| Objective:To observe the precipitating factors, clinical manifestations, laboratory examinations as well as the therapeutic strategies of paroxysmal kinesigenic dyskinesia(PKD).Methods:A total of9cases of patients with PKD were included in this study. General clinical finding, age of onset, duration of disease, period of treatment, predisposing factors, aura, duration and frequency of the seizures, misdiagnosed disease, family history and related past medical history, MRI and CT, laboratory findings, therapeutic strategies, the effect of medication, ect. were investigated in the study.Results:6cases of male and3cases of female patients were investigated in this study. Male:female ratio=2:1.8cases of Primary PKD,1case of secondary PKD were included. First onset occur at the age of9～25, averageing12-year-old. Age of onset of secondary PKD is24years old. One case of the patient hasa family history.8cases of the patients manifested by episodic disorder induced by sudden movement such as answering a phone call, position changes from seated to standing, eating with chopsticks, climbing stairs, typing, etc..4cases of patients were triggered byemotional tension, anxiety, depression.1case of patient shown sleep disorder.2cases were induced by shock of vioce.2cases of patients were induced by frightening. More than78%of the patients have more than one trigger factors. Clinical manifestations are diverse, including dystonia, athetosis dance-like, throwing motion and other extrapyramidal movement.2cases of patients mainly manifested by limb and foot dance-like movements. Seizures of7patients involves bilateral limbs. Two patients impact neck and manifested by spasmodic torticollis. Two cases of patients impact face, pouting, forcing wink. One case had speaking disturbance.2cases of patients had paresthesia of physical tightness and numbness before the onset. Consciousness remained during the attack of the seizure. No sphincter dysfunction were investigated. All the patients could clearly remember the process after the onset of seizures. Interictal movement is fully normal during the relief of the onset. Duration of attack is short, seven cases the30s or less, two cases of seizures less than1min. The average duration of the onset is20s. EEG, imaging studies have no specific changes.5cases of patients medicated with carbamazepine.4cases of patients medicated with topiramate (TPM). Treatment worked well in all the patients.Conclusion:PKD is a rare paroxysmal movement disorders featured by the onset of sudden movement triggered by the positional changes Manifestation includes unilateral or bilateral limb dance-like movements, throwing action and athetosis. PKD is a benign disease characterized by dystonic disorders. Small dosage of antiepileptic drugs are effective. Duration of the attack is short and interphase manifested perfectly normal. The disease are self-limiting. With aging, clinical seizures of most patientscould gradually decrease, Clinical diagnosis should be differentiated from epilepsy, hysteria, chorea phase. |
