Clinical notes
Olanzapine for the treatment of hemiballismus: A case report

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Abstract

Mukand JA, Fitzsimmons C, Wennemer HK, Carrillo A, Cai C, Bailey KM. Olanzapine for the treatment of hemiballismus: a case report.

Hemiballismus is a rare movement disorder characterized by involuntary, large amplitude movements of the limbs of 1 side of the body. We describe the case of a man in his late sixties with slurred speech, agitation, and right-sided hemiballismus resulting from a left thalamic hemorrhagic stroke. Treatment with haloperidol was unsuccessful, but both the hemiballismus and agitation diminished significantly after initiation of olanzapine (Zyprexa). The improvement in the hemiballismus was quantified by recording the number of hemiballistic movements that occurred while the patient performed standardized 30-minute sessions (daily for 5d). With the first task (reaching within the base of support while seated), the average number of hemiballismic movements per session decreased from a baseline of 23.5 to 3.0 in the upper extremity and from 20.5 to 7.0 in the lower extremity. With the second task (catching a ball while seated), the abnormal movements decreased from 52 to 6.3 in the upper extremity and from 34.5 to 2.7 in the lower extremity. This case suggests that olanzapine may be a valuable pharmacologic alternative for patients with hemiballismus.

Section snippets

Case description

A right-handed, Hispanic man in his late sixties was admitted with the acute onset of slurred speech, confusion, and sudden flailing movements of the right arm. A computed tomography scan showed an acute left thalamic hemorrhage and 2 old infarctions in the left occipital and right frontal lobes. His medical history was significant for hypertension, tobacco abuse (10 cigarettes a day for >40y), alcohol abuse, and a history of a stroke 10 years previously, with no residual functional deficits.

Discussion

Olanzapine, like clozapine, is a dopamine and serotonin receptor antagonist and has little or no effect on other receptors.34 It should theoretically treat hemiballismus by counteracting the increased synthesis and release of dopamine. Animal studies show that olanzapine, like clozapine, inhibits oral dyskinesias induced by both serotonergic (5-HT2) and dopaminergic (D1) agonists.27 Additionally, olanzapine has been effective in treating movement disorders, such as Huntington’s chorea, tardive

Conclusions

The hemiballistic movements, agitation, and FIM scores all improved after treatment with olanzapine. Consequently, the olanzapine was not discontinued to prove a causal link between the improvements and the medication. We believed that discontinuing the olanzapine would have had adverse effects for the patient and therefore would have been unethical. This case report does not conclusively prove that olanzapine is responsible for the reduced hemiballismus and FIM gains in this patient. He did

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