title: Clinical improvement of secondary focal limb dystonia in neurodegenerative disease following a five-day lidocaine infusion: a case report.
abstract: Dystonia associated with neurodegenerative disease has minimal effective treatment options and can be devastating to a patient's ability to perform tasks of daily living. We present a case of a 55 year-old man who had progressive symptoms of an atypical asymmetric parkinsonian neurodegenerative disease. This patient presented with a dystonic left upper extremity that was refractory to treatment. In an attempt to treat worsening pain associated with the dystonia, he was given a five-day lidocaine infusion for associated pain and within 24 h had improvement in mobility of his dystonic extremity. Dystonia was measured by the Burke-Fahn-Marsden (BFM) dystonia rating and disability scales on hospital day five and at an eight week follow up visit. These scores were compared with scores derived from his previous pre-treatment neurologic examination. The BFM dystonia scale score was initially 16 and improved to 12 on both immediate post-treatment and eight-week follow-up. The BFM disability score improved from 16 to 6 post treatment and to 8 on follow-up appointment. Most importantly, the patient could feed and dress himself for the first time in several years. No adverse events of treatment were encountered. Treatment effect lasted three months with a slow return to baseline motor function. This case report raises interesting questions regarding the mechanism of dystonia in neurodegenerative disease and suggests the afferent sensory system as a potential target for therapeutics.
authors.affiliation: Drexel University College of Medicine, Department of Neurology, Philadelphia, PA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Irwin
authors.forename: G
authors.initials: G
authors.lastname: Revuelta
authors.forename: C F
authors.initials: CF
authors.lastname: Lippa
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D004421:Dystonia / Q000188:drug therapy* / Q000209:etiology; D020821:Dystonic Disorders / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine