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Paroxysmal dyskinesias in patients with HIV infection

From the Departments of Internal Medicine (Dr. Mirsattari) and Pharmacology (Dr. Power), University of Manitoba, Winnipeg, Manitoba, Canada; the Departments of Neurology (Dr. Berry) and Pathology (Dr. Holden), St. Paul’s Hospital, Vancouver, British Columbia, Canada; the Department of Neurology (Dr. Nath), University of Kentucky, Lexington, KY; and the Department of Clinical Neurosciences (Dr. Power and W. Ni), University of Calgary, Alberta, Canada.

Address correspondence and reprint requests to Dr. Christopher Power, Department of Clinical Neurosciences, 107 HMRB, University of Calgary, 3330 Hospital Drive, Calgary AB T2N 4N1 Canada.

OBJECTIVE: To determine the clinical features of paroxysmal dyskinesias among HIV type 1 (HIV-1)-seropositive patients.

BACKGROUND: Movement disorders have been associated with HIV infection, although the full spectrum of these disorders remains uncertain.

METHODS: Six adult HIV-1-seropositive patients presenting with paroxysmal dyskinesias were identified. Each patient underwent metabolic, CSF, EEG, and neuroimaging studies.

RESULTS: Mean age at onset was 34.5 years and five of six patients were AIDS defined. Dyskinesias were focal, multifocal, or hemidystonic in four patients and generalized in another two patients. Two of the six patients had paroxysmal kinesigenic dyskinesias and the remaining four patients had paroxysmal nonkinesigenic dyskinesias. Choreoathetosis (n = 3), myoclonus (n = 2), postural tremor (n = 5), and dysarthria (n = 3) were observed. Benzodiazepines appeared beneficial in three of six patients. Two patients with HIV-associated dementia and paroxysmal nonkinesigenic dyskinesia had a progressive course to death. Autopsy of a patient with paroxysmal nonkinesigenic dyskinesias revealed intense astrogliosis and loss of calbindin-positive neurons in the subcortical gray matter.

CONCLUSIONS: Paroxysmal dyskinesias may present as a primary HIV-1-induced neurologic syndrome. The occurrence of paroxysmal dyskinesias is associated with neuronal injury and loss in the subcortical gray matter but the mechanism remains unknown.

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