0:00

We're here with our 67-year-old man with atrophy

0:05

that is parietal frontal, and to a lesser extent,

0:08

measial temporal,

0:09

but to a greater extent, lateral temporal,

0:12

which is all typical of Huntington's disease,

0:15

along with marked atrophy of the

0:17

caudate overall volume or size.

0:20

There's a positive involvement

0:22

of the cerebellar hemispheres.

0:24

And we're here to talk about about

0:25

drug-induced chorea.

0:27

Now, one example of a drug that requires

0:31

a pre-existing basal ganglia problem,

0:34

but is very shocking,

0:35

are oral contraceptives.

0:38

Oral contraceptives,

0:40

there's a hundred of them that are likely to

0:42

produce chorea in patients who have

0:45

had previous chorea episodes.

0:47

So, what type of episodes am I talking about?

0:49

If they've ever had sydenham's chorea,

0:52

chorea related to SLE,

0:53

levodopa, in other words,

0:56

drug induced chorea from some other medication,

0:58

levodopa being used for Parkinson's disease

1:02

or Parkinsonian-like syndromes,

1:04

then those individuals are at higher risk for the

1:07

acute onset of chorea with birth control pills.

1:11

Typically,

1:12

it's a buccolingual masticatory syndrome,

1:17

characterized by repetitive movements of the

1:20

tongue-twisting and protrusion of the tongue,

1:23

lip smacking and chewing.

1:24

These are the most common neuroleptic induced

1:27

tardive dyskinesias produced by levodopa,

1:30

but can also be produced in younger individuals

1:33

who are at risk by birth control pills.

1:36

Levodopa induced chorea develops in more than 40%

1:39

of all individuals with Parkinson's disease

1:41

who are depending on Levodopa

1:44

as a source of treatment.

1:45

So, this is extremely common.

1:47

One you might not think about,

1:49

but somebody presents with chorea as a younger patient,

1:52

we've talked originally about HIV,

1:54

but as a drug,

1:56

chronic exposure to amphetamines

1:58

and other stimulants.

2:00

Including stimulants used to treat ADD,

2:03

like Ritalin or Adderal

2:05

may induce orofacial dyskinesias

2:08

and chorea of the trunk and extremities,

2:10

particularly those that are in the at risk category.

2:14

Let's move on, shall we?