Pregabalin: a treatment option for dystonia?

Abstract

To date, no studies are available on the effect of pregabalin in dystonia. A patient with subarachnoidal and cerebral hemorrhage was treated with pregabalin for neuropathic pain. Upon withdrawal of the medication she experienced spontaneous and painful supination in the right foot and internal hip rotation when standing up. When pregabalin was reinstituted, these dystonic symptoms subsided, but reappeared when the medication was again discontinued. One possible explanation for these symptoms could be neuronal hyperactivity within still-functioning pathways in connection with the motor cortex. Preponderance of activity in potentially compensatory structures could be suppressed by pregabalin: therefore, its potential benefit in subacute secondary dystonia in cases with orbital brain involvement is suggested.

Extrapyramidal side effects after metoclopramide administration in a post-anesthesia care unit -A case report-

“…Our patient also used pregabalin before surgery, and pregabalin binds with high affinity to voltage-gated calcium channels in central nervous system and modulates the calcium-dependent releases of several neurotransmitters [12]. In one case report only, dystonia occurred when pregabalin was discontinued and subsided when pregabalin was re-introduced only to reappear again when pregabalin was again discontinued [13]. Our patient took pregabalin daily before surgery and no dystonic reactions occurred after it was discontinued postoperatively.…”

Current therapies and therapeutic decision making for childhood‐onset movement disorders

“…Agents such as gabapentin and pregabalin are related medications, which act on the alpha2‐delta protein, an auxiliary subunit of voltage‐gated calcium channels. They were initially designed as antiepileptics, but have found a potential use in psychiatry as antianxiety agents for treatment of self‐harm behavior and neuropathic pain and have been used off label in dystonia and dyskinetic movement disorders . Gabapentin has been noted to be beneficial in children with severely disabling dystonia, particularly if manifesting with pain or dystonic spasms.…”