Treatment of Dyskinetic and Choreatic Movement Disorders in Adults

Abstract

Involuntary movements due to chorea or facial dyskinesia were successfully treated in 13 out of 16 patients with antidopaminergic drugs of the phenothiazine, butyrophenone or reserpine type. In 3 of the 4 chorea patients, the movements were significantly suppressed, but with development of parkinsonian rigidity in 1 of them. 11 patients had buccal-lingual-masticatory movements, mainly from degenerative brain disease, and often associated with mild rigidity. Significant suppression of the dyskinesia occurred in 9 without unduly exacerbating the parkinsonism. The dose of drug could often be reduced over the following few months or years, and sometimes movements did not recur after withdrawal of the drug. Present views on choreatic and dyskinetic syndromes attribute them to dopaminergic dominance in the striatum, or to the development of supersensitivity of dopamine receptors brought about by partial blockage by neuroleptic drugs or neuronal damage. There is also evidence that imbalance may occur between two types of dopamine receptors – excitatory and inhibitory, as well as between the dopaminergic and the cholinergic transmitter systems. The actions of dopamine-depleting and dopamine-receptor-blocking drugs can be explained by a resetting of the balance of the dopaminergic transmitters. It is suggested that treatment of choreatic syndromes should be carefully monitored, and that drugs should be reduced in dosage whenever possible. Combinations of dopamine-depleting and dopamine-receptor-blocking drugs may be effective, and the potential of central cholinergic activating drugs as useful treatment for dyskinetic disorders is also discussed.