Şahin Sevim, Cansu Ali
Department of Pediatric Neurology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
Clin Neuropharmacol. 2015 Jul-Aug;38(4):144-6. doi: 10.1097/WNF.0000000000000084.
Levetiracetam (LEV) efficacy in the treatment of chorea in Huntington disease, paroxysmal nonkinesigenic dyskinesia, paroxysmal kinesigenic choreoathetosis, and dyskinetic cerebral palsy was reported in some studies. We described a case of a child with Sydenham chorea treated with LEV. A 7.5-year-old male patient presented with chorea, orofacial dyskinesia, speech impairment, and irritability. Echocardiographic examination revealed mitral insufficiency. Sydenham chorea was diagnosed after excluding other diseases causing chorea. Although his choreiform movements were decreased substantially with haloperidol treatment, speech impairment, orofacial dyskinesia, and light chorea were continued. Therefore, on day 9, LEV was added, and his complaints resolved in a few days. The severity of the chorea according to the Universidade Federal de Minas Gerais Sydenham's Chorea Rating Scale decreased from 47 to 5 points after LEV treatment. Thus, on day 13, the dose of haloperidol was reduced and gradually discontinued within 4 days. Symptoms did not reoccur. The follow-up at 1.5 months revealed recurrence of complaints due to discontinuation of LEV by parents. Signs and symptoms were regressed completely within 1 week after LEV retreatment. We suggest that LEV with fewer adverse effects comparing to other drugs may be considered to be a good alternative in the treatment of Sydenham chorea.
一些研究报道了左乙拉西坦（LEV）治疗亨廷顿病、阵发性非运动诱发性运动障碍、阵发性运动诱发性舞蹈手足徐动症及运动障碍型脑性瘫痪中舞蹈症的疗效。我们描述了1例用LEV治疗的西德纳姆舞蹈症患儿。一名7.5岁男性患者出现舞蹈症、口面部运动障碍、言语障碍及易怒症状。超声心动图检查显示二尖瓣关闭不全。排除其他导致舞蹈症的疾病后，诊断为西德纳姆舞蹈症。尽管使用氟哌啶醇治疗后其舞蹈样动作大幅减少，但言语障碍、口面部运动障碍及轻度舞蹈症仍持续存在。因此，在第9天加用LEV，其症状在数天内缓解。根据米纳斯吉拉斯联邦大学西德纳姆舞蹈症评定量表，LEV治疗后舞蹈症严重程度从47分降至5分。于是，在第13天，氟哌啶醇剂量减少，并在4天内逐渐停用。症状未复发。1.5个月时的随访显示，因家长停用LEV，症状再次出现。再次使用LEV治疗1周内，体征和症状完全消退。我们认为，与其他药物相比，不良反应较少的LEV可被视为治疗西德纳姆舞蹈症的良好替代药物。
