Objective: We describe hyperkinetic movement disorders with a variable response to smoking and nicotine and review clinical and pre-clinical evidence regarding the role of smoking, particularly on nicotinic cholinergic receptors and its role in movement disorders.

Background: Smoking leads to incidental exposure to nicotine which allows us to examine its acute affect on various movement disorders in vivo, with dramatic but both positive and negative effects noted. Epidemiological studies have also noted a potential protective effect of smoking on primary dystonia and Parkinson’s disease. The acute and chronic role of smoking and nicotine on the cholinergic system with regards to motor control, mood and synaptic plasticity may have therapeutic implications for hyperkinetic movement disorders.

Method: We retrospectively identified 4 adult cases at two centres in Australia and Ireland who had a demonstrable response to smoking and provide video evidence. A literature review to identify all other published cases of smoking and/or nicotine-related hyperkinetic movement disorders and its potential pathophysiological mechanisms was also performed.

Results: 4 cases were identified that had an immediate response to nicotine self-administered via smoking. These movement disorders spanned genetic and idiopathic dystonia as well as idiopathic Parkinson’s related dyskinesia. 2 cases demonstrated an immediate but short-lived improvement in their symptoms, mirroring the rapid action and offset of nicotine when inhaled. One case with a response to smoking did not note a clear improvement with transdermal nicotine, and one case noted a clear deterioration with smoking. This prompted us to review the scarcity of previously reported cases, the neuropharmacology of smoking as well as the available evidence for the potential differing role of nicotinic cholinergic neurons in these movement disorders.

Conclusion: We provide further clinical evidence of the under-appreciated role of nicotine and smoking on hyperkinetic movement disorders, which may have therapeutic implications.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/nicotine-and-influences-on-hyperkinetic-movement-disorders/