title: Amelioration of persistent, non-ketotic hyperglycemia-induced hemichorea by repetitive transcranial magnetic stimulation.
abstract: Diabetic hemichorea-hemiballism with non-ketotic hyperglycemia is usually a benign syndrome. Here, we report a 78-year-old woman with persistent hemichorea (HC) for longer than 1 year with a recurrence after rapid correction of hyperglycemia. Following the disappearance of the characteristic T1 hyperintensity at 3 months after onset, an MRI demonstrated T2* hypointensity and atrophic changes in the contralateral striatum, suggesting irreversible neuronal loss and some vascular proliferation. The electrophysiological examination using transcranial magnetic stimulation revealed significantly shorter cortical silent periods (CSPs) on the contralateral primary motor cortex (M1), possibly in relation to cortical hyperexcitability. We have applied 10 daily sessions of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the contralateral M1 to reduce the hyperexcitability. The HC was suppressed during and for several minutes after rTMS with prolongation of CSPs. After rehabilitation therapy, the patient was able to walk independently with a walker. We suggest that the combination of low-frequency rTMS and rehabilitation therapy may be a possible choice in medically refractory involuntary movements.
authors.affiliation: Department of Neurology, Hiroshima City General Rehabilitation Center, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kaseda
authors.forename: Takemori
authors.initials: T
authors.lastname: Yamawaki
authors.forename: Junko
authors.initials: J
authors.lastname: Ikeda
authors.forename: Miwa
authors.initials: M
authors.lastname: Hayata
authors.forename: Eisuke
authors.initials: E
authors.lastname: Dohi
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Ohshita
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Ochi
authors.forename: Eiichi
authors.initials: E
authors.lastname: Nomura
authors.forename: Masayasu
authors.initials: M
authors.lastname: Matsumoto
keywords: Basal ganglia; Hemichorea; Hyperglycemia; MRI; Rehabilitation; Repetitive transcranial magnetic stimulation