Ziconotide-Induced Oro-lingual Dyskinesia: 3 Cases

Tremor Other Hyperkinet Mov (N Y). 2020 Oct 6:10:37. doi: 10.5334/tohm.431.

Abstract

Background: Ziconotide (ZCN), a nonopioid analgesic, is first-line intrathecal therapy for patients with severe chronic pain refractory to other management options. We describe three cases of ZCN-induced movement disorders.

Cases: Case one is a 64-year-old woman who presented with oro-lingual (OL) dyskinesia with dysesthesias and bilateral upper extremity kinetic tremor. Case two is a 43-year-old man with a 20-month history of ZCN treatment who developed OL dyskinesia with dysesthesias, involuntary left hand and neck movements, hallucinations, dysesthesias on his feet, and gait imbalance. Case three is a 70-year-old man with a 4-month history of ZCN use who developed OL dyskinesia with dysesthesias.

Conclusions: Intrathecal treatment of pain with ZCN may be complicated by a drug-induced movement disorder where OL dyskinesia is characteristic. The movement disorder is likely to be dose related and reversible with ZCN discontinuation, but a chronic movement disorder is also possible.

Keywords: Dysesthesias; Dyskinesia; Lingual; Oral; Ziconotide.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Analgesics, Non-Narcotic / administration & dosage
  • Analgesics, Non-Narcotic / adverse effects*
  • Chronic Pain / drug therapy*
  • Dyskinesia, Drug-Induced / physiopathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • omega-Conotoxins / administration & dosage
  • omega-Conotoxins / adverse effects*

Substances

  • Analgesics, Non-Narcotic
  • omega-Conotoxins
  • ziconotide

Grants and funding

Authors received no outside funding for the organization or writing of this manuscript. Dr. Kris Grajny has no financial disclosures. Dr. Jennifer Durphy is part of the speaker’s bureau for Acorda Pharmaceuticals. Dr. Octavian Adam has served as a consultant for Abbott. Sharmeen Azher has no financial disclosures. Megan Gupta has no financial disclosures. Dr. Eric Molho does consulting work as a blinded video rater for CNS Ratings and Mitsubishi Tanabe Pharma. He has clinical trial grants with CHDI/HSG, Impax Pharmaceuticals, MJF/PSG, Biogen, Biohaven Pharmaceuticals, and Enterin inc. He is part of the speaker’s bureau with Neurocrine Biosciences. He has an educational grant with Merz Pharmaceuticals.