Transient Dysarthria and Hemiparesis in an Adolescent.

Abstract

An adolescent male in his teens had recurrent episodes of transient left lower limb weakness, persisting for three years. These episodes were consistently triggered by specific movements, such as postural changes or movement initiation, occurring multiple times per day. The patient adapted his behaviour to avoid triggering symptoms. Based on the clinical presentation, paroxysmal kinesigenic dyskinesia was diagnosed. Although dysarthria is uncommon in paroxysmal kinesigenic dyskinesia, its presence in this case highlights the condition's clinical variability. Carbamazepine therapy was initiated, which resulted in a significant reduction in the frequency of episodes. This case underscores the importance of recognising movement-triggered transient motor symptoms, including rare symptoms such as dysarthria, to prevent misdiagnosis and unnecessary testing. Early recognition and treatment can significantly improve outcomes and quality of life in patients with paroxysmal kinesigenic dyskinesia.

Learning points: Paroxysmal kinesigenic dyskinesia is a rare disorder characterised by brief, recurrent episodes of involuntary movements triggered by sudden voluntary motion.Atypical symptoms such as dysarthria and hemiparesis in paroxysmal kinesigenic dyskinesia may mimic transient ischaemic attacks or structural brain lesions.Anticonvulsants such as carbamazepine are highly effective in treating paroxysmal kinesigenic dyskinesia and can significantly reduce episode frequency and improve quality of life when initiated early.