Objective: We present a patient of PHD that occurred also after immobility without sleep and its severity increases in days of more exertion. Furthermore, we applied a new clinical “exercise -immobility test” that provoke dyskinesia and confirm the role of immobility.

Background: Paroxysmal dyskinesias (PDs) are an episodic dystonic/choreoathetoid movement disorders of variable precipitating factors, duration and heterogeneous phenotypes and genotypes. They include kinesigenic, non-kinesigenic, exercise-induced, and paroxysmal Hypnogenic dyskinesia (PHD).

Methods: An 18-years old, male, Sudanese patient, manual worker presented to the outpatient clinic by attacks of choreoathetosis of all limbs, trunk and face, lasting from one-to-three minutes, and typically occurring on waking almost 1 to 3 times daily, since childhood. the attack severity increases with prolonged sleep durations and days of more exertion and decrease during vacation days. They also reported rare attacks (2 attacks during the last years) that occurred on moving after prolonged immobility (like sitting in car) for 1 to 2 hours without sleep. The patient underwent sleep EEG with occurrence of dyskinesia for 2 minutes on waking not associated with epileptiform abnormality and MRI brain was normal. To provoke the attack, we asked the patient to perform an exercise (cycling for 20 minutes started at 6 pm) followed by staying immobile for 2 hours without falling asleep (exercise-immobility test).

Results: nterestingly, the patient developed an attack of generalized dyskinesia (25 Seconds) during immobility after one hour from the exercise. While patient still immobile, he had further two attacks during immobility (75 and 30 seconds) separated by 20 minutes.

Conclusions: in the current case, exercise-immobility test confirmed that different triggers could precipitate patient’s dyskinesia. We suggest the use of this test to identify and classify the patients’ phenotype more precisely.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-use-of-a-clinical-exercise-immobility-test-in-a-patient-with-paroxysmal-hypnogenic-dyskinesia/