Treatment of paroxysmal nonkinesigenic dyskinesia

Paroxysmal nonkinesigenic dyskinesia (PNKD) is a rare movement disorder characterized by intermittent attacks of hyperkinetic involuntary movements without loss of consciousness. It may be classified into primary (genetic or sporadic) or secondary. The attacks usually occur at rest and may be precipitated by alcohol, coffee, cola, tobacco, fatigue, and emotion. Eighty percent of the patients are of autosomal dominant inheritance with a MR-1 gene mutation on chromosome 2q. Management is the avoidance of precipitating factors. Usually, medical treatment is less rewarding. Medications which have shown benefit in some include carbamazepine, benztropine, or clonazepam. Deep Brain Stimulation (ViM, or GPi target) might be considered in severe and medically refractory cases.