Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research and SSKM Hospital, Kolkata, India.
Department of General Medicine, Patliputra Medical College and Hospital, Dhanbad, India.
Eur J Neurol. 2022 Aug;29(8):2241-2248. doi: 10.1111/ene.15353. Epub 2022 Apr 28.
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.
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.
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.
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.
以前没有研究评估过糖尿病（DM）患者和急性发作非舞蹈性、非投掷性运动的频率和临床-影像学特征。我们进行了一项前瞻性研究，以调查 DM 中急性发作运动障碍的谱。
我们招募了 2014 年 8 月至 2021 年 7 月期间在印度西孟加拉邦的三家医院住院的所有急性发作运动障碍和高血糖患者。
59 例患者（平均年龄=55.4±14.3 岁，52.5%为男性）中，41 例（69.5%）有舞蹈性或投掷性运动，18 例（30.5%）有非舞蹈性和非投掷性运动。舞蹈症是最常见的运动障碍（n=18，30.5%），其次是单纯舞蹈症（n=15，25.4%）、舞蹈手足徐动症（n=8，13.6%）、震颤（n=5，8.5%）、面肌痉挛（n=3，5.1%）、帕金森病（n=3，5.1%）、肌阵挛（n=3，5.1%）、肌张力障碍（n=2，3.4%）和不安腿综合征（n=2，3.4%）。DM 的平均病程为 9.8±11.4 年（89.8%的患者为 2 型 DM）。经常检测到非酮症高血糖（76.3%）。大多数（55.9%）患者没有磁共振成像（MRI）改变；其余患者显示纹状体高信号。8 例 MRI 改变患者的运动偏侧性不一致。大多数患者（76.3%）完全恢复。
这是最大的临床系列，描述了 DM 中急性发作运动障碍的临床-影像学谱。值得注意的是，近三分之一的患者有非舞蹈性和非投掷性运动。我们的发现强调了在急性或亚急性发作运动障碍患者中测量毛细血管血糖的重要性，无论其既往血糖状态如何。
