Neuronal intranuclear inclusion disease: two cases of dopa-responsive juvenile parkinsonism with drug-induced dyskinesia

Movement Disorders : Official Journal of the Movement Disorder Society
Szu-Chia LaiChin-Song Lu

Abstract

There are very few conditions that present with dopa-responsive juvenile parkinsonism. We present two such children with neuronal intranuclear inclusion disease (NIID) who had an initial good levodopa response that was soon complicated by disabling dopa-induced dyskinesia. One child was diagnosed by rectal biopsy in life, and the other diagnosis was confirmed at postmortem. In this patient, dopamine transporter imaging showed severely decreased binding of the radiotracer in the striatum on both sides. Bilateral subthalamic deep brain stimulation in this patient produced initial improvement, but this was not sustained. Both patients died within 10 years of symptom onset. As well as levodopa responsiveness with rapid onset of dyskinesia, clues to the diagnosis of NIID in patients presenting with parkinsonism include the presence of gaze-evoked nystagmus, early onset dysarthria and dysphagia and oculogyric crises. Differential diagnosis of clinical symptoms and neuropathological findings are discussed including the approach to rectal biopsy for early diagnosis.

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Citations

Jul 16, 2019·Journal of Child Neurology·Jennifer VermilionJonathan W Mink
Dec 5, 2019·Brain : a Journal of Neurology·Hugo Morales-BriceñoVictor S C Fung
Jan 4, 2020·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Hafiz Khuram RazaHao Chen
Feb 22, 2017·Movement Disorders : Official Journal of the Movement Disorder Society·Elizabeth J Slow, Anthony E Lang
Jul 6, 2019·Parkinsonism & Related Disorders·Nicki Niemann, Joseph Jankovic

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