A teenager whose left arm & leg would briefly twist without his control
1. 13 year old Ali was brought with complaints of involuntary twisting movements of left arm & leg for three years. This occurred whenever he initiated walking after a period of rest (sitting or lying down).
1. 13 year old Ali was brought with complaints of involuntary twisting movements of left arm & leg for three years. This occurred whenever he initiated walking after a period of rest (sitting or lying down).
2. Ali was disturbed with these abnormal movements, as he lost balance a few times resulting in fall on few occasions. These lasted 30-60 seconds and stopped on own. He could speak during these episodes and did not lose consciousness. These movements never occurred while resting.
3. Ali lived with his parents in Doha and he was shown to a few doctors of various specialties. No diagnosis was arrived at. He was referred for neurologist's opinion, as local doctors suspected epilepsy or some psychological problem.
4. I carefully listened to Ali's history. These episodes always occurred while he initiated walking after rest (on getting up from chair or bed). The left arm & leg would abnormally twist and stop on own within a minute. He could self-induce these movements on demand in the OPD.
5. Abnormal movements occurred 10-15 times on daily basis. He was unable to take part in sports or outdoor games, as he was scared of falling. He spent most of his time sitting, which caused significant weight gain.
The diagnosis was clear, as I had seen similar cases in past.
The diagnosis was clear, as I had seen similar cases in past.
6. The diagnosis was paroxysmal kinesigenic dyskinesia (PKD).
MRI brain and EEG (done at Doha) were normal.
I discussed about the diagnosis and treatment options with Ali's parents. He was started on medical treatment. Review after two months via online consultation was done.
MRI brain and EEG (done at Doha) were normal.
I discussed about the diagnosis and treatment options with Ali's parents. He was started on medical treatment. Review after two months via online consultation was done.
7. Ali showed dramatic improvement. Within 3-4 days of starting the medicines, his abnormal movements stopped and he did not have any recurrence of symptoms in those two months. I suggested him to continue the same medicines.
8. Take home message:
*Involuntary movements lasting <1 min on initiation of walking after a period of rest is suggestive of PKD.
*Diagnosis is often delayed by 4-5 years due to lack of awareness of PKD.
*Medical treatment results in excellent outcome in PKD.
#MedTwitter
*Involuntary movements lasting <1 min on initiation of walking after a period of rest is suggestive of PKD.
*Diagnosis is often delayed by 4-5 years due to lack of awareness of PKD.
*Medical treatment results in excellent outcome in PKD.
#MedTwitter
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