Objective: To report a case of methamphetamine-induced choreoathetosis and review the literature regarding its clinical features, related phenomenology, and treatment response.

Background: Acute onset of chorea has a broad differential diagnosis, including structural, metabolic, autoimmune, infectious and drug induced etiologies. Methamphetamine is a potent psychostimulant affects dopaminergic, norepinephrine, and serotonin pathways in the central nervous system. While frequently associated with psychiatric symptoms, metamphetamine-induced acute movement disorders are rare and underrecognized. Identifying these cases is vital as the condition often reversible. We report a case of acute-onset generalized choreoathetosis following methamphetamine use and provide a review of the literature.

Method: We retrospectively collected patient’s clinical data, laboratory findings, neuroimaging, and treatment outcomes from the patient’s initial presentation through follow-up.

Results: A 44 year-old man with untreated essential hypertension presented to emergency department with acute onset of generalized involuntary movements for 1 day. He sometimes drinks alcohol but denies use of medications or illicit substances. He had no personal or family history of movement disorders. Examination revealed generalized choreoathetosis involving the face, neck, and limbs without other focal neurological deficits. Laboratory tests showed an HbA1C of 6.7% and elevated creatine phosphokinase (CPK) 675 U/L. Electrolytes, complete blood count, thyroid function and parathyroid hormone levels were normal. Brain MRI was normal. Although the patient initially denied substance use, a urine toxicology screen was positive for amphetamines. The patient was treated with haloperidol 1 mg orally and lorazepam 0.5 mg per day. This resulted in the gradual resolution of symptoms, and normalization of CPK levels over several days.

Conclusion: Methamphetamine should be considered in the differential diagnosis of acute choreoathetosis, particularly when metabolic and structural causes are excluded. Literature suggest these symptoms are often reversible and linked to dopaminergic dysfunction, though chronic high-dose use may lead to more persistent manifestations.

References: – Das, A., Price, D., & Clothier, J. (2018). Choreoathetoid movements associated with methamphetamine: A case report and review of literature. The American journal on addictions, 10.1111/ajad.12759. Advance online publication. https://doi.org/10.1111/ajad.12759
– Asser, A., & Taba, P. (2015). Psychostimulants and movement disorders. Frontiers in neurology, 6, 75. https://doi.org/10.3389/fneur.2015.00075
– Brust J. C. (2010). Substance abuse and movement disorders. Movement disorders : official journal of the Movement Disorder Society, 25(13), 2010–2020. https://doi.org/10.1002/mds.22599
– Kim, B., Yun, J., & Park, B. (2020). Methamphetamine-Induced Neuronal Damage: Neurotoxicity and Neuroinflammation. Biomolecules & therapeutics, 28(5), 381–388. https://doi.org/10.4062/biomolther.2020.044
– Yang, X., Wang, Y., Li, Q., Zhong, Y., Chen, L., Du, Y., He, J., Liao, L., Xiong, K., Yi, C. X., & Yan, J. (2018). The Main Molecular Mechanisms Underlying Methamphetamine- Induced Neurotoxicity and Implications for Pharmacological Treatment. Frontiers in molecular neuroscience, 11, 186. https://doi.org/10.3389/fnmol.2018.00186

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MDS Abstracts - https://www.mdsabstracts.org/abstract/methamphetamine-an-underrecognized-cause-of-acute-chorea-a-case-report-and-literature-review/