title: Neuronal intranuclear inclusion disease: two cases of dopa-responsive juvenile parkinsonism with drug-induced dyskinesia.
abstract: There are very few conditions that present with dopa-responsive juvenile parkinsonism. We present two such children with neuronal intranuclear inclusion disease (NIID) who had an initial good levodopa response that was soon complicated by disabling dopa-induced dyskinesia. One child was diagnosed by rectal biopsy in life, and the other diagnosis was confirmed at postmortem. In this patient, dopamine transporter imaging showed severely decreased binding of the radiotracer in the striatum on both sides. Bilateral subthalamic deep brain stimulation in this patient produced initial improvement, but this was not sustained. Both patients died within 10 years of symptom onset. As well as levodopa responsiveness with rapid onset of dyskinesia, clues to the diagnosis of NIID in patients presenting with parkinsonism include the presence of gaze-evoked nystagmus, early onset dysarthria and dysphagia and oculogyric crises. Differential diagnosis of clinical symptoms and neuropathological findings are discussed including the approach to rectal biopsy for early diagnosis.
authors.affiliation: Neuroscience Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Szu-Chia
authors.initials: SC
authors.lastname: Lai
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Jung
authors.forename: Padraic
authors.initials: P
authors.lastname: Grattan-Smith
authors.forename: Ella
authors.initials: E
authors.lastname: Sugo
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Lin
authors.forename: Rou-Shayn
authors.initials: RS
authors.lastname: Chen
authors.forename: Chiung-Chu
authors.initials: CC
authors.lastname: Chen
authors.forename: Yah-Huei
authors.initials: YH
authors.lastname: Wu-Chou
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Lang
authors.forename: Chin-Song
authors.initials: CS
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000978:Antiparkinson Agents / Q000009:adverse effects; D002648:Child; D004409:Dyskinesia, Drug-Induced / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D045586:Intranuclear Inclusion Bodies / Q000378:metabolism / Q000473:pathology*; D007980:Levodopa / Q000009:adverse effects; D008297:Male; D009474:Neurons / Q000378:metabolism / Q000473:pathology*; D020734:Parkinsonian Disorders / Q000188:drug therapy / Q000473:pathology*; D010455:Peptides / Q000378:metabolism; D013624:Taiwan; D025801:Ubiquitin / Q000378:metabolism
chemical_list: D000978:Antiparkinson Agents; D010455:Peptides; D025801:Ubiquitin; C097188:polyglutamine; D007980:Levodopa