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Case One is 64-year-old woman with stereotypic tongue and mouth movements. Excessive eye blinking and upper limb action tremor is also seen.
Table 1
Comparison of Three Cases of Ziconotide-Induced Oropharyngeal Dyskinesias.
| Case 1 | Case 2 | Case 3 | |
|---|---|---|---|
| Age | 64 | 43 | 70 |
| Gender | Female | Male | Male |
| Medical conditions | Spinal hemangioblastoma (resected) | DM1, Peripheral neuropathy, scleroderma, psoriatic arthritis | Cervical spondylosis, depression |
| Centrally acting medications | duloxetine 30 mg AM and 60 mg PM, pregabalin 100 mg TID | cyclobenzaprine 10 mg, hydroxyzine 50 mg, clonazepam 2 mg PRN, topiramate 100 mg BID, vortioxetine 20 mg | levetiracetam 500 mg BID, pregabalin 50 mg QHS, nortriptyline 25 mg QHS, oxycodone 10 mg PRN |
| Movement disorder | Stereotypic tongue movements, lower facial twitching with tactile dysesthesias | Stereotypic tongue movements with tactile dysesthesias | Stereotypic tongue movements with tactile dysesthesias |
| Other neurological features | Delayed saccades, bilateral upper extremity kinetic tremor, dysphagia | Involuntary left hand and neck movements, hallucinations, tactile dysesthesias on feet, gait imbalance | N/A |
| Maximum ZCN dose | 6 mcg | 9 mcg | 3.6 mcg |
| Duration of ZCN treatment at onset of movement disorder. | 12 months | 20 months | 4 months |
| Outcome of ZCN discontinuation. | Mild residual dyskinesia | Complete resolution of movements | Complete resolution of movements |
[i] Legend: ZCN = Ziconotide, QHS = nightly, PRN = as needed, BID = twice daily, TID = three times daily.