Clinical characteristics, diagnosis and treatment of pure paroxysmal kinesigenic dyskinesia and complicated type with epilepsy
10.3760/cma.j.cn113694-20240428-00307
- VernacularTitle:单纯发作性运动诱发性运动障碍与发作性运动诱发性运动障碍伴随癫痫发作患者临床鉴别与诊治
- Author:
Wensi HAO
1
;
Jiaqi HAN
;
Rui MA
;
Xiating ZHANG
;
Lehong GAO
;
Hua WEI
;
Yicong LIN
;
Jia CHEN
;
Yuping WANG
Author Information
1. 首都医科大学宣武医院神经内科，北京100053
- Keywords:
Movement disorders;
Epilepsy;
Seizures;
Electroencephalography;
Magnetoencephalography
- From:
Chinese Journal of Neurology
2024;57(9):951-958
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical features, electroencephalogram (EEG) and magnetoencephalogram (MEG) of patients with pure paroxysmal kinesigenic dyskinesia (PKD) and PKD with epilepsy, so as to better distinguish them and guide the treatments.Methods:The clinical data of 200 patients diagnosed with PKD in the Outpatient Department of Xuanwu Hospital, Capital Medical University from 2000 to 2023 were analyzed retrospectively. The patients were divided into 2 groups: pure PKD (174 cases) and PKD with epilepsy (26 cases) according to whether accompanied by epilepsy. The differences in clinical features, drug therapy, EEG and MEG were compared between the 2 groups.Results:The clinical features of the 2 groups were essentially similar, and the proportion of PKD dyskinesia induced by emotional stress in the pure PKD group (54/174, 31.03%) was higher than that in the PKD with epilepsy group (2/26, 7.69%; χ 2=5.010, P=0.025). In terms of pharmacological response, carbamazepine was the most commonly used medication in both groups, but patients with PKD with epilepsy may need a higher therapeutic dosages (0.2-0.4 g/d, and gradually increased to 0.8 g/d) to effectively manage both dyskinesia and seizures. Regarding the EEG and MEG, the proportion of EEG abnormalities was higher in PKD patients with epilepsy, mainly manifested as focal spikes [1/70(1.43%) vs 9/21(42.86%), χ 2=24.268, P<0.001], together with aberrant MEG discharge (4/18 vs 3/5, χ 2=1.155, P=0.282). The MEG dipoles were mainly distributed in the brain regions close to the frontal lobe and central region. Conclusions:The clinical manifestations of motor symptoms of pure PKD and PKD with epilepsy are similar, and carbamazepine remains the most effective treatment. PKD patients with epilepsy have a higher proportion of abnormal EEG, mainly manifested as focal spikes, and are more likely to show abnormal discharge of MEG, which could be used to distinguish them.
