Objective: Abnormal movements related to COVID-19 vaccination have rarely been reported in the literature. Our case aims to highlight hyperkinetic movements which developed in a patient shortly after receiving the COVID-19 vaccine.

Background: A 73 year-old man developed paroxysmal left sided arm/leg involuntary movements, with speech arrest and impaired attention. Each episode lasted for several seconds, with abrupt onset multiple times a day, without residual deficits in between the episodes. He also developed slow involuntary oral-buccal-lingual (OBL) movements around the same time. In tandem with these movements, his cognitive function became impaired, with poor memory and slow mentation. These symptoms started 2 weeks after his third dose of Pfizer-BioNTech COVID-19 vaccine. He had no abnormal reaction to the vaccine, nor COVID-19 or flu symptoms during or before that period of time. The symptoms peaked within 3 to 5 months and started getting better on their own.

Method: Labs were significant for elevated LGI1 antibody in the serum. MRI brain and EEG were unremarkable. Malignancy work-up was negative.

Results: IVIG and clonazepam further improved the symptoms.

Conclusion: Our patient had paroxysmal hyperkinetic movements, including dystonia, hemichorea and myoclonus, with seizure-like activity as suggested by speech arrest and impaired attention during the episode. This is a typical presentation of LGI-1 antibody mediated movement disorders manifesting as paroxysmal faciobrachial dystonic seizures (except that the movements in our case also involved the leg, which is uncommon but reported ^1-3). The presence of the antibody in the serum and CSF, and the reduced titer in the serum in conjunction with the improved symptoms also support its causality. A case on post-COVID-19 LGI-1 antibody with opsoclonus-myoclonus was reported⁴ and a few cases on new onset chorea post-COVID-19 infection were also reported ^5,6. Our case however was most likely related to the vaccination itself, rather than the infection, given the onset 2 weeks after the vaccination, the spontaneous improvement prior to any treatment being initiated, and the absence of COVID-19 infection from the history. The Pfizer-BioNTech vaccine has been reported to cause hemichorea-hemiballismus movements related to metabolic derangements in the contralateral putamen ⁷. Our case is the first report of antibody mediated hyperkinetic movements related to this commonly used vaccine, with a benign course.

References: 1. Alotaibi and Bashir. Faciobrachial dystonic seizures as a sign of relapse in a child with LGI-1 encephalitis. Child Neurol Open 2022; 9: 2329048×221105960
2. Rahangdale et al. A case of paroxysmal dystonia associated with LGI-1 antibody encephalitis. Clin Neurol Neurosurg 2019; 186: 109908.
3. Lin et al. Long-term seizure outcomes in patients with anti-leucine-rich glioma –inactivated 1 encephalitis. Epilepsy Behav 2021; 122: 108159.
4. Smyth et al. Post-Covid -19 opsoclonus –myoclonus syndrome and encephalopathy associated with leucine-rich glioma–inactivated 1 (LGI-1) antibodies. J Neurol Sci 2021; 430: 119982.
5. Ashrafi F, Salari M, Hojjati Pour F. Chorea as a Post-COVID-19 Complication. Mov Disord Clin Pract. 2022;9:1144–8.
6. Grimm BG, Natteru PA, Groth CL. New-Onset Chorea Post-COVID-19 Infection: A Case Report. Cureus. 2023;15(7):e41327.
7. Batot et al, Clinical and radiological follow-up of a Pfizer-BioNTech COVID-19 vaccine-induced hemichorea-hemiballismus. Tremor and Other Hyperkinetic Movements 2022; 12:16.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hyperkinetic-movements-related-to-covid-19-vaccine/