Neuronal intranuclear inclusion disease: Two cases of dopa-responsive juvenile parkinsonism with drug-induced dyskinesia

• Published in: Movement disorders Vol. 25; no. 9; pp. 1274 - 1279
• Main Authors: Lai, Szu-Chia, Jung, Shih-Ming, Grattan-Smith, Padraic, Sugo, Ella, Lin, Yen-Wen, Chen, Rou-Shayn, Chen, Chiung-Chu, Wu-Chou, Yah-Huei, Lang, Anthony E., Lu, Chin-Song
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15.07.2010; Wiley
• Subjects: Adolescent; Antiparkinson Agents - adverse effects; Biological and medical sciences; Child; deep brain stimulation; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; dopa-induced dyskinesia; Dyskinesia, Drug-Induced - etiology; Dyskinesia, Drug-Induced - pathology; Female; Humans; Intranuclear Inclusion Bodies - metabolism; Intranuclear Inclusion Bodies - pathology; juvenile parkinsonism; Levodopa - adverse effects; Male; Medical sciences; Neurology; neuronal intranuclear inclusion disease; Neurons - metabolism; Neurons - pathology; oculogyric crisis; Parkinsonian Disorders - drug therapy; Parkinsonian Disorders - pathology; Peptides - metabolism; rectal biopsy; Taiwan; Ubiquitin - metabolism; Taiwan; Nervous system diseases; Inclusion; Deep brain stimulation; rectal biopsy; Involuntary movement; Cerebral disorder; Parkinsonism; Biopsy; Oculogyric crisis; dopa-induced dyskinesia; Central nervous system disease; Rectum; Neurological disorder; Dopa; juvenile parkinsonism; Extrapyramidal syndrome; Dyskinesia; neuronal intranuclear inclusion disease
• ISSN: 0885-3185; 1531-8257; 1531-8257
• DOI: 10.1002/mds.22876

There are very few conditions that present with dopa‐responsive juvenile parkinsonism. We present two such children with neuronal intranuclear inclusion disease (NIID) who had an initial good levodopa response that was soon complicated by disabling dopa‐induced dyskinesia. One child was diagnosed by rectal biopsy in life, and the other diagnosis was confirmed at postmortem. In this patient, dopamine transporter imaging showed severely decreased binding of the radiotracer in the striatum on both sides. Bilateral subthalamic deep brain stimulation in this patient produced initial improvement, but this was not sustained. Both patients died within 10 years of symptom onset. As well as levodopa responsiveness with rapid onset of dyskinesia, clues to the diagnosis of NIID in patients presenting with parkinsonism include the presence of gaze‐evoked nystagmus, early onset dysarthria and dysphagia and oculogyric crises. Differential diagnosis of clinical symptoms and neuropathological findings are discussed including the approach to rectal biopsy for early diagnosis. © 2010 Movement Disorder Society