Atormac
briv
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 2052  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (552 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References

 Article Access Statistics
    Viewed418    
    Printed2    
    Emailed0    
    PDF Downloaded3    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 2  |  Page : 515-516

Paroxysmal Dysarthria Ataxia–Tremor–Blepharospasm Syndrome in Bickerstaff Brainstem Encephalitis: A Variant of Paroxysmal Dysarthria Ataxia Syndrome


1 Department of Neurology, AOR San Carlo, Potenza; Department of Neurology, Alto Vicentino Hospital - AULSS 7 Pedemontana, Santorso, Italy
2 Department of Neurology, AOR San Carlo, Potenza; Department of Neuroscience, S. Giovanni di Dio Hospital, Crotone, Italy

Date of Submission28-Dec-2019
Date of Decision01-May-2020
Date of Acceptance18-May-2020
Date of Web Publication24-Apr-2021

Correspondence Address:
Enrico Ferrante
Department of Neurology, Alto Vicentino Hospital - AULSS 7 Pedemontana, Santorso (VI)
Italy
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.314518

Rights and Permissions



How to cite this article:
Ferrante E, Trimboli M. Paroxysmal Dysarthria Ataxia–Tremor–Blepharospasm Syndrome in Bickerstaff Brainstem Encephalitis: A Variant of Paroxysmal Dysarthria Ataxia Syndrome. Neurol India 2021;69:515-6

How to cite this URL:
Ferrante E, Trimboli M. Paroxysmal Dysarthria Ataxia–Tremor–Blepharospasm Syndrome in Bickerstaff Brainstem Encephalitis: A Variant of Paroxysmal Dysarthria Ataxia Syndrome. Neurol India [serial online] 2021 [cited 2021 May 14];69:515-6. Available from: https://www.neurologyindia.com/text.asp?2021/69/2/515/314518




Sir,

We read with interest the article by Maramattom.[1]

This article reported a case of Bickerstaff encephalitis presenting paroxysmal episodes lasting for <1 min and characterized by side to side head tremor, head tilt to the left, dysarthria, along with blepharospasm. MRI showed a symmetric midbrain lesion. Paroxysmal Dysarthria Ataxia–Tremor–Blepharospasm Syndrome was diagnosed and classified as variant of Paroxysmal Dysarthria Ataxia (PDA) syndrome.[2] This new syndrome, as described cases of PDA, well responded to carbamazepine. Furthermore, the author rightly stated PDA syndrome may remit spontaneously in MS.

We noted that an ictal video-EEG to exclude the possible epileptic nature of the paroxysmal attacks was not performed in this patient.[3] Moreover, a brain MRI follow-up to monitor any causative lesion changes after symptoms resolution have not been done.

We have recently described a similar case as variant of PDA Syndrome.[4]

A 67-year-old man developed paroxysmal ataxia, dysarthria (distorted voice that sounded like a 45-rpm record played at 33 rpm), diplopia, and hemifacial spasms episodes lasting for 15–40 s and occurring ~40 times/day. Ictal video-EEGs did not show paroxysmal discharges. Brain MRI revealed a right-midbrain lesion by Neuro-Behçet's disease. PADDHS attacks lasted for 5 months and then disappeared, and brain MRI returned to normal.

In our opinion, since the number and intensity of episodes described by Maramattom reduced by >90% after 1-week treatment with an antiepileptic drug (Carbamazepine 600 mg a day), a video-EEG, to exclude the possible epileptic nature of the paroxysmal attacks, should have been performed.

In conclusion, our case showed that spontaneous resolution of PAD attacks are also described in Neuro-Behçet's disease; furthermore, it demonstrates that a temporal relationship between symptoms resolution and brain MRI causative lesion disappearance should be sought.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Maramattom BV. Paroxysmal dysarthria ataxia-tremor-blepharospasm syndrome in bickerstaff brainstem encephalitis: A variant of paroxysmal dysarthria ataxia syndrome. Neurol India 2019;67:1388-9.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Gorard DA, Gibberd FB. Paroxysmal dysarthria and ataxia: Associated MRI abnormality. J Neurol Neurosurg Psychiatry 1989;52:1444-5.  Back to cited text no. 2
    
3.
Lüders H, Vaca GF, Akamatsu N, Amina S, Arzimanoglou A, Baumgartner C, et al. Classification of paroxysmal events and the four-dimensional epilepsy classification system. Epileptic Disord 2019;21:1-29.  Back to cited text no. 3
    
4.
Ferrante E, Marazzi MR, Trimboli M, Dalla Costa D, Erminio C, Nobili L. Brainstem lesion causing paroxysmal ataxia, dysarthria, diplopia and hemifacial spasm (PADDHS). Epileptic Disord 2019;21:389-90.  Back to cited text no. 4
    




 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow