Objective: Reporting a rare case of generalized chorea in a 35-year-old female following cardiac arrest, which demonstrated rapid improvement with a short course of clonazepam. This suggests the potential consideration of clonazepam as a first-line therapy for post-hypoxic injury chorea.

Background: Chorea, a rare movement disorder, can result from hypoxic damage to the striatum following cardiac arrest. Although chronic post-hypoxic myoclonus has an established first-line treatment, there is a lack of guidelines for other post-hypoxic movement disorders such as chorea.

Method: Case report. Describing clinical features and treatment. discussion and conclusion

Results:

 A 33-year-old woman was revived following a cardiac arrest caused by a drug overdose. Twelve days later, she began experiencing generalized chorea characterized by extensive flinging motions of her arms and legs. Imaging of the brain revealed lesions in both the caudate nucleus and putamen. Initially, the patient received tetrabenazine treatment, which did not alleviate the choreiform movements. Subsequently, clonazepam was administered, leading to an immediate improvement in symptoms by the following day. As a result, the patient discontinued tetrabenazine on her own. After two days of clonazepam therapy, the chorea completely disappeared.

Conclusion: Multiple medications, including tetrabenazine, trihexyphenidyl, opioids, and clonazepam, have been previously attempted for the treatment of post-hypoxic hyperkinetic movement disorders like chorea. However, there is no consensus on the preferred first-line therapy. Clonazepam is often avoided due to its sedative properties and potential for abuse with prolonged use. Nevertheless, we observed a swift resolution of chorea with a brief two-day course of clonazepam in this case. Additionally, we suggest a plausible mechanism to explain why clonazepam was more effective than tetrabenazine in a patient with striatal hypoxic injury. We theorize that since hypoxic damage to the striatum leads to rapid cell demise, modulating the basal ganglia pathways downstream with clonazepam may be more efficacious than altering the upstream input to the impaired striatum with tetrabenazine.

Our findings illustrate the swift alleviation of post-hypoxic chorea through a brief administration of clonazepam. We advocate for the consideration of clonazepam as the primary treatment option for post-hypoxic chorea.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clonazepam-as-first-line-therapy-for-post-hypoxic-chorea-a-case-report-and-discussion/