Disclosures: Margaret E. Beckwith, MD: No financial relationships or conflicts of interest
Case Description: After a 15-day acute hospital stay for persistent choreiform movements in her head, torso, and lower extremities, the patient was admitted to a rehabilitation hospital. Previous testing had ruled out seizures. She had the following normal labs and imaging: CBC, electrolytes, CRP, cortisol, vitamin D, procalcitonin, TSH, hepatitis panel, blood cultures, EKG, CTA head and neck, MRI brain, KUB, and echocardiogram. Her A1c was 12.2% and her UA was negative for ketones. Her initial urine drug screen was positive for cocaine. Her Abnormal Involuntary Movement Score (AIMS) upon admission to rehab was 32 and improved to 25 with therapy. When deutetrabenazine was initiated on day 16 she demonstrated a significant decrease in her AIMS score. Upon discharge AIMS was 4 and the patient demonstrated minimal evidence of her movement disorder. Within a few months of discharge, the patient became noncompliant with her medical regimen and her movement disorder worsened. She pursued medical help and was restarted on her daily dose of deutetrabenazine. Within a day her movement disorder improved.
Setting: Rehabilitation hospital
Patient: 23 year old female chronic cocaine abuser Assessment/
Results: After receiving deutetrabenazine the patient had a remarkable improvement in her movement disorder which was attributed to her cocaine use.
Discussion: Our patient had a persistent, debilitating choreiform movement disorder after thirty days of abstinence from cocaine. She did not respond to conventional therapy but she responded remarkably well to deutetrabenazine. We hypothesized that given her choreoathetoid movements she was experiencing a D2 receptor hypersensitivity reaction despite being dopamine depleted. By further decreasing central nervous system dopamine levels with deutetrabenazine, we were able to markedly reduce the severity of our patient’s debilitating condition.
Conclusion: Consideration for the use of VMAT2 inhibitors may be worth investigating for the treatment of movement disorder that appears to stem from dopaminergic hyperactivity where other therapies have failed.
Level of Evidence: Level V
To cite this abstract in AMA style:
Beckwith ME, Elovic E. Use of Deutetrabenazine in the Rehabilitation of Recalcitrant Drug Induced Dystonia [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/use-of-deutetrabenazine-in-the-rehabilitation-of-recalcitrant-drug-induced-dystonia/. Accessed May 9, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/use-of-deutetrabenazine-in-the-rehabilitation-of-recalcitrant-drug-induced-dystonia/