Clinical notesOlanzapine for the treatment of hemiballismus: A case report
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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Treatment of Persistent Hemiballism with Deep Brain Stimulation of the Globus Pallidus Internus: Case Report and Literature Review
2019, World NeurosurgeryCitation Excerpt :Most patients with hemiballism improve without intervention. However, for persistent hemiballism, current treatment options include dopamine blockers, anticonvulsants, intrathecal baclofen therapy, botulinum injections, tetrabenazine, antipsychotics, and deep brain stimulation (DBS).4-8 For hemiballism refractory to pharmaceutical interventions, DBS is an effective primary neurosurgical treatment.3
Movement disorders in cerebrovascular disease
2013, The Lancet NeurologyCitation Excerpt :Although usually self-limited, post-stroke chorea and ballism can substantially increase morbidity through injury and impaired coordination and might, therefore, need short-term treatment. Pharmacological therapy consists chiefly of antidopaminergic therapy with traditional and newer generation of neuroleptics that act by blocking dopamine receptors (table 2).3,104–110 These agents, although usually effective, carry the risk of drug-induced parkinsonism and tardive dyskinesia and, therefore, tetrabenazine, a dopamine-depleting agent, has become the preferred choice because it does not cause tardive dyskinesia.111,131,132
Hemichorea-hemiballism syndrome caused by nonketotic hyperglycemia in a newly diagnosed diabetes mellitus type 2 patient with euglycemia at presentation
2020, Phillippine Journal of Internal MedicineLong-term effects of olanzapine in various movement disorders
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