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• W1964534036 abstract "Gabapentin (1-[aminomethyl]-cyclo-hexaneacetic acid) (GBP) has been used in many clinical situations, including neuropathic pains,1 epilepsy, bipolar illness, anxiety, and migraine prophylaxis.2 GBP is structurally related to γ-aminobutyric acid (GABA) and may alter synthesis and release of GABA in the brain and has high-affinity binding to the α-2-Δ subunit of voltage-activated calcium channels.3 Movement disorders reported in association with GBP include choreoathetosis4 and dystonia.5 We present a patient with Parkinson's disease (PD) who developed new-onset dyskinesia when GBP was introduced with full resolution when the drug was stopped. A 75-year-old man with a 6-year history of PD was well controlled on levodopa/carbidopa 100/25 mg five times a day and entacapone 200 mg five times a day. He had reported no previous problems with dyskinesia, though he had had some hallucinations. He complained of a 2- to 3-week history of sharp pain radiating from his lower back to right thigh, exacerbated by twisting and turning. On examination, straight leg test was positive for pain on the right side with passive movements. MRI scan of his lower back demonstrated central canal stenosis at L4/L5 level. For this neuropathic pain, he started a low dose of GBP 200 mg t.i.d. All other medications remained unchanged. Two weeks later in the follow-up clinic, we noted dyskinetic movements involving both upper and lower extremities (choreoathetosis). The GBP was therefore discontinued and within 3 days the dyskinetic movements had disappeared. On continued observation over 2 to 3 months, they have not recurred. His pain was subsequently managed successfully with spinal surgery Dyskinesias are a well-recognized complication of dopaminergic treatment in PD and, when induced by levodopa or dopamine agonists, are considered to be at least partially due to dopamine receptor hypersensitivity,6 caused by loss of dopaminergic innervation in the striatum.7 Interestingly, GBP is known to increase the release of dopamine in central pathways. It also increases the release of serotonin and noradrenaline while decreasing the levels of glutamic acid.8 A prior double-blind, placebo-controlled crossover study of GBP examined 20 patients with PD with motor fluctuations and dyskinesias at baseline assessment. GBP (maximum dose of 2,400 mg/day) significantly improved parkinsonian symptoms (UPDRS III) without exacerbating dyskinesia.9 A similar trial involved 19 patients with advanced parkinsonism and GBP treatment (300–400 mg t.i.d.) also showed improvement in rigidity, bradykinesia, and tremors, though no comment was made on dyskinesia.10 In contrast to these reports, two subjects without PD developed dyskinetic movements associated with gabapentin, which resolved after GBP discontinuation. The first one was a 60-year-old with a motor vehicle accident, cervical spine fracture without myelopathy treated with 900 mg/day, and the second patient a 41-year-old with generalized anxiety disorder treated with 1,200 mg/day. Dyskinetic movements of the face and extremities in both patients developed over 3 days and resolved within 2 to 3 days of stopping GBP.11 A direct link between dyskinesia and GBP would be strengthened with a rechallenge of the drug, but we did not feel medically justified to test this question. Based on GBP effects on dopaminergic pharmacology, prior reports of choreic and dystonic movements, and our case, we caution clinicians to observe PD patients closely for the possible development or exacerbation of dyskinesias when GBP is prescribed. Prasanth M. Raju MBBS, MRCP*, Richard W. Walker MBBS, MD, FRCP, FRACP [email protected]*, Mark A. Lee MBChB, MRCP, MD*, * Department of Medicine, Northumbria Healthcare NHS Trust, North Tyneside General Hospital, Newcastle upon Tyne, United Kingdom." @default.
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• W1964534036 date "2007-01-01" @default.
• W1964534036 modified "2023-10-14" @default.
• W1964534036 title "Dyskinesia induced by gabapentin in idiopathic Parkinson's disease" @default.
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• W1964534036 doi "https://doi.org/10.1002/mds.21209" @default.
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