Facio-brachio-crural dystonic episodes and drop attacks due to leucine rich glioma inactivated 1 encephalitis in two elderly Indian women
A 68-year-old woman presented to us with sudden jerky right sided movements of 10 days duration that were also causing her to fall. These movements had started acutely and predominantly involved the right sided arm and leg. They occurred multiple times a day and initially were spontaneous and brief lasting a few seconds. They interfered with walking and caused frequent falls. Observation of a few of these episodes revealed facial grimacing and brief right upper limb dystonic posturing lasting 1-2 s. While standing or walking, the movements occasionally involved the right leg causing buckling at the knee and falls. There was no significant past medical history and routine investigations including prolonged electroencephalography (EEG) monitoring and magnetic resonance imaging (MRI) brain were normal. She was diagnosed with late onset paroxysmal non-kinesogenic dyskinesia (PNKD), likely symptomatic and was put on clonazepam, phenytoin without significant improvement. She was discharged after 5 days. After 1 month, she was readmitted from the emergency room with drowsiness and hyponatremia (serum sodium 116 meq/l). After correction of Na and improvement in sensorium, she was noticed to have frequent bilateral alternating attacks up to 30-50/day involving the face, arm and legs. Carbamazepine, lamotrigine and sodium valproate were added to her regimen. She had some symptomatic relief, but the episodes persisted. Her falls abated, but she continued to have mild faciobrachial dystonic (FBD) attacks. Serum was stored for future analysis. She declined to be video graphed and was requested discharge from our facility. At telephonic follow-up 6 months later, she was asymptomatic and off on all medications.