Topiramate is a broad-spectrum anticonvulsant that is now widely used for adult and pediatric epilepsy. In a singular case, topiramate was recently reported to benefit vascular hemichorea-hemiballismus. The authors describe three cases of hemichorea-hemiballismus, one of vascular etiology and two of metabolic etiology, effectively treated with topiramate.

Hemichorea-hemiballismus may respond to topiramate.

The relationship between antiseizure drugs and movement disorders is complex and not adequately reviewed so far. Antiseizure drugs as a treatment for tremor and other entities such as myoclonus and restless leg syndrome is the most common scenario, although the scientific evidence supporting their use is variable. However, antiseizure drugs also represent a potential cause of iatrogenic movement disorders, with parkinsonism and tremor the most common disorders. Many other antiseizure drug-induced movement disorders are possible and not always correctly identified. This review was conducted by searching for all the possible combinations between 15 movement disorders (excluding ataxia) and 24 antiseizure drugs. The main objective was to describe the movement disorders treated and worsened or induced by antiseizure drugs. We also summarized the proposed mechanisms and risk factors involved in the complex interaction between antiseizure drugs and movement disorders. Antiseizure drugs mainly used to treat movement disorders are clonazepam, gabapentin, lacosamide, levetiracetam, oxcarbazepine, perampanel, phenobarbital, pregabalin, primidone, topiramate, and zonisamide. Antiseizure drugs that worsen or induce movement disorders are cenobamate, ethosuximide, felbamate, lamotrigine, phenytoin, tiagabine, and vigabatrin. Antiseizure drugs with a variable effect on movement disorders are carbamazepine and valproate while no effect on movement disorders has been reported for brivaracetam, eslicarbazepine, lacosamide, and stiripentol. Although little information is available on the adverse effects or benefits on movement disorders of newer antiseizure drugs (such as brivaracetam, cenobamate, eslicarbazepine, lacosamide, and rufinamide), the evidence collected in this review should guide the choice of antiseizure drugs in patients with concomitant epilepsy and movement disorders. Finally, these notions can lead to a better understanding of the mechanisms involved in the pathophysiology and treatments of movement disorders. 

/pdf/antiseizure-drugs-and-movement-disorders-150qr9hb.pdf

Antiseizure Drugs and Movement Disorders

Pediatric movement disorders.

Chapter 15 – Chorea, ballism, and athetosis

Chapter 16 – Chorea, Ballism, Athetosis: Phenomenology and Etiology

horea is a dyskinesia or abnormal involuntary movement due to pathology of the basal ganglia, particularly the caudate nucleus. ChoreiC form movements are rapid, irregular muscular contractions. Chorea occurs in hereditary disorders such as Huntington disease, Wilson disease, ataxia telangiectasia, and Lesch Nyhan syndrome, or as a purported sequela of infection, such as in Sydenham chorea or chorea gravidarum. It can also occur after treatment with neuroleptics and other dopamine blocking agents.'S2 In the elderly, chorea most often occurs in an idiopathic form, senile chorea, or in association with cerebrovascular disease.* Senile chorea is characterized by choreiform movements, often buccolingual but sometimes generalized in older patient^.^,^ There is a gradual rather than abrupt onset of symptons, no intellectual deterioration, and no family history of early-onset ~h0rea. l .~ Two pathology cases studied by Alcock showed shrinkage and a reduced number of neurons in the putamen and caudate with sparing of the globus pallidus and cerebral cortex.6 Senile chorea has been treated with dopamine antagonists. These agents act via dopamine-receptor blockage or inhibition of dopamine uptake or storage. We report the first case to our knowledge of senile chorea successfully treated with sodium valproate.

Successful treatment of age-related chorea with sodium valproate.

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Successful treatment of age-related chorea with sodium valproate.