Clonazepam and botulinum toxin for the treatment of alien limb phenomenon.
We discuss a patient who developed an "alien limb" on her right side after brain herniation. She reported feeling as though her arm movements were controlled by a stranger and displayed limb levitation and groping behaviors. She received 0.5 mg clonazepam b.i.d. This was followed by a limb levitation frequency reduction of 73%. Discontinuation and retrial of clonazepam verified this response. She suffered a psychotic episode that she attributed to clonazepam. Clonazepam was discontinued. She received botulinum toxin injections to her arm that reduced her limb levitation by 84%. This is the first report of response to medication in alien limb syndrome.
Haq
Ihtsham U
IU
Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, [corrected] USA. ihaq@wfubmc.edu.
Malaty
Irene A
IA
Okun
Michael S
MS
Jacobson
Charles E
CE
Fernandez
Hubert H
HH
Rodriguez
Ramon R
RR
D000293:Adolescent; D055964:Alien Limb Phenomenon / Q000188:drug therapy* / Q000473:pathology; D001905:Botulinum Toxins / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology; D002998:Clonazepam / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D001523:Mental Disorders / Q000139:chemically induced; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D002998:Clonazepam; D001905:Botulinum Toxins