Oral contraceptive pills induced hemichorea in an adolescent female with polycystic ovarian disease

Sharmila,; Ta, Babu

doi:10.4103/0253-7613.153440

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…The underlying cause of chorea gravidarum appears to be increased levels of estrogen; patients who experience abnormal movements during pregnancy are at increased risk of hemichorea in association with oral estrogen, whether from oral contraceptive pills containing estrogen or from post-menopausal hormone replacement therapy [ 105 106 107 108 ] Studies have shown that estrogen increases dopamine release in the brain through several different mechanisms as well as by increasing dopamine receptor density post-synaptically [ 104 ]. The mechanism for estrogen-induced hemichorea, whether through pregnancy or oral administration, thus appears to be on the basis of pre-existing sensitivity.…”

Section: Resultsmentioning

confidence: 99%

“…Multiple other medications have been identified as causing an asymmetric or hemichorea including gabapentin [ 113 ], valproate [ 114 ], amphetamine [ 115 ], anti-histamine [ 116 117 ], selective serotonin reuptake inhibitors [ 118 ], neuroleptics [ 119 ] and z-drugs [ 120 ]. As previously mentioned, oral estrogen has been associated with drug-induced chorea as well, although this appears to be through a specific hormonal mechanism [ 105 106 107 108 109 ]. Medication-induced chorea appears to be a heterogeneous group of conditions, likely with multiple mechanisms of action.…”

Section: Resultsmentioning

confidence: 99%

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One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

Cincotta¹,

Walker

2022

Tremor and Other Hyperkinetic Movements

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Background: Chorea can be due to a large number of etiologies. Unilateral chorea is classically related to a contralateral structural lesion, e.g. of the putamen or subthalamic nucleus, however, based upon personal impressions, we have observed that systemic disease, in particular metabolic or autoimmune conditions, can also lead to a unilateral or markedly asymmetric presentations. We sought to investigate this impression by reviewing the literature. Methods: A PubMed search was conducted using the terms asymmetric” AND “chorea” OR “hemichorea” OR “unilateral” AND “chorea” OR “monochorea” OR “right greater than left” AND “chorea” OR “left greater than right” AND “chorea” OR “right more than left” AND “chorea” OR “left more than right” AND “chorea” as well as “hemiballismus” NOT “stroke” NOT “infarct” NOT “dyskinesia. A total of 243 sources were felt to meet criteria and were reviewed. Results: The most common etiology of reported hemi- or asymmetric chorea was diabetic non-ketotic hyperglycemic hemichorea/hemiballismus. Other common diagnoses were Sydenham’s disease, antiphospholipid syndrome and drug-induced chorea. The vast majority of patients with hemi- or asymmetric chorea had acquired rather than genetic, degenerative or congenital causes. Conclusion: Despite the potential limitations of our literature review, the evidence presented here supports the observation that the vast majority of asymmetric or unilateral chorea presentations are due to acquired causes, and in this situation an exhaustive search for reversible etiology should be undertaken. However, presentation with symmetric, generalized chorea does not exclude reversible causes, and investigations should address these in addition to genetic and neurodegenerative etiologies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

Cincotta¹,

Walker

2022

Tremor and Other Hyperkinetic Movements

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“…Although better reported in adults, anticholinergics, L-DOPA, dopamine-agonists, opioids, TCAs, baclofen and lithium may also cause chorea [ 16 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 ]. Oral contraceptives may cause chorea in adolescent girls, especially in patients with previous SC [ 183 , 184 ]. Myoclonus may be induced by opioids, SSRIs, etomidate, carbamazepine and its derivatives, ketamine and analgesic withdrawal [ 3 , 178 , 185 , 186 , 187 , 188 ].…”

Section: Drug-induced and Toxic Movement Disordersmentioning

confidence: 99%

Acute Movement Disorders in Childhood

Garone

Graziola

Grasso

et al. 2021

JCM

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Acute-onset movement disorders (MDs) are an increasingly recognized neurological emergency in both adults and children. The spectrum of possible causes is wide, and diagnostic work-up is challenging. In their acute presentation, MDs may represent the prominent symptom or an important diagnostic clue in a broader constellation of neurological and extraneurological signs. The diagnostic approach relies on the definition of the overall clinical syndrome and on the recognition of the prominent MD phenomenology. The recognition of the underlying disorder is crucial since many causes are treatable. In this review, we summarize common and uncommon causes of acute-onset movement disorders, focusing on clinical presentation and appropriate diagnostic investigations. Both acquired (immune-mediated, infectious, vascular, toxic, metabolic) and genetic disorders causing acute MDs are reviewed, in order to provide a useful clinician’s guide to this expanding field of pediatric neurology.

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“…[57,58]. Six cases of chorea were reported related to the use of oral contraceptive estrogen pills, which improved within weeks to months of hormone cessation [59,60]. The pathophysiology of chorea gravidarum is likely similar, if not identical to that of chorea secondary to estrogen supplementation; both conditions resolve as estrogen levels normalize.…”

Section: Metabolic and Pregnancy-related Choreamentioning

confidence: 99%

Treatment of Secondary Chorea: A Review of the Current Literature

Feinstein

Walker

2020

Tremor and Other Hyperkinetic Movements

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Background: Chorea consists of involuntary movements affecting the limbs, trunk, neck or face, that can move from one body part to another. Chorea is conceptualized as being "primary" when it is attributed to Huntington's disease (HD) or other genetic etiologies, or "secondary" when it is related to infectious, pharmacologic, metabolic, autoimmune disorders, or paraneoplastic syndromes. The mainstay of the secondary chorea management is treating the underlying causative disorder; here we review the literature regarding secondary chorea. We also discuss the management of several non-HD genetic diseases in which chorea can be a feature, where metabolic targets may be amenable to intervention and chorea reduction. Methods: A PubMed literature search was performed for articles relating to chorea and its medical and surgical management. We reviewed the articles and cross-references of pertinent articles to assess the current clinical practice, expert opinion, and evidence-based medicine to synthesize recommendations for the management of secondary chorea. Results: There are very few double-blind randomized controlled trials assessing chorea treatments regardless of etiology. Most recommendations are based on small open-label studies, case reports, and expert opinion. Discussion: Treatment of secondary chorea is currently based on expert opinion, clinical experience, and small case studies, with limited evidence-based medical data. When chorea is secondary to an underlying infection, medication, metabolic abnormality, autoimmune process, or paraneoplastic illness, the movements typically resolve following treatment of the underlying disease. Tardive dyskinesia is most rigorously studied secondary chorea with the best evidence-based medicine treatment guidelines recommending the use of pre-synaptic dopamine-depleting agents. Even though there is an insufficient pool of EBM, small clinical trials, case reports, and expert opinion are valuable for guiding treatment and improving the quality of life for patients with chorea. Highlights: There is a dearth of well-controlled studies regarding the treatment of chorea. Expert opinion and clinical experiences are fundamental in guiding chorea management and determining successful treatment. In general, secondary chorea improves with treating the underlying medical abnormality; treatments include antibiotics, antivirals, immunosuppression, dopamine depleting agents, chelation, and supportive care.

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Oral contraceptive pills induced hemichorea in an adolescent female with polycystic ovarian disease

Cited by 8 publications

References 5 publications

One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

Acute Movement Disorders in Childhood

Treatment of Secondary Chorea: A Review of the Current Literature

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