentation) shortly after treatment with the tricyclic antidepressant clomipramine. The diagnosis of WD was made 8 months earlier based on abnormal copper metabolism parameters and was confirmed by genetic testing. Initially, the patient presented with akathisia, sialorrhea, oromandibular dystonia (occasionally grimacing) and slight dysarthria. The patient's symptoms diminished after treatment with d-penicillamine was initiated. No further deterioration was observed after copper-chelating therapy was started.
The authors diagnosed acute focal dystonia induced by clomipramine.
Botulinum toxin and intensive rehabilitation was initiated; complete regression of hand dystonia was observed. Based on the case, the authors suggest that care should be exercised with regard to starting medications that could potentially impact the extrapyramidal system in WD patients.
Keywords
Wilson disease, dystonia, clomipramine
About this articleTitle
Acute focal dystonia induced by a tricyclic antidepressant in a patient with Wilson disease: a case report
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
502-506
Page views
247
Article views/downloads
444
DOI
10.5114/ninp.2013.38230
Bibliographic record
Neurol Neurochir Pol 2013;47(5):502-506.
Keywords
Wilson disease
dystonia
clomipramine
Authors
Tomasz Litwin
Grzegorz Chabik
Anna Członkowska
