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Case Reports
. 2024 Nov 27:18:1483587.
doi: 10.3389/fnins.2024.1483587. eCollection 2024.

Drug-induced parkinsonism in a patient with DiGeorge syndrome: a case report

Clancy Cerejo  1 , Nicolas De Cleene  1 , Gerald Walser  1 , Atbin Djamshidian  1 , Klaus Seppi  1 , Beatrice Heim  1
Affiliations
Case Reports

Drug-induced parkinsonism in a patient with DiGeorge syndrome: a case report

Clancy Cerejo et al. Front Neurosci. .

Abstract

DiGeorge syndrome, also referred as 22q11.2 deletion syndrome is a multisystem disorder associated with an increased risk of early-onset parkinsonism. In this case report, we present a case of a 47-year-old male patient with complex comorbidities and seizures. This patient presented with increased seizure frequency and on examination was found to have parkinsonism. Due to the symptoms constellation, a genetic analysis was done which revealed presence of DiGeorge syndrome. However, his DaTscan was normal and hence a possibility of medication induced parkinsonism was considered. Through this case report, we want to emphasize the fact that while it is important to consider genetic testing for young patients with parkinsonism especially in those with complex comorbidities, other possible causes of parkinsonism should not be ignored.

Keywords: DiGeorge syndrome; drug induced; early-onset; lamotrigine; parkinsonism.

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Conflict of interest statement

AD has received honoraria from BIAL, Roche, NovoNordisk and Esai. BH reports honoraria from Novartis AG, BIAL, AbbVie and grants from the Austrian science fund (FWF) outside the submitted work. KS reports honoraria from the International Parkinson and Movement Disorders Society, grants from the FWF Austrian Science Fund, the Michael J. Fox Foundation, and the International Parkinson and Movement Disorder Society, as well as personal fees from Teva, UCB, Lundbeck, AOP Orphan Pharmaceuticals AG, AbbVie, Roche, and Grünenthal outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Interctal; (B,C), Ictal; (D) Postictal. The feed rate was set to 20 s to improve the visualization of the seizure. Medication during the EEG: Levetiracetam 1,500 mg 1-0-1 + Lamotrigin 100 mg 1-0—½. EEG interpretation: Pronounced muscle artifacts at the beginning of the episode, rhythmic theta activity with subsequent transition to delta activity on the right fronto-temporal, increasing in amplitude and spread over the right hemisphere and to the opposite side. The exact onset of ictal activity cannot be precisely determined due to the overlap with muscle artifacts (oroalimentary automatisms), duration <1 min.
Figure 2
Figure 2
EEG interpretation: mildly abnormal EEG with diffuse theta enhancement. No potentials typical of epilepsy. Current medication: Brivaracetam 100 mg 1-0-1, Lamotrigine 200 mg 1-0-1.
Figure 3
Figure 3
MRI Brain T2 weighted, FLAIR, SWI, T1 weighted images showing mild generalized cortical atrophy and iron deposits in the bilateral globus pallidus.
See this image and copyright information in PMC

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