Objective: To collect and characterize cases of lesion-induced chorea-ballismus and investigate if lesions involve the subthalamic nucleus.

Background: Lesion-induced (hemi)chorea-ballismus is a relatively rare disorder, which has traditionally been linked with lesions in the subthalamic nucleus. However, more recent evidence suggests that lesions outside the subthalamic nucleus are also common. [1,2]

Method: Cases were collected from patients treated at Turku University Hospital between 1996 and 2021. First, a systematic search from the hospital records was conducted using the following criteria: (1) age 18 or above, (2) ICD-10 diagnosis code G25.5 (other chorea), and (3) head CT or MRI scan available. Second, full medical records and imaging data of these cases were evaluated by the investigators to identify cases of lesion-induced chorea-ballismus. Cases without lesions or lesions considered not to be causal to chorea-ballismus were excluded.

Results: From the 28 cases identified by the search, nine cases of lesion-induced chorea-ballismus were identified. The lesion etiologies were an ischemic stroke (n=7), olfactory meningioma (n=1) and traumatic hemorrhage (n=1). Lesion locations involved the putamen, caudate, subcortical white matter, and cortex with only one of the lesions intersecting the subthalamic nucleus together with the thalamus. Five patients showed hemichorea-hemiballismus on the contralateral body side to the lesion, one left hemichorea with bilateral lesions, and three bilateral chorea and bilateral lesions. The choreatic or ballistic movements passed spontaneously in days or weeks for four patients, continued after 6 months but eased in days or weeks after starting medication for four patients, and persisted without change for one patient.

Conclusion: Locations of lesions causing chorea-ballismus rarely involve the subthalamic nucleus, suggesting that there may be a publication bias in the published literature and evaluating subthalamic involvement may not be very helpful in the diagnostic workup.

References: [1.] Postuma RB, Lang AE. Hemiballism: revisiting a classic disorder. Lancet Neurol. Nov 2003;2(11):661-8. doi:10.1016/s1474-4422(03)00554-4
[2.] Laganiere S, Boes AD, Fox MD. Network localization of hemichorea-hemiballismus. Neurology. 06 07 2016;86(23):2187-95. doi:10.1212/WNL.0000000000002741

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MDS Abstracts - https://www.mdsabstracts.org/abstract/lesion-induced-chorea-ballismus-in-southwest-finland/