Acute onset movement disorders in diabetes mellitus: A clinical series of 59 patients

Souvik Dubey, Subhankar Chatterjee, Ritwik Ghosh, Elan D. Louis, Avijit Hazra, Samya Sengupta, Shambaditya Das, Abhirup Banerjee, Alak Pandit, Biman Kanti Ray, Julián Benito-León

Research output: Contribution to journalArticlepeer-review

Abstract

Background and purpose: No previous study has assessed the frequency and clinical–radiological characteristics of patients with diabetes mellitus (DM) and acute onset nonchoreic and nonballistic movements. We conducted a prospective study to investigate the spectrum of acute onset movement disorders in DM. Methods: We recruited all the patients with acute onset movement disorders and hyperglycemia who attended the wards of three hospitals in West Bengal, India from August 2014 to July 2021. Results: Among the 59 patients (mean age = 55.4 ± 14.3 years, 52.5% men) who were included, 41 (69.5%) had choreic or ballistic movements, and 18 (30.5%) had nonchoreic and nonballistic movements. Ballism was the most common movement disorder (n = 18, 30.5%), followed by pure chorea (n = 15, 25.4%), choreoathetosis (n = 8, 13.6%), tremor (n = 5, 8.5%), hemifacial spasm (n = 3, 5.1%), parkinsonism (n = 3, 5.1%), myoclonus (n = 3, 5.1%), dystonia (n = 2, 3.4%), and restless leg syndrome (n = 2, 3.4%). The mean duration of DM was 9.8 ± 11.4 years (89.8% of the patients had type 2 DM). Nonketotic hyperglycemia was frequently (76.3%) detected. The majority (55.9%) had no magnetic resonance imaging (MRI) changes; the remaining showed striatal hyperintensity. Eight patients with MRI changes exhibited discordance with sidedness of movements. Most of the patients (76.3%) recovered completely. Conclusions: This is the largest clinical series depicting the clinical–radiological spectrum of acute onset movement disorders in DM. Of note was that almost one third of patients had nonchoreic and nonballistic movements. Our findings highlight the importance of a capillary blood glucose measurement in patients with acute or subacute onset movement disorders, irrespective of their past glycemic status.

Original languageEnglish (US)
JournalEuropean Journal of Neurology
DOIs
StateAccepted/In press - 2022

Keywords

  • Choreoballism
  • Diabetes mellitus
  • Diabetic striatopathy
  • Hyperglycemia
  • Movement disorders

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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