Objective: Report a case of a rare drug-induced movement disorder, the moving ear syndrome, describe its phenomenology and its treatment with botulinum toxin

Background: Since its description by Caviness et al in 1994, the moving ear syndrome has been rarely reported. It consists of a focal dyskynesia of the cranial and pinna muscles, affecting either one or both sides, and some bilateral cases may be asymmetrical. Some patients developed this syndrome without any previous comorbidity, and some were on neuroleptics or other drugs before the syndrome started. The movement may be rhythmic or semirhythmic of the posterior and superior ear muscles. Imaging tests may be negative, and the response to medications, such as clonazepam, may warrant a test. However, botulinum toxin, due to this movement disorder resemblance to a dystonic syndrome, may be of greater benefit.

Method: We describe a 63-year-old woman who was started on bromopride for a gastrointestinal disorder, developing soon after moving ear syndrome associated with cranial vault musculature and corrugator muscles dyskinesia. The rest of her neurologic examination was otherwise unremarkable. There was no cognitive problems.  The movements consisted of bilateral and concomitant, irregular, semirhythmic movements of the ear, with elevation and retraction, without pain, associated with retraction of the whole scalp muscles and corrugator muscles bilaterally. There was no palatal or limb tremor. There was no abnormal movement of any other part of her body (video available)

Results: The patient was admitted and investigated for brainstem lesions and brain inflammatory diseases, and blood tests, cerebrospinal fluid analysis and brain magnetic resonance imaging were normal.

Conclusion: The patient was treated with 200 hundred mouse units of onabotulinum toxin, on several points of the scalp, corrugators and superior and posterior ear muscles bilaterally, totaling about 50 injection sites. The pinna muscles were injected about 20 ui each (total 80 ui). The patient responded very well, with complete resolution of the abnormal movements in the ears and scalp/corrugators 2 weeks after the injections.

References: Chaudhuri KR et al. The moving ear syndrome: a focal dyskinesia. Journal of Neurology, Neurosurgery, and Psychiatry 1 996;60: 106-110. Caviness JN et a;. Unusual focal dyskinesias. The ears, the shoulders, the back and the abdomen. Mov Disord 1994; 5:531-38. Godeiro-Junior C et al. Moving ear syndrome: the role of botulinum toxin. Mov Disord. 2008 Jan;23(1):122-4.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/moving-ear-syndrome-secondary-to-bromopride-and-response-to-botulinum-toxin/