Acute onset movement disorders in diabetes mellitus: A clinical series of 59 patients. (28th April 2022)

• Record Type: Journal Article
• Authors: Dubey, Souvik; Chatterjee, Subhankar; Ghosh, Ritwik; Louis, Elan D.; Hazra, Avijit; Sengupta, Samya; Das, Shambaditya; Banerjee, Abhirup; Pandit, Alak; Ray, Biman Kanti; Benito‐León, Julián
• Is Part Of: European journal of neurology. Volume 29:Number 8(2022)
• Page Start: 2241
• Page End: 2248
• Publication Date: 2022-04-28
• Subjects: Choreoballism -- Diabetes mellitus -- Diabetic striatopathy -- Hyperglycemia -- Movement disorders; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.15353
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract: Background and purpose: No previous study has assessed the frequency and clinical–radiological characteristics of patients with diabetes mellitus (DM) and acute onset nonchoreic and nonballistic movements. We conducted a prospective study to investigate the spectrum of acute onset movement disorders in DM. Methods: We recruited all the patients with acute onset movement disorders and hyperglycemia who attended the wards of three hospitals in West Bengal, India from August 2014 to July 2021. Results: Among the 59 patients (mean age = 55.4 ± 14.3 years, 52.5% men) who were included, 41 (69.5%) had choreic or ballistic movements, and 18 (30.5%) had nonchoreic and nonballistic movements. Ballism was the most common movement disorder ( n = 18, 30.5%), followed by pure chorea ( n = 15, 25.4%), choreoathetosis ( n = 8, 13.6%), tremor ( n = 5, 8.5%), hemifacial spasm ( n = 3, 5.1%), parkinsonism ( n = 3, 5.1%), myoclonus ( n = 3, 5.1%), dystonia ( n = 2, 3.4%), and restless leg syndrome ( n = 2, 3.4%). The mean duration of DM was 9.8 ± 11.4 years (89.8% of the patients had type 2 DM). Nonketotic hyperglycemia was frequently (76.3%) detected. The majority (55.9%) had no magnetic resonance imaging (MRI) changes; the remaining showed striatal hyperintensity. Eight patients with MRI changes exhibited discordance with sidedness of movements. Most of the patients (76.3%) recovered completely. Conclusions: This is the largest clinical series depicting the clinical–radiological spectrum of acute onset movement disorders in DM. Of note was that almost one third of patients had nonchoreic and nonballistic movements. Our findings highlight the importance of a capillary blood glucose measurement in patients with acute or subacute onset movement disorders, irrespective of their past glycemic status. Abstract : This is the largest clinical series depicting the clinical–radiological spectrum of acute onset movement disorders (choreic and ballistic movements and nonchoreic and nonballistic movements) in diabetes mellitus. Although ballism was the most common, followed by pure chorea, almost one third of patients had nonchoreic and nonballistic movements (tremor, hemifacial spasm, parkinsonism, myoclonus, dystonia, and restless leg syndrome). The majority had no magnetic resonance imaging (MRI) changes, and the remaining showed striatal hyperintensity. MRI changes frequently exhibited discordance with sidedness of movements. Our findings highlight the importance of a blood glucose measurement in patients with acute onset movement disorders, irrespective of their past glycemic status.