Paroxysmal non-kinesigenic dyskinesia, post-streptococcal syndromes and psychogenic movement disorders: a diagnostic challenge

We report a case of a 15-year-old boy presenting with sudden attacks of hyperkinetic movements of the limbs, trunk and neck. Clinical features were suggestive of paroxysmal non-kinesigenic dyskinesia, but the elevated antistreptolysin O antibody titre and history of recurrent upper airways infection...

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Published inBMJ case reports Vol. 2015; p. bcr2014207449
Main Authors Peila, Elena, Mortara, Paolo, Cicerale, Alessandro, Pinessi, Lorenzo
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 20.03.2015
BMJ Publishing Group
SeriesCase Report
Subjects
Adaptation, Psychological
Adolescent
Antibiotics
Consciousness
Diagnosis, Differential
Directive Counseling
Disease prevention
Dyskinesia
Dystonia
Europe (West)
Humans
Interview, Psychological
Male
Movement disorders
Movement Disorders - diagnosis
Movement Disorders - physiopathology
Movement Disorders - therapy
Penicillin
Psychotherapy
Psychotherapy, Psychodynamic - methods
Streptococcus infections
Treatment Outcome
Unusual Presentation of More Common Disease/Injury
White
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Summary:We report a case of a 15-year-old boy presenting with sudden attacks of hyperkinetic movements of the limbs, trunk and neck. Clinical features were suggestive of paroxysmal non-kinesigenic dyskinesia, but the elevated antistreptolysin O antibody titre and history of recurrent upper airways infection led us to consider a post-streptococcal syndrome as a possible diagnosis. The patient started therapy with benzathine penicillin, sodium valproate and clonazepam without any significant improvement. A successive psychiatric assessment revealed the presence of a psychogenic movement disorder. Psychodynamic psychotherapy and individual counselling were started with progressive improvement of psychological symptoms and gradual resolution of hyperkinetic episodes, without any recurrence recorded during the follow-up (10 months).
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
ObjectType-Feature-4
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ObjectType-Report-1
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ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2014-207449