Epilepsy, parkinsonism, and neuroleptic malignant syndrome in a child.
A 9-year-old girl with akinetic-rigid parkinsonism with tremor is described. She was hospitalized with neuroleptic malignant syndrome that started 3 days after anticonvulsant drug treatment owing to epileptic seizures. Cranial magnetic resonance imaging (MRI) was normal, and during the follow-up, magnetic resonance spectroscopy revealed a decrement on N-acetylaspartate in the basal ganglia, suggesting neuronal dysfunction. The basal ganglia and dopamine are involved in the pathophysiology of parkinsonism and neuroleptic malignant syndrome and have been recognized in seizure propagation and seizure threshold. Parkinsonism in children is considered an acquired, secondary, and reversible disorder with a dramatic improvement to treatment. However, our patient still has parkinsonism 2 years after diagnosis. This case represents the unusual presentation of epilepsy, parkinsonism, and neuroleptic malignant syndrome, which might have a common pathophysiologic pathway (dopaminergic dysfunction) involving the basal ganglia and the hypothalamus.
Martínez
Héctor R
HR
Servicio de Neurología y Neurología Pediátrica, Hospital Universitario UANL, Monterrey, NL México. drhectormtz@yahoo.com
Cantú-Martínez
Leonel
L
González
Humberto C
HC
Flores
Laura de León
Lde L
Villarreal
Héctor J
HJ
Onofre-Castillo
Javier
J
D000927:Anticonvulsants / Q000009:adverse effects*; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001479:Basal Ganglia / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D052160:Benzothiazoles / Q000627:therapeutic use; D002220:Carbamazepine / Q000627:therapeutic use; D002648:Child; D004569:Electroencephalography; D004827:Epilepsy / Q000188:drug therapy*; D017029:Epilepsy, Complex Partial / Q000139:chemically induced / Q000503:physiopathology; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis / Q000503:physiopathology*; D020734:Parkinsonian Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology*; D010672:Phenytoin / Q000009:adverse effects*; D000077487:Pramipexole; D013995:Time
D000927:Anticonvulsants; D000978:Antiparkinson Agents; D052160:Benzothiazoles; D001224:Aspartic Acid; D002220:Carbamazepine; D010672:Phenytoin; D000077487:Pramipexole; C000179:N-acetylaspartate