Hemichorea associated with gabapentin therapy with hypoperfusion in contralateral basal ganglion - a case of a paraplegic patient with neuropathic pain

Abstract

Functional imaging in patients with movement disorders has suggested abnormalities of regional cerebral blood flow (rCBF). We describe a patient with thoracic cord lesion with subsequent severe neuropathic pain. Right hemichorea developed and was related to adjunctive therapy with gabapentin. The patient's hemichorea decreased gradually after cessation of gabapentin. The study of rCBF revealed hypoperfusion in the contralateral basal ganglia compared with the previous study of rCBF. Our patient is the first patient with neuropathic pain, treated with gabapentin who developed hemichorea, in the absence of brain lesions. Imaging studies of rCBF showed a perfusion defect in the contralateral basal ganglion.

Rabbit syndrome in a neuroleptic naive patient with associated basal ganglia perfusion alterations treated with madopar fade‒out of perioral tremor after administration of L‒DOPA: role of thalamus in pathophysiology of post‒stroke rabbit syndrome

“…Several studies have demonstrated abnormal basal ganglia function in a variety of conditions, such as pain traumatic brain injury and various posture and movement disorders. [11][12][13][14][15][16][17][18][19][20] Extrapyramidal movement disorders, such as Huntington's chorea, Parkinson's disease and rabbit syndrome, have been described to involve decreased perfusion of the basal ganglia. 21,22 In contrast, increased perfusion of the basal ganglia has been described in patients with schizophrenia, especially in those with auditory hallucinations, 13 but it has never been described in patients with rabbit syndrome.…”

Choreoathetosis in a patient with neuromyelitis optica spectrum disorder

“…Gabapentin enhances gamma aminobutyric acid (GABA) synthesis and inhibits GABA degradation. There have been a few case reports regarding this association, and increased GABA activity at the level of the subthalamic nucleus or globus pallidus was suspected, but the precise neurophysiological mechanism was not clear.…”

Beneficial response to gabapentin portraying with interval change of brain SPECT imaging in a case with failed back surgery syndrome

“…Only one other published case due to thoracic epidural haematoma, as reported by Lai et al. (16), appeared to respond to gabapentin as shown by cerebral SPECT scanning. The second SPECT after beneficial gabapentin was compared to the first SPECT performed 2 weeks after surgery in this study and showed persistent hypoperfusion of left temporal region and obvious decrease in uptake in the left basal ganglia and caudate.…”