Dystonic movements and developmental coordination disorder – Successful treatment with methylphenidate

A 6.3 years old girl presents with salient movements of hands and mouth, occurring first time with 4.9 y of age, mostly appearing while excitement, fun and loud praying. She moves both hands, clasps and rubs them and shows spiraling movements of the arms, often accompanied with movements of the lips. No motor arrest, consciousness undisturbed, Duration 1–2 minutes, no series, several times a day. A treatment with oxcarbazepine for kinesigenic dyskinesia led initially to an improvement of 50% with no constant effect. An MRI of the brain and laboratory investigation including neurotransmitter analysis showed no pathology. She receives logopedics since 3rd year of life because a familiar expressive speech development disorder, motor and occupational therapy because of developmental coordination disorder since 1 year.

Examination: Tone of the trunk reduced, shortly improvable by attention, movements clumsy. Mirrormovements while complex motor exercises, dysdiadochokinesis. No ataxia, tremor or spasticity.

Video of a play situation: Sitting with low tone of trunk, inconstant attention, sometimes appearing movements of the hands, spiraling, sometimes flattering, sometimes rubbing, often fingers crossing, ulnar abduction of the hands, accompanied with movements of the lips like pursing and grimacing.

In the multidisciplinary diagnostics a relationship between movement disorder, muscular hypotonia, coordination disorder and disorder of the (sustained) attention occurred, in the sense of a common pathologic mechanism, most likely in the dopamine metabolism. We started a treatment with low dose methylphenidate, which led to a significant improvement in mood, speech and motor function, the movement patterns distinguished. After the determination of the oxcarbazepine treatment the effect of MPH diminished, but after increasing the dose the full effect appeared again. An interaction between oxcarbazepine and methylphenidate was not described so far in the literature.